@Article{info:doi/10.2196/59688, author="Chew, Shuxian Eleanor and Scully, Eugenia Aileen and Koh, Shi-Man Samanth and Woon, Ee-Lin and Low, Miao-Shi Juanita Krysten and Kwan, Yu-Heng and Tan, Wei-Ming John and Pua, Yong-Hao and Tan, Ia-Choo Celia and Haseler, Jonathan Luke", title="Understanding Patient and Physiotherapist Requirements for a Personalized Automated Smartphone Telemonitored App for Posttotal Knee Arthroplasty Rehabilitation: Qualitative Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Apr", day="14", volume="12", pages="e59688", keywords="knee replacement", keywords="knee arthroplasty", keywords="mobile", keywords="application", keywords="interview", keywords="telemonitored", keywords="smartphone rehabilitation", keywords="mobile phone", abstract="Background: Total knee arthroplasty (TKA) is a cost-effective surgical intervention for painful knee osteoarthritis in older adults, but postsurgery rehabilitation access is limited. Telerehabilitation offers a solution, but existing models require significant therapist involvement and a costly setup. A personalized smartphone-based automated program could be a cost-effective alternative. Objective: This study aimed to understand the requirements of both patients and physiotherapists in developing an automated telemonitored rehabilitation smartphone app for individuals undergoing TKA. To ensure uptake and long-term sustainability, this study adopted a person-based approach. Methods: A multistakeholder qualitative study of user needs was conducted. Physiotherapists and patients who underwent TKA were recruited via purposive sampling. Individual in-depth, hour-long interviews were conducted via Zoom by an experienced, trained female interviewer with a Master of Arts in Sociology. Data were audio-recorded and transcribed by the same interviewer. Two reviewers (ESC and SSK) independently analyzed the data using thematic analysis, with data triangulation achieved through cross-checking of data sources by 3 reviewers (ESC, SSK, and AES). Interviews were conducted to data saturation. Results: Six patients and 4 physiotherapists participated. For the patient interface, patients emphasized ease of use and specified features like a search function and multilingual options. For the physiotherapist interface, physiotherapists stated ease of accessing patient data and outcome measures for effective monitoring as important. Both patients and physiotherapists highlighted the need for timely, condition-specific information, supplemented by visual aids to support exercises, pain management, and recovery goals. They also stressed the significance of progress tracking, feedback, and the ability to access health care professionals for reassurance. Motivational features, including reminders, prompts, and exercise logs, were recommended to improve adherence. Both groups similarly identified the need for initial training to ensure confident use of the app. Conclusion: This study provided insights into the requirements of potential end users of a smartphone app for automated telemonitored rehabilitation following TKA. This is useful for steering the development of a user-centric smartphone app. ", doi="10.2196/59688", url="https://rehab.jmir.org/2025/1/e59688" } @Article{info:doi/10.2196/65188, author="Fleszar-Pavlovic, E. Sara and Noriega Esquives, Blanca and Lovan, Padideh and Brito, E. Arianna and Sia, Marie Ann and Kauffman, Adelyn Mary and Lopes, Maria and Moreno, I. Patricia and Koru-Sengul, Tulay and Gong, Rui and Wang, Trent and Wieder, D. Eric and Rueda-Lara, Maria and Antoni, Michael and Komanduri, Krishna and Lesiuk, Teresa and Penedo, J. Frank", title="Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e65188", keywords="allogeneic stem cell transplantation", keywords="hematologic malignancy", keywords="bone marrow transplant", keywords="mindfulness-based music therapy", keywords="mindfulness", keywords="music therapy", keywords="eHealth", keywords="music therapy intervention", keywords="adult", keywords="adolescence", keywords="allogeneic", keywords="stem cell transplantation", keywords="stem cell", keywords="transplantation", keywords="qualitative study", keywords="treatment", keywords="hematologic cancers", keywords="psychological distress", keywords="side effects", keywords="mindfulness-based stress reduction", keywords="stress reduction", keywords="anxiety", keywords="depression", keywords="diagnosis", keywords="blood sample collection", keywords="eHealth tool", keywords="quality of life", keywords="cancer survivors", abstract="Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the ``think aloud'' method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation. Trial Registration: ClinicalTrials.gov NCT05968963; https://clinicaltrials.gov/study/NCT05968963 ", doi="10.2196/65188", url="https://formative.jmir.org/2025/1/e65188" } @Article{info:doi/10.2196/67275, author="Hutchison, G. Michael and Di Battista, P. Alex and Pyndiura, L. Kyla", title="Evaluating User Experience and Satisfaction in a Concussion Rehabilitation App: Usability Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e67275", keywords="mild traumatic brain injury", keywords="recovery", keywords="mHealth", keywords="app", keywords="digital health", keywords="smartphone", keywords="eHealth", keywords="digital", keywords="technology", keywords="usability", keywords="concussion rehabilitation", keywords="brain injury", keywords="rehabilitation protocols", keywords="evidence-based exercise", keywords="single-arm pilot study", keywords="home-based rehabilitation", keywords="user-friendly", keywords="questionnaire", keywords="telehealth", keywords="telemedicine", abstract="Background: Evidence-based guidelines support the use of structured exercise to facilitate concussion recovery. Despite the growing number of mobile health (mHealth) apps aimed at managing concussions, few focus on delivering exercise rehabilitation protocols. Therefore, a mobile app was developed to provide personalized rehabilitation programs based on evidence-based exercise principles designed to cater to individuals recovering from concussions. Objective: This study aimed to evaluate the usability and user experience of a mobile app designed to deliver an evidence-based rehabilitation program to individuals recovering from concussions. Methods: A two-week prospective single-arm pilot study was conducted among adults with a physician-diagnosed concussion. Participants engaged in home-based rehabilitation exercises through a mobile app. Usability was assessed using a combination of the mHealth App Usability Questionnaire (MAUQ) and five custom questions evaluating confidence in recommendations, exercise flow, clarity of voice commands, and usability of the exercise report feature. Following the two-week period, participants rated each question on a 7-point Likert scale ranging from ``strongly agree'' to ``strongly disagree''. Results: Twenty-six participants consented and were enrolled in the study, with 23 participants (82\%) completing all study components at the end of two weeks. The majority of participants were women, aged 26-38 years, and on average, approximately at three months postconcussion. Responses to both the MAUQ and custom questions were overwhelmingly positive. Overall, seven MAUQ questions received 100\% positive responses, with no single question scoring below 83\% positive responses. In the ``ease of use and satisfaction'' category, 100\% of users responded positively to questions on ease of learning, usability, interface likeness, and comfort in social settings, while 83\%-96\% (19-22) of users responded positively to the remaining four questions. In the ``system information arrangement'' category, 100\% (N=23) of users rated screen navigation, function usability, and health care service acceptability positively, with 87\%-96\% of users approving action acknowledgment, error recovery, and expected functions. Under the ``usefulness'' category, 96\% (n=22) of users found the app beneficial for health and well-being, and 91\% (n=21) users felt it effectively managed their health. For the five custom questions, 100\% (N=23) users responded positively to voice command clarity, exercise awareness, ease of following exercises, and report understandability, with a single unfavorable response noted for confidence in app recommendations. Conclusions: The findings of this study indicate that the mobile app is a user-friendly platform for delivering evidence-based exercise rehabilitation to individuals recovering from concussions. Positive user feedback, particularly in the areas of recommendation confidence, ease of exercise flow, and clarity of voice commands, highlights the app's potential to support concussion recovery. Future iterations of the app will aim to improve time efficiency and streamline error recovery processes to further enhance the user experience. ", doi="10.2196/67275", url="https://formative.jmir.org/2025/1/e67275" } @Article{info:doi/10.2196/66298, author="Halicki-Asakawa, Aman{\'e} and Mocci, Julia and Libben, Maya", title="Mobile App--Delivered Motivational Interviewing for Women on Eating Disorder Treatment Waitlists (MI-Coach: ED): Protocol for an App Development and Pilot Evaluation", journal="JMIR Res Protoc", year="2025", month="Apr", day="10", volume="14", pages="e66298", keywords="eating disorders", keywords="motivational interviewing", keywords="treatment barriers", keywords="digital interventions", keywords="pilot test", keywords="protocol", keywords="eating disorder", keywords="eating", keywords="woman", keywords="women", keywords="female", keywords="Canada", keywords="Canadian", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="app development", keywords="app-based", keywords="mental health", keywords="pilot evaluation", keywords="waitlists", keywords="mixed methods", keywords="feasibility", keywords="acceptability", keywords="service delivery", abstract="Background: A significant increase in eating disorder (ED) service waitlists has been observed in the past several years, exacerbating existing barriers to care (eg, long waitlists, scarcity of treatment centers, and positive beliefs surrounding pathology). Given that treatment delays have important clinical correlates (eg, entrenchment of ED pathology), exploring new methods of mental health service delivery for this population is of critical concern. App-based motivational interviewing (MI) delivered prior to the start of treatment has the potential to improve accessibility by simultaneously addressing structural (eg, travel costs) and individual (eg, low motivation) barriers to care. Despite the potential benefits, there remains a lack of empirically validated, ED-specific MI-based mobile apps. Evaluating the feasibility and acceptability of such interventions is a crucial first step before progressing to full-scale efficacy trials. Objective: This multiphasic mixed methods study aims to develop and assess the feasibility and acceptability of MI-Coach: ED, a novel app designed to increase motivation among women waitlisted for ED treatment. Specifically, this study seeks to determine participant engagement levels, user satisfaction, and perceived usability of the app, as well as to explore preliminary trends in motivation and ED-related symptoms following app use. Methods: Phase I adapted the content and interface of an existing app based on evidence-based principles (MI-Coach) for an ED population. Phase II pilot tested the app through a pre-post evaluation. Participants (n=30) aged 18 years and older were recruited from ED treatment waitlists in British Columbia, Canada. After completing baseline assessments evaluating demographic and clinical variables (eg, motivation, eating pathology, depression, and anxiety symptoms), participants were provided access to MI-Coach: ED for 1 month. Participants completed postintervention assessments and provided both quantitative and qualitative feedback on the app. Feasibility will be evaluated through the total number of participants recruited, study dropout rates, and engagement indicators (eg, modules completed) within the app. Acceptability will be assessed through self-report measures and semistructured exit interviews, which will explore user experiences, perceived benefits, and barriers to app engagement. Additionally, exploratory analyses will examine changes in motivation and ED symptoms before and after the intervention. Results: The MI-Coach: ED app has been developed, and recruitment was initiated in November 2022 and terminated in May 2024. Results are being analyzed and will be submitted for publication in May 2025. Conclusions: This study has the potential to transform ED service delivery and mitigate the impacts of existing treatment barriers for this population. By leveraging a digital MI-based intervention, MI-Coach: ED could serve as a scalable and accessible pretreatment tool, helping to bridge the gap between initial help-seeking and formal ED treatment. Findings from this study will inform the refinement of the intervention and recruitment strategies for future large-scale efficacy trials. International Registered Report Identifier (IRRID): DERR1-10.2196/66298 ", doi="10.2196/66298", url="https://www.researchprotocols.org/2025/1/e66298" } @Article{info:doi/10.2196/53133, author="Lee, Seonmi and Jeong, Jaehyun and Kim, Myungsung and Lee, Sangil and Kim, Sung-Phil and Jung, Dooyoung", title="Development of a Mobile Intervention for Procrastination Augmented With a Semigenerative Chatbot for University Students: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="10", volume="13", pages="e53133", keywords="procrastination", keywords="chatbot", keywords="generative model", keywords="semigenerative model", keywords="time management", keywords="cognitive behavioral therapy", keywords="psychological assessment", keywords="intervention engagement", keywords="emotional support", keywords="user experience", keywords="mobile intervention", keywords="artificial intelligence", keywords="AI", abstract="Background: Procrastination negatively affects university students' academics and mental health. Traditional time management apps lack therapeutic strategies like cognitive behavioral therapy to address procrastination's psychological aspects. Therefore, we developed and integrated a semigenerative chatbot named Moa into a to-do app. Objective: We intended to determine the benefits of the Moa-integrated to-do app over the app without Moa by verifying behavioral and cognitive changes, analyzing the influence of engagement patterns on the changes, and exploring the user experience. Methods: The developed chatbot Moa guided users over 30 days in terms of self-observation, strategy establishment, and reflection. The architecture comprised response-generating and procrastination factor--detection algorithms. A pilot randomized controlled trial was conducted with 85 participants (n=37, 44\% female; n=48, 56\% male) from a university in South Korea. The control group used a to-do app without Moa, whereas the treatment group used a fully automated Moa-integrated app. The Irrational Procrastination Scale, Pure Procrastination Scale, Time Management Behavior Scale, and the Perceived Stress Scale were examined using linear mixed models with repeated measurements obtained before (T0) and after (T1) 1-month use and after 2-month use (T2) to assess the changes in irrational procrastination, pure procrastination, time management and behavior, academic self-regulation, and stress. Intervention engagement, divided into ``high,'' ``middle'' and ``low'' clusters, was quantified using app access and use of the to-do list and grouped using k-means clustering. In addition, changes in the psychological scale scores between the control and treatment groups were analyzed within each cluster. User experience was quantified based on the usability, feasibility, and acceptability of and satisfaction with the app, whereas thematic analysis explored the users' subjective responses to app use. Results: In total, 75 participants completed the study. The interaction of time {\texttimes} procrastination was significant during the required use period (P=.01). The post hoc test indicated a significant improvement from T0 to T1 in the Time Management Behavior Scale and Perceived Stress Scale scores only in the treatment group (P<.001 and P=.009). The changes in Pure Procrastination Scale score after the required use period were significant in all clusters except for the low cluster of the control group. The high cluster in the treatment group exhibited a significant change in the Irrational Procrastination Scale after Bonferroni correction (P=.046). Usability was determined to be good in the treatment group (mean score 72.8, SD 16.0), and acceptability was higher than in the control group (P=.03). Evaluation of user experience indicated that only the participants in the treatment group achieved self-reflection and experienced an alliance with the app. Conclusions: The chatbot-integrated app demonstrated greater efficacy in influencing user behavior providing psychological support. It will serve as a valuable tool for managing procrastination and stress together. Trial Registration: Clinical Research Information Service (CRIS) KCT0009056; https://tinyurl.com/yc84tedk ", doi="10.2196/53133", url="https://mhealth.jmir.org/2025/1/e53133", url="http://www.ncbi.nlm.nih.gov/pubmed/40208664" } @Article{info:doi/10.2196/65889, author="Burch, E. Kathleen and Tryon, L. Valerie and Pierce, M. Katherine and Tully, M. Laura and Ereshefsky, Sabrina and Savill, Mark and Smith, Leigh and Wilcox, B. Adam and Hakusui, Komei Christopher and Padilla, E. Viviana and McNamara, P. Amanda and Kado-Walton, Merissa and Padovani, J. Andrew and Miller, Chelyah and Miles, J. Madison and Sharma, Nitasha and Nguyen, H. Khanh Linh and Zhang, Yi and Niendam, A. Tara", title="Co-Designing a Web-Based and Tablet App to Evaluate Clinical Outcomes of Early Psychosis Service Users in a Learning Health Care Network: User-Centered Design Workshop and Pilot Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="9", volume="12", pages="e65889", keywords="eHealth", keywords="user-centered design", keywords="learning health system", keywords="psychosis", keywords="early psychosis", keywords="user-driven development", keywords="web-based", keywords="data visualization", keywords="surveys and questionnaires", keywords="measurement-based care", abstract="Background: The Early Psychosis Intervention Network of California project, a learning health care network of California early psychosis intervention (EPI) programs, prioritized incorporation of community partner feedback while designing its eHealth app, Beehive. Though eHealth apps can support learning health care network data collection aims, low user acceptance or adoption can pose barriers to successful implementation. Adopting user-centered design (UCD) approaches, such as incorporation of user feedback, prototyping, iterative design, and continuous evaluation, can mitigate these potential barriers. Objective: We aimed to use UCD during development of a data collection and data visualization web-based and tablet app, Beehive, to promote engagement with Beehive as part of standard EPI care across a diverse user-base. Methods: Our UCD approach included incorporation of user feedback, prototyping, iterative design, and continuous evaluation. This started with user journey mapping to create storyboards, which were then presented in UCD workshops with service users, their support persons, and EPI providers. We incorporated feedback from these workshops into the alpha version of Beehive, which was also presented in a UCD workshop. Feedback was again incorporated into the beta version of Beehive. We provided Beehive training to 4 EPI programs who then piloted Beehive's beta version. During piloting, service users, their support persons, and EPI program providers completed Beehive surveys at enrollment and every 6 months after treatment initiation. To examine preliminary user acceptance and adoption during the piloting phase, we assessed rates of participant enrollment and survey completion, with a particular focus on completion of a prioritized survey: the Modified Colorado Symptom Index. Results: UCD workshop feedback resulted in the creation of new workflows and interface changes in Beehive to improve the user experience. During piloting, 48 service users, 42 support persons, and 72 EPI program providers enrolled in Beehive. Data were available for 88\% (n=42) of service users, including self-reported data for 79\% (n=38), collateral-reported data for 42\% (n=20), and clinician-entered data for 17\% (n=8). The Modified Colorado Symptom Index was completed by 54\% (n=26) of service users (total score: mean 24.16, SD 16.81). In addition, 35 service users had a support person who could complete the Modified Colorado Symptom Index, and 56\% (n=19) of support persons completed it (mean 26.71, SD 14.43). Conclusions: Implementing UCD principles while developing the Beehive app resulted in early workflow changes and produced an app that was acceptable and feasible for collection of self-reported clinical outcomes data from service users. Additional support is needed to increase collateral-reported and clinician-entered data. ", doi="10.2196/65889", url="https://humanfactors.jmir.org/2025/1/e65889" } @Article{info:doi/10.2196/56296, author="Hong, Qiumian and Wei, Shuochi and Duoliken, Hazizi and Jin, Lefan and Zhang, Ning", title="Application of Behavior Change Techniques and Rated Quality of Smoking Cessation Apps in China: Content Analysis", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="24", volume="13", pages="e56296", keywords="smoking cessation", keywords="behavior change techniques", keywords="mobile application", keywords="content analysis", keywords="China", abstract="Background: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science--based techniques are being incorporated into smoking cessation apps remains unknown. Objectives: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps. Methods: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps. Results: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100\%), prompting review of goals (8/9, 88.89\%), prompting self-monitoring of one's smoking behavior (7/9, 77.78\%), and assessing current and past smoking behavior (7/9, 77.78\%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36\%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36\%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score ($\beta$=.74; P=.02; R2=0.52) and higher information score ($\beta$=.76; P=.02; R2=0.52). Conclusions: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking. ", doi="10.2196/56296", url="https://mhealth.jmir.org/2025/1/e56296" } @Article{info:doi/10.2196/57789, author="Thell, Maria and Edvardsson, Kerstin and Aljeshy, Reem and Ibrahim, Kalid and Warner, Georgina", title="A Trauma Support App for Young People: Co-design and Usability Study", journal="JMIR Form Res", year="2025", month="Mar", day="18", volume="9", pages="e57789", keywords="co-design", keywords="young people", keywords="trauma", keywords="app development", keywords="usability testing", abstract="Background: One of the most common reasons young people with mental health issues, such as posttraumatic stress disorder, do not seek help is stigma, which digital support tools could help address. However, there is a lack of trauma support apps specifically designed for young people. Involving the target group in such projects has been shown to produce more engaging and effective results. Objective: This study aimed to apply a child rights--based participatory approach to develop a trauma support app with young people. Methods: Seven young people (aged 14-19 years; 3 males and 4 females) with experiences of trauma were recruited as coresearchers. A child rights--based framework guided the working process. The app was developed through a series of Design Studio workshops and home assignments, using the manualized intervention Teaching Recovery Techniques as the foundation for its content. The coresearchers were trained in research methodology and conducted usability testing with other young people (n=11) using the think-aloud method, the System Usability Scale (SUS), and qualitative follow-up questions. Results: A functional app prototype was developed using a no-code platform, incorporating various trauma symptom management techniques. These techniques covered psychoeducation, normalization, relaxation, and cognitive shifting, presented in multiple formats, including text, audio, and video. The contributions of the coresearchers to the design can be categorized into 3 areas: mechanics (rules and interactions shaping the app's structure), dynamics (user-visible elements, such as the outcome when pressing a button), and aesthetics (the emotional responses the app aimed to evoke in users during interaction). Beyond influencing basic aesthetics, the coresearchers placed significant emphasis on user experience and the emotional responses the app could evoke. SUS scores ranged from 67.5 to 97.5, with the vast majority exceeding 77.5, indicating good usability. However, usability testing revealed several issues, generally of lower severity. For instance, video content required improvements, such as reducing light flickering in some recordings and adding rewind and subtitle selection options. Notably, the feature for listening to others' stories was removed to minimize emotional burden, shifting the focus to text formats with more context. Conclusions: Young people who have experienced trauma can actively participate in the cocreation of a mental health intervention, offering valuable insights into the needs and preferences of their peers. Applying a child rights--based framework to their involvement in a research project supported the fulfillment of the Convention on the Rights of the Child Article 12. ", doi="10.2196/57789", url="https://formative.jmir.org/2025/1/e57789" } @Article{info:doi/10.2196/63260, author="Hansson, Helena and Castor, Charlotte and Larsen, B{\ae}kgaard Hanne and Topperzer, Krogh Martha and Olesen, Linnet Mette", title="Development of an eHealth Intervention in Pediatric Home Infusion Therapy: Interview Study of Needs and Preferences of Parents and Health Care Professionals", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="13", volume="8", pages="e63260", keywords="pediatrics", keywords="digital", keywords="interventions", keywords="eHealth", keywords="home care", keywords="intravenous infusion", keywords="qualitative research", abstract="Background: With the provision of home infusion therapy in children with acute or long-term illness on the rise, eHealth technologies have the potential to bridge the transition between hospital and home. However, eHealth interventions intended to support parents in managing home infusion therapy are sparse. Gaining insight into the needs and experiences of parents and health care professionals is crucial to developing feasible and sustainable eHealth interventions that target their needs. This study describes the first phase of a research study designed to develop and evaluate an eHealth intervention to support home infusion therapy. Objective: This study aimed to identify the experiences and needs of parents and health care professionals during home infusion therapy and their preferences for digital features in a future eHealth intervention. Methods: A qualitative study was conducted at 3 pediatric departments at a university hospital in Denmark. We individually interviewed 17 parents of 14 children who had received home infusion therapy with a portable pump. In addition, 5 focus groups were conducted with 15 health care professionals. We conducted a qualitative content analysis of the data, which we collected from February to July 2020. Results: We identified 6 subthemes that we merged into 3 main themes: increasing safe self-management at home; adapting information and responsibility to individual changing needs; and requesting digital features to ensure skill level, safety, and quality of care. The analysis showed that parents and health care professionals had corresponding needs and preferences, for example, a need for a high sense of safety and easier ways to communicate during home infusion therapy. Both groups emphasized the need for digital features to improve problem-solving and communication as a supplement to existing care to promote a safe environment, self-management, and quality of care. A vital issue was that an eHealth intervention should be aligned with the workflow of health care professionals and comply with regulations regarding confidentiality in communication and data sharing. Conclusions: Our study highlights the needs that parents and health care professionals have for increased safety and easier access to communication when receiving and providing home infusion therapy. The findings will be used to help develop an eHealth intervention supporting home infusion therapy tailored to individual needs. ", doi="10.2196/63260", url="https://pediatrics.jmir.org/2025/1/e63260" } @Article{info:doi/10.2196/59485, author="Dewan, Ananya and Eifler, M. and Hood, Amelia and Sanchez, William and Gross, Marielle", title="Building a Decentralized Biobanking App for Research Transparency and Patient Engagement: Participatory Design Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="5", volume="12", pages="e59485", keywords="mobile health", keywords="mHealth", keywords="application", keywords="smartphone", keywords="digital health", keywords="digital intervention", keywords="participatory design", keywords="biobanking", keywords="research transparency", keywords="donation", keywords="patient-derived biospecimens", keywords="plain language communications", keywords="patient education", abstract="Background: Patient-derived biospecimens are invaluable tools in biomedical research. Currently, there are no mechanisms for patients to follow along and learn about the uses of their donated samples. Incorporating patients as stakeholders and meaningfully engaging them in biomedical research first requires transparency of research activities. Objective: In this paper, we describe the use of participatory design methods to build a decentralized biobanking ``de-bi'' mobile app where patients could learn about biobanking, track their specimens, and engage with ongoing research via patient-friendly interfaces overlaying institutional biobank databases, initially developed for a breast cancer use case. Methods: This research occurred in 2 phases. In phase 1, we designed app screens from which patients could learn about ongoing research involving their samples. We embedded these screens in a survey (n=94) to gauge patients' interests regarding types of feedback and engagement opportunities; survey responses were probed during 6 comprehensive follow-up interviews. We then held an immersive participatory design workshop where participants (approximately 50) provided general feedback about our approach, with an embedded codesign workshop where a subset (n=15) provided targeted feedback on screen designs. For phase 2, we refined user interfaces and developed a functional app prototype in consultation with institutional stakeholders to ensure regulatory compliance, workflow compatibility, and composability with local data architectures. We presented the app at a second workshop, where participants (n=25, across 9 groups) shared thoughts on the app's usability and design. In this phase, we conducted cognitive walkthroughs (n=13) to gain in-depth feedback on in-app task navigation. Results: Most of the survey participants (61/81, 75\%) were interested in learning the outcomes of research on their specimens, and 49\% (41/83) were interested in connecting with others with the same diagnosis. Participants (47/60, 78\%) expressed strong interest in receiving patient-friendly summaries of scientific information from scientists using their biospecimens. The first design workshop identified confusion in terminology and data presentation (eg, 9/15, 60\% of co-designers were unclear on the biospecimens ``in use''), though many appreciated the ability to view their personal biospecimens (7/15, 47\%), and most were excited about connecting with others (12/15, 80\%). In the second workshop, all groups found the app's information valuable. Moreover, 44\% (5/9) noted they did not like the onboarding process, which was echoed in cognitive walkthroughs. Walkthroughs further confirmed interest in biospecimen tracking, and 23\% (3/13) had confusion about not finding any of their biospecimens in the app. These findings guided refinements in onboarding, design, and user experience. Conclusions: Designing a patient-facing app that displays information about biobanked specimens can facilitate greater transparency and engagement in biomedical research. Co-designing the app with patient stakeholders confirmed interest in learning about biospecimens and related research, improved presentation of data, and ensured usability of the app in preparation for a pilot study. ", doi="10.2196/59485", url="https://humanfactors.jmir.org/2025/1/e59485", url="http://www.ncbi.nlm.nih.gov/pubmed/40053747" } @Article{info:doi/10.2196/64661, author="Connelly, Jenni and Swingler, Kevin and Rodriguez-Sanchez, Nidia and Whittaker, C. Anna", title="Identifying Food Preferences and Malnutrition in Older Adults in Care Homes: Co-Design Study of a Digital Nutrition Assessment Tool", journal="JMIR Aging", year="2025", month="Mar", day="3", volume="8", pages="e64661", keywords="ageing", keywords="digital technology", keywords="dietary measurement", keywords="care homes", keywords="co-design", keywords="dietary intake", keywords="food diary", abstract="Background: Malnutrition is a challenge among older adults and can result in serious health consequences. However, the dietary intake monitoring needed to identify malnutrition for early intervention is affected by issues such as difficulty remembering or needing a dietitian to interpret the results. Objective: This study aims to co-design a tool using automated food classification to monitor dietary intake and food preferences, as well as food-related symptoms and mood and hunger ratings, for use in care homes. Methods: Participants were 2 separate advisory groups and 2 separate sets of prototype testers. The testers for the first prototype were 10 community-dwelling older adults based in the Stirlingshire area in Scotland who noted their feedback on the tool over 2 weeks in a food diary. The second set of testers consisted of 14 individuals (staff: n=8, 57\%; and residents: n=6, 43\%) based in 4 care homes in Scotland who provided feedback via interview after testing the tool for a minimum of 3 days. In addition, 130 care home staff across the United Kingdom completed the web-based survey on the tool's needs and potential routes to pay for it; 2 care home managers took part in follow-up interviews. Data were collected through food diaries, a web-based survey, audio recordings and transcriptions of focus groups and interviews, and research notes. Systematic text condensation was used to describe themes across the different types of data. Results: Key features identified included ratings of hunger, mood, and gastrointestinal symptoms that could be associated with eating specific foods, as well as a traffic light system to indicate risk. Issues included staff time, Wi-Fi connectivity, and the accurate recognition of pureed food and fortified meals. Different models for potential use and commercialization were identified, including peer support among residents to assist those considered less able, staff-only use of the tool, care home--personalized database menus for easy meal photo selection, and targeted monitoring of residents considered to be at the highest risk using the traffic light system. Conclusions: The tool was deemed useful for monitoring dietary habits and associated symptoms, but necessary design improvements were identified. These should be incorporated before formal evaluation of the tool as an intervention in this setting. Co-design was vital to help make the tool fit for the intended setting and users. ", doi="10.2196/64661", url="https://aging.jmir.org/2025/1/e64661", url="http://www.ncbi.nlm.nih.gov/pubmed/40053797" } @Article{info:doi/10.2196/57911, author="Hacking, Coen and de Boer, Bram and Verbeek, Hilde and Hamers, Jan and Aarts, Sil", title="Developing an App for Real-Time Daily Life Observations in a Nursing Home Setting: Qualitative User-Centered Co-Design Approach", journal="JMIR Hum Factors", year="2025", month="Feb", day="27", volume="12", pages="e57911", keywords="co-design", keywords="user-centered design", keywords="app development", keywords="nursing home", keywords="user-centered", keywords="design", keywords="efficiency", keywords="usability", keywords="tablet", keywords="mobile phone", abstract="Background: Assessing the daily lives of older adults, including their activities, social interactions, and well-being is essential, particularly in nursing homes, as it gains insights into their quality of life. Methods such as the Microsoft Excel-based Maastricht Electronic Daily Life Observation (MEDLO) tool are time-consuming and require extensive manual input, making them difficult to use. Objective: This study aimed to develop an app-based version of the MEDLO using a user-centered design (UCD) and co-design approach to enhance efficiency and usability. We looked to actively involve researchers and care professionals who have used the MEDLO before, throughout the development process. Methods: Participants included a diverse group of researchers and care professionals experienced in using the MEDLO tool. The UCD approach involved multiple iterative phases including semistructured interviews, user research sessions, and application development. Data were analyzed using a qualitative (thematic) approach of UCD and user research sessions. The app, which was preferred to the traditional Excel-based MEDLO, underwent multiple iterations. This method primed the continuous iterative development of the app, aimed for a minimum viable product (MVP). Results: This study included 14 participants, primarily female, from diverse professional backgrounds. Their feedback highlighted the need for efficiency improvements in tool preparation and data management. Key improvements included automated data handling, an intuitive tablet interface, and functionalities such as randomization and offline data syncing. Conclusions: The iterative development process led to an app that aligns with end-user needs, indicating potential for improved usability. Early and continuous user involvement was key in enhancing the application's usability, demonstrating the importance of user feedback in the development process. ", doi="10.2196/57911", url="https://humanfactors.jmir.org/2025/1/e57911" } @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/10.2196/56533, author="Smith, R. Abigail and Mueller, R. Elizabeth and Lewis, E. Cora and Markland, Alayne and Smerdon, Caroline and Smith, L. Ariana and Sutcliffe, Siobhan and Wyman, F. Jean and Low, Kane Lisa and Miller, M. Janis and ", title="Assessment of Environmental, Sociocultural, and Physiological Influences on Women's Toileting Decisions and Behaviors Using ``Where I Go'': Pilot Study of a Mobile App", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="12", volume="13", pages="e56533", keywords="ecological momentary assessment", keywords="time location factors", keywords="voiding diary", keywords="voiding behaviors", keywords="population studies", keywords="mobile application", keywords="app", keywords="bladder health", keywords="data collection tool", keywords="decision support", abstract="Background: Little is known about women's decisions around toileting for urination and how those decisions influence moment-to-moment behaviors to manage bladder needs. The new smartphone app ``Where I Go'' captures such nuanced and granular data in real-world environments. Objective: This study aims to describe participant engagement with ``Where I Go'', variation in novel parameters collected, and readiness for the data collection tool's use in population-based studies. Methods: ``Where I Go'' has three components: (1) real-time data, (2) short look-back periods (3?4 h), and (3) event location (GPS recorded at each interaction). The sample size was 44 women. Recording of real-time toileting events and responding to look-back questions was measured over 2 days of data collection. The participant's self-entered location descriptions and the automatic GPS recordings were compared. Results: A total of 44 women with an average age of 44 (range 21-85) years interacted with the app. Real-time reporting of at least 1 toileting event per day was high (38/44, 86\%, on day 1 and 40/44, 91\%, on day 2) with a median of 5 (IQR 3-7 on day 1 and IQR 3-8 on day 2) toileting events recorded each day. Toileting most commonly occurred at home (85/140, 61\%, on day 1 and 129/171, 75\%, on day 2) due to a need to go (114/140, 66\%, on day 1 and 153/171, 74\%, on day 2). The most common reasons for delaying toileting were ``work duties'' (33/140, 21\%, on day 1 and 21/171, 11\%, on day 2) and ``errands or traveling'' (19/140, 12\%, on day 1 and 19/171, 10\%, on day 2). Response to at least 1 look-back notification was similarly high (41/44, 93\%, on day 1 and 42/44, 95\%, on day 2), with number of responses higher on average on day 2 compared with day 1 (mean on day 1=3.2, 95\% CI 3.0-3.5; mean on day 2=4.3, 95\% CI 3.9-4.7; P<.001). Median additional toileting events reported on the look-back survey were 1 (IQR 1-2) and 2 (IQR 1-2) on days 1 and 2, respectively. Overall concordance between self-reported location recording and GPS was 76\% (188/247). Participants reported lower urge ratings when at home versus away when reporting real-time toileting (median rating 61, IQR 41-84 vs 72, IQR 56-98), and daily fluid intake showed a small to medium positive correlation with toileting frequency (day 1 r=0.3, day 2 r=0.24). Toileting frequency reported in ``Where I Go'' showed a small positive correlation with the frequency item from the International Consultation on Incontinence Questionnaire (r=0.31 with day 1 toileting frequency and r=0.21 with day 2 toileting frequency). Conclusions: ``Where I Go'' has potential to increase the understanding of factors that affect women's toileting decisions and long-term bladder health. We anticipate its use as a data collection tool in population-based studies. International Registered Report Identifier (IRRID): RR2-10.2196/54046 ", doi="10.2196/56533", url="https://mhealth.jmir.org/2025/1/e56533" } @Article{info:doi/10.2196/67043, author="Jacob, Christine and M{\"u}ller, Roman and Sch{\"u}ler, Sonja and Rey, Alix and Rey, Guillaume and Armenian, Berj and Vonlaufen, Alain and Drepper, Michael and Zimmerli, Marius", title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e67043", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="technology assessment", keywords="technology adoption", keywords="technology implementation", keywords="usability study", keywords="colonoscopy", keywords="app", keywords="application", keywords="examinations", keywords="smartphone", keywords="usability", abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ", doi="10.2196/67043", url="https://humanfactors.jmir.org/2025/1/e67043" } @Article{info:doi/10.2196/51271, author="De Croon, Robin and Segovia-Lizano, Daniela and Finglas, Paul and Vanden Abeele, Vero and Verbert, Katrien", title="An Explanation Interface for Healthy Food Recommendations in a Real-Life Workplace Deployment: User-Centered Design Study", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="11", volume="13", pages="e51271", keywords="food recommender systems", keywords="personalized nutrition", keywords="healthy eating", keywords="human-computer interaction", keywords="real-life deployment", keywords="food catering", keywords="meal recommendations", keywords="nutritional profile", keywords="transparency", abstract="Background: Despite widespread awareness of healthy eating principles, many individuals struggle to translate this knowledge into consistent, sustainable dietary change. Food recommender systems, increasingly used in various settings, offer the potential for personalized guidance and behavior change support. However, traditional approaches may prioritize user preferences or popularity metrics without sufficiently considering long-term nutritional goals. This can inadvertently reinforce unhealthy eating patterns. Emerging research suggests that incorporating explanations into recommender systems can increase transparency, promote informed decision-making, and potentially influence food choices. Yet, the effectiveness of explanations in promoting healthy choices within complex, real-world food environments remain largely unexplored. Objective: This study aims to investigate the design, implementation, and preliminary evaluation of a food recommender system that integrates explanations in a real-world food catering application. We seek to understand how such a system can promote healthy choices while addressing the inherent tensions between user control, meal variety, and the need for nutritionally sound recommendations. Specifically, our objectives are to (1) identify and prioritize key design considerations for food recommenders that balance personalization, nutritional guidance, and user experience; and (2) conduct a proof-of-principle study in a real-life setting to assess the system's effect on user understanding, trust, and potentially on dietary choices. Methods: An iterative, user-centered design process guided the development and refinement of the system across 4 phases: (Phase 0) an exploratory qualitative study (N=26) to understand stakeholder needs and initial system impressions, (Phases 1 and 2) rapid prototyping in real-life deployments (N=45 and N=16, respectively) to iteratively improve usability and features, and (Phase 3) a proof-of-principle study with employees (N=136) to evaluate a set of design goals. We collected a mix of data, including usage logs, pre- and post-study questionnaires, in-app feedback, and a pre- and post--Food Frequency Questionnaire to establish nutritional profiles. Results: Although we experienced a high drop-out (77\% after 7 weeks), motivated and remaining participants valued personalization features, particularly the ability to configure allergies and lifestyle preferences. Explanations increased understanding of recommendations and created a sense of control, even when preferences and healthy options did not fully align. However, a mismatch persisted between individual preferences and nutritionally optimal recommendations. This highlights the design challenge of balancing user control, meal variety, and the promotion of healthy eating. Conclusions: Integrating explanations into personalized food recommender systems might be promising for supporting healthier food choices and creating a more informed understanding of dietary patterns. Our findings could highlight the importance of balancing user control with both the practical limitations of food service settings and the need for nutritionally sound recommendations. While fully resolving the tension between immediate preferences and long-term health goals is an ongoing challenge, explanations can play a crucial role in promoting more conscious decision-making. ", doi="10.2196/51271", url="https://mhealth.jmir.org/2025/1/e51271" } @Article{info:doi/10.2196/59386, author="Grieve, Natalie and Braaten, Kyra and MacPherson, Megan and Liu, Sam and Jung, E. Mary", title="Involving End Users in the Development and Usability Testing of a Smartphone App Designed for Individuals With Prediabetes: Mixed-Methods Focus Group Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e59386", keywords="usability evaluation", keywords="mHealth", keywords="usability testing", keywords="app", keywords="end-user", keywords="focus group", keywords="participant", keywords="survey", keywords="diabetes", keywords="user-centered", keywords="cognitive walkthrough", keywords="cognitive walkthroughs", keywords="questionnaire", keywords="mobile phone", keywords="digital health", keywords="prediabetes", abstract="Background: Technology is more likely to be used when it is designed to meet the needs of end users. To supplement the Small Steps for Big Changes diabetes prevention program, a smartphone app was developed in partnership with past Small Steps for Big Changes clientele. Usability testing is critical for the ongoing use and adoption of mobile health apps by providing insight on where appropriate adjustments and improvements need to be made to ensure user satisfaction. Objective: A focus group with 7 participants was conducted to examine the app's usability and collect feedback for future iterations. Methods: Past Small Steps for Big Changes clientele participated in a cognitive walkthrough of 8 novel tasks and completed the System Usability Scale survey. Participants were then given the option to use the app for 3 weeks before completing the User-Mobile Application Rating Scale. Results: Analysis of the cognitive walkthrough identified 26 usability problems; each was coded using a heuristic evaluation to describe usability errors. The most frequently coded errors included inappropriate progress feedback, information appearing in an illogical order, counterintuitive design, and issues with app aesthetics. A mean summary score of 66.8\% (SD 18.91) was reported for the System Usability Scale, representing a marginal acceptability score and indicating that design issues needed to be resolved. A User-Mobile Application Rating Scale mean score of 3.59 (SD 0.33) was reported, implying an average acceptability rating. Conclusions: These findings identified necessary improvements in the app, ranging from minor aesthetic problems to major functionality problems. Involving end users allows the app to be tailored to the client's preferences and increases the likelihood of usage. This app aligns with Small Steps for Big Changes' program components and behavior change techniques that can improve health outcomes for future clients and allow them to self-monitor their exercise, diet, and goals. ", doi="10.2196/59386", url="https://formative.jmir.org/2025/1/e59386" } @Article{info:doi/10.2196/60333, author="Lu, Hsin-Hui and Liang, Shih-Yuan and Huang, Yi-Chia", title="Efficacy, Feasibility, and Acceptability of an Emotional Competence Tele-Intervention for Mandarin-Speaking Children Aged 5 to 7 Years With Developmental Language Disorder: Pilot Study With an Interrupted Time-Series Design", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="11", volume="8", pages="e60333", keywords="language disorder", keywords="pediatrics", keywords="evidence-based intervention", keywords="telemedicine", keywords="tele-practice", keywords="visual support", keywords="mobile phone", abstract="Background: Children with developmental language disorder (DLD) often experience language difficulties that hinder their ability to acquire emotional competence. Poor emotional competence is associated with emotional and behavioral problems in young children. Objective: This research involved two studies focusing on (1) the emotional competence of Mandarin-speaking children aged 5 to 7 years with DLD and (2) the efficacy, feasibility, and acceptability of a tele-intervention designed to enhance their emotional competence in Taiwan. Methods: Five children with DLD from study 1 declined to participate in study 2, the emotional competence tele-intervention, and were excluded from the analysis. We compared the emotional competence of 20 Mandarin-speaking children with DLD to that of 24 children with typical language development (TLD). The children with DLD were, on average, aged 5.79 (SD 0.47) years, whereas the children with TLD were, on average, aged 5.93 (SD 0.31) years. We assessed the children's emotional competence, nonverbal ability, verbal comprehension, vocabulary acquisition, and expressive language skills. In study 2, all children with DLD included in study 1 engaged in an emotional competence tele-intervention. An interrupted time-series design was used to examine their emotional competence. In total, 20 children with DLD provided data on emotional competence evaluated using the Emotional Lexicon Test. These data were individually collected at 3 time points after study?1 (time?1). These phases included baseline (time?1 to time?2), during the tele-intervention (time?2 to time?3), and follow-up (time?3 to time?4), spanning approximately 18 to 20 weeks from time?1 to time?4. Recruitment, retention, and attendance rates were calculated to evaluate the intervention's feasibility, and participant mood was evaluated after each session to calculate the intervention's acceptability. Results: No significant changes in the children's ability to understand basic or complex emotional terms were observed during the baseline period. However, changes were observed during the tele-intervention period, and these changes remained throughout the follow-up period. With a recruitment rate of 80\% (20/25), all participants completed 4 intervention sessions, with retention and attendance rates exceeding 95\% (19/20). A total of 90\% (18/20) of the participants deemed each session to be acceptable. Conclusions: Mandarin-speaking children aged 5 to 7 years with DLD exhibited lower emotional competence compared with their counterparts with TLD. Tele-interventions are effective in enhancing the emotional competence of children with DLD, demonstrating feasibility and acceptability for these children and their parents in Taiwan. ", doi="10.2196/60333", url="https://pediatrics.jmir.org/2025/1/e60333" } @Article{info:doi/10.2196/62738, author="Pupong, Kittiwara and Hunsrisakhun, Jaranya and Pithpornchaiyakul, Samerchit and Naorungroj, Supawadee", title="Development of Chatbot-Based Oral Health Care for Young Children and Evaluation of its Effectiveness, Usability, and Acceptability: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="3", volume="8", pages="e62738", keywords="chatbot", keywords="conversational agents", keywords="tele-dentistry", keywords="oral health behavior", keywords="in-person toothbrushing", keywords="hands-on", keywords="children", keywords="covid-19", keywords="oral health education", keywords="development.", abstract="Background: Chatbots are increasingly accepted in public health for their ability to replicate human-like communication and provide scalable, 24/7 services. The high prevalence of dental caries in children underscores the need for early and effective intervention. Objective: This study aimed to develop the 30-Day FunDee chatbot and evaluate its effectiveness, usability, and acceptability in delivering oral health education to caregivers of children aged 6 to 36 months. Methods: The chatbot was created using the artificial intelligence (AI) chatbot behavior change model, integrating behavioral change theories into content designed for 3?5 minutes of daily use over 30 days. A pre-post experimental study was conducted from December 2021 to February 2022 in Hat Yai District, Songkhla Province, and Maelan District, Pattani Province, Thailand. Fifty-eight caregivers completed a web-based structured questionnaire at baseline and 2 months post baseline to evaluate knowledge, protection motivation theory-based perceptions, and tooth-brushing practices. Usability was assessed via chatbot logfiles and a web-based questionnaire at 2 months post baseline. Acceptability was evaluated through three methods: (1) open-ended chatbot interactions on day 30, (2) a web-based structured questionnaire at 2 months post baseline, and (3) semistructured telephone interviews with 15 participants 2 weeks post intervention. Participants for interviews were stratified by adherence levels and randomly selected from Hatyai and Maelan districts. All self-reported variables were measured on a 5-point Likert scale (1=lowest, 5=highest). Results: The chatbot was successfully developed based on the 4 components of the AI chatbot behavior change model. Participants had a mean age of 34.5 (SD 8.6) years. The frequency of tooth brushing among caregivers significantly improved, increasing from 72.4\% at baseline to 93.1\% two months post baseline (P=.006). Protection motivation theory-based perceptions also showed significant improvement, with mean scores rising from 4.0 (SD 0.6) at baseline to 4.5 (SD 0.6) two months post baseline (P<.001). The chatbot received high ratings for satisfaction (4.7/5, SD 0.6) and usability (4.7/5, SD 0.5). Participants engaged with the chatbot for an average of 24.7 (SD 7.2) days out of 30. Caregivers praised the chatbot's content quality, empathetic communication, and multimedia design, but noted the intervention's lengthy duration and messaging system as limitations. Conclusions: The 30-Day FunDee chatbot effectively enhanced caregivers' perceptions of oral health care and improved tooth-brushing practices for children aged 6?36 months. High user satisfaction and engagement demonstrate its potential as an innovative tool for oral health education. These findings warrant further validation through large-scale, randomized controlled trials. Trial Registration: Thai Clinical Trials Registry Tctr20210927004; https://www.thaiclinicaltrials.org/show/Tctr20210927004 ", doi="10.2196/62738", url="https://pediatrics.jmir.org/2025/1/e62738" } @Article{info:doi/10.2196/54216, author="Steyn, Sherrie and Slabbert, Meggan", title="Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study", journal="JMIR Form Res", year="2025", month="Jan", day="30", volume="9", pages="e54216", keywords="treatment gap", keywords="mental health", keywords="health", keywords="depression", keywords="anxiety", keywords="South Africa", keywords="CBT", keywords="cognitive behavioral therapy", keywords="app-based intervention", keywords="mobile health", keywords="mental health app", keywords="smartphone", keywords="mobile phone", abstract="Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy--based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52\% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69\% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as ``unemployed but seeking employment'' ($\chi$24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30\% (SD 29.473\%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. ", doi="10.2196/54216", url="https://formative.jmir.org/2025/1/e54216" } @Article{info:doi/10.2196/63564, author="Kamarudin, Sabrina Siti and Idris, Badilla Idayu and Sharip, Shalisah and Ahmad, Norfazilah", title="LoVE4MUM Mobile App to Prevent Postpartum Depression: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Jan", day="27", volume="14", pages="e63564", keywords="postpartum depression", keywords="mHealth intervention", keywords="mobile phone", keywords="prevention", keywords="self-guided", keywords="virtual engagement", keywords="engagement", keywords="maternal", keywords="protocol", keywords="randomized controlled trial", keywords="postpartum", keywords="depression", keywords="well-being", keywords="mobile health", keywords="preventive care", keywords="mobile app", keywords="mental health literacy", keywords="postpartum care", abstract="Background: Postpartum depression remains a significant concern, posing substantial challenges to maternal well-being, infant health, and the mother-infant bond, particularly in the face of barriers to traditional support and interventions. Previous studies have shown that mobile health (mHealth) interventions offer an accessible means to facilitate early detection and management of mental health issues while at the same time promoting preventive care. Objective: This study aims to evaluate the effectiveness of the Leveraging on Virtual Engagement for Maternal Understanding \& Mood-enhancement (LoVE4MUM) mobile app, which was developed based on the principles of cognitive behavioral therapy and psychoeducation and serves as an intervention to prevent postpartum depression. Methods: This single-blinded, pilot randomized controlled trial includes 64 mothers recruited from the postnatal ward and randomized using a 1:1 ratio to receive either postpartum care (treatment as usual) or postpartum care (treatment as usual) plus the self-guided LoVE4MUM mobile app. The primary outcome is the effectiveness of the mobile app at improving postpartum depression. Secondary outcomes are changes in the mental health literacy score and negative automatic thoughts, which are collected using a self-reported questionnaire. Results: Patient recruitment began on September 1, 2024. As of January 1, 2025, recruitment was successfully completed, with a total of 72 participants enrolled: 36 in the intervention group and 36 in the control group . The final results are anticipated to be available by March 2025, and publication is expected by the end of 2025. Conclusions: By examining the LoVE4MUM app alongside standard postpartum care, this pilot randomized controlled trial seeks to offer preliminary evidence on the potential of mHealth tools to improve maternal mental health as well as to reduce postpartum depression symptoms. The findings are expected to contribute to the future development of effective, accessible, and scalable interventions for mothers. Trial Registration: ClinicalTrials.gov NCT06366035; https://clinicaltrials.gov/study/NCT06366035 International Registered Report Identifier (IRRID): PRR1-10.2196/63564 ", doi="10.2196/63564", url="https://www.researchprotocols.org/2025/1/e63564" } @Article{info:doi/10.2196/65022, author="Zeiler, Michael and Dietzel, Nikolas and Haug, Fabian and Haug, Julian and Kammerer, Klaus and Pryss, R{\"u}diger and Heuschmann, Peter and Graessel, Elmar and Kolominsky-Rabas, L. Peter and Prokosch, Hans-Ulrich", title="A User-Centered Design Approach for a Screening App for People With Cognitive Impairment (digiDEM-SCREEN): Development and Usability Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="22", volume="12", pages="e65022", keywords="dementia", keywords="usability", keywords="development", keywords="digiDEM", keywords="cognitive impairment", keywords="older adults", keywords="aging", keywords="mobile health", keywords="mHealth", keywords="design", keywords="feedback", keywords="screening", keywords="user centred", keywords="cognitive disorder", keywords="user-centered", keywords="mobile app", abstract="Background: Dementia is a widespread syndrome that currently affects more than 55 million people worldwide. Digital screening instruments are one way to increase diagnosis rates. Developing an app for older adults presents several challenges, both technical and social. In order to make the app user-friendly, feedback from potential future end users is crucial during this development process. Objective: This study aimed to establish a user-centered design process for the development of digiDEM-SCREEN, a user-friendly app to support early identification of persons with slight symptoms of dementia. Methods: This research used qualitative and quantitative methods and involved 3 key stakeholder groups: the digiDEM research team, the software development team, and the target user group (older adults ?65 years with and without cognitive impairments). The development of the screening app was based on an already existing and scientifically analyzed screening test (Self-Administered Tasks Uncovering Risk of Neurodegeneration; SATURN). An initial prototype was developed based on the recommendations for mobile health apps and the teams' experiences. The prototype was tested in several iterations by various end users and continuously improved. The app's usability was evaluated using the System Usability Scale (SUS), and verbal feedback by the end users was obtained using the think-aloud method. Results: The translation process during test development took linguistic and cultural aspects into account. The texts were also adapted to the German-speaking context. Additional instructions were developed and supplemented. The test was administered using different randomization options to minimize learning effects. digiDEM-SCREEN was developed as a tablet and smartphone app. In the first focus group discussion, the developers identified and corrected the most significant criticism in the next version. Based on the iterative improvement process, only minor issues needed to be addressed after the final focus group discussion. The SUS score increased with each version (score of 72.5 for V1 vs 82.4 for V2), while the verbal feedback from end users also improved. Conclusions: The development of digiDEM-SCREEN serves as an excellent example of the importance of involving experts and potential end users in the design and development process of health apps. Close collaboration with end users leads to products that not only meet current standards but also address the actual needs and expectations of users. This is also a crucial step toward promoting broader adoption of such digital tools. This research highlights the significance of a user-centered design approach, allowing content, text, and design to be optimally tailored to the needs of the target audience. From these findings, it can be concluded that future projects in the field of health apps would also benefit from a similar approach. ", doi="10.2196/65022", url="https://humanfactors.jmir.org/2025/1/e65022" } @Article{info:doi/10.2196/65142, author="Salwei, Elizabeth Megan and Anders, Shilo and Reale, Carrie and Slagle, M. Jason and Ricketts, Todd and Weinger, B. Matthew", title="Evaluating the Safety and Usability of an Over-the-Counter Medical Device for Adults With Mild to Moderate Hearing Loss: Formative and Summative Usability Testing", journal="JMIR Hum Factors", year="2025", month="Jan", day="20", volume="12", pages="e65142", keywords="usability", keywords="human factors", keywords="patient safety", keywords="over-the-counter hearing aids", keywords="direct-to-consumer hearing aids", keywords="medical device", keywords="hearing loss", keywords="adult", keywords="hearing impairment", keywords="hearing aid use", keywords="hearing care", keywords="formative usability test", keywords="safety", keywords="mobile phone", abstract="Background: Only 15\% of the nearly 30 million Americans with hearing loss use hearing aids, partly due to high cost, stigma, and limited access to professional hearing care. Hearing impairment in adults can lead to social isolation and depression and is associated with an increased risk of falls. Given the persistent barriers to hearing aid use, the Food and Drug Administration issued a final rule to allow over-the-counter hearing aids to be sold directly to adult consumers with perceived mild to moderate hearing loss at pharmacies, stores, and online retailers without seeing a physician or licensed hearing health care professional. Objective: We evaluated the safety and usability of an over-the-counter hearing aid prior to Food and Drug Administration approval and market release. Methods: We first conducted a formative usability test of the device and associated app with 5 intended users to identify outstanding safety and usability issues (testing round 1). Following design modifications, we performed a summative usability test with 15 intended users of the device (testing round 2). We concurrently conducted a test with 21 nonintended users (ie, users with contraindications to use) to ascertain if consumers could determine when they should not use the device, based on the packaging, instructions, and labeling (testing round 3). Participants were asked to complete 2?5 tasks, as if they were using the hearing aid in real life. After each task, participants rated the task difficulty. At the end of each session, participants completed a 10-question knowledge assessment and the System Usability Scale and then participated in debriefing interviews to gather qualitative feedback. All sessions were video recorded and analyzed to identify use errors and design improvement opportunities. Results: Usability issues were identified in all 3 usability testing rounds. There were minimal safety-related issues with the device. Round 1 testing led to several design modifications which then increased task success in round 2 testing. Participants had the most difficulty with the task of pairing the hearing aids to the cell phone. Participants also had difficulty distinguishing the right and left earbuds. Nonintended users did not always understand device contraindications (eg, tinnitus and severe hearing loss). Overall, test findings informed 9 actionable design modifications (eg, clarifying pairing steps and increasing font size) that improved device usability and safety. Conclusions: This study evaluated the usability and safety of an over-the-counter hearing aid for adults with mild to moderate hearing loss. Human factors engineering methods identified opportunities to improve the safety and usability of this direct-to-consumer medical device for individuals with perceived mild-moderate hearing loss. ", doi="10.2196/65142", url="https://humanfactors.jmir.org/2025/1/e65142" } @Article{info:doi/10.2196/57614, author="Romm, Lie Kristin and Skoge, Mari and Barrett, Ann Elizabeth and Berentzen, Lars-Christian and Bergsager, Dagfinn and Fugelli, P{\aa}l and Bjella, Thomas and Gardsjord, Strand Erlend and Kling, Kristine and Kruse, Hembre Sindre and Kv{\ae}rner, Jorunn Kari and Melle, Ingrid and Mork, Erlend and Ihler, Myhre Henrik and Rognli, Borger Eline and Simonsen, Carmen and V{\ae}rnes, Gunnar Tor and Aminoff, Ragnhild Sofie", title="A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability", journal="JMIR Form Res", year="2025", month="Jan", day="17", volume="9", pages="e57614", keywords="eHealth", keywords="shared decision-making", keywords="user involvement", keywords="user-centered design", keywords="mental disorder", keywords="mobile technology", keywords="illness course", keywords="recovery", keywords="mobile apps", keywords="mHealth", abstract="Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings---from development to implementation---and to conduct further research on early health technology assessments to guide these processes. ", doi="10.2196/57614", url="https://formative.jmir.org/2025/1/e57614" } @Article{info:doi/10.2196/60447, author="Rosin, Magda and Ni Mhurchu, Cliona and Umali, Elaine and Mackay, Sally", title="Healthy Kai (Food) Checker Web-Based Tool to Support Healthy Food Policy Implementation: Development and Usability Study", journal="JMIR Form Res", year="2025", month="Jan", day="13", volume="9", pages="e60447", keywords="healthy food policy", keywords="policy implementation", keywords="nutrition", keywords="food environment", keywords="hospital", keywords="workplace", keywords="web-based tool", keywords="digital tool", keywords="database", keywords="user testing", keywords="food", keywords="drink", keywords="nutrition professionals", keywords="acceptability", keywords="usability", abstract="Background: Public health programs and policies can positively influence food environments. In 2016, a voluntary National Healthy Food and Drink Policy was released in New Zealand to improve the healthiness of food and drinks for hospital staff and visitors. However, no resources were developed to support policy implementation. Objective: This study aimed to design, develop, and test a new web-based tool to support food providers implementing the National Healthy Food and Drink Policy in New Zealand. Methods: The Double Diamond model, a structured framework with 4 design phases, was used to design and develop a web-based tool. Findings from our previous research, such as (1) systematic review of barriers and facilitators to workplace healthy food policy implementation; (2) scoping review of current tools and resources available in New Zealand, Australia, and Canada; (3) interviews with food providers and public health nutrition professionals; and (4) food and drink availability audit results in New Zealand hospitals were used in the ``Discover'' (understanding of current gaps) and ``Define'' (prioritizing functions and features) phases. Subsequent phases focused on generating ideas, creating prototypes, and testing a new web-based tool using Figma, a prototyping tool. During the ``Develop'' phase, project stakeholders (11 public health nutrition professionals) provided feedback on the basic content outline of the initial low-fidelity prototype. In the final ``Deliver'' phase, a high-fidelity prototype resembling the appearance and functionality of the final tool was tested with 3 end users (public health nutrition professionals) through interactive interviews, and user suggestions were incorporated to improve the tool. Results: A new digital tool, Healthy Kai (Food) Checker---a searchable database of packaged food and drink products that classifies items according to the Policy's nutritional criteria---was identified as a key tool to support Policy implementation. Of 18 potential functions and features, 11 were prioritized by the study team, including basic and advanced searches for products, sorting list options, the ability to compile a list of selected products, a means to report products missing from the database, and ability to use on different devices. Feedback from interview participants was that the tool was easy to use, was logical to navigate, and had an appealing color scheme. Suggested visual and usability improvements included ensuring that images represented the diverse New Zealand population, reducing unnecessary clickable elements, adding information about the free registration option, and including more frequently asked questions. Conclusions: Comprehensive research informed the development of a new digital tool to support implementation of the National Healthy Food and Drink Policy. Testing with end users identified features that would further enhance the tool's acceptability and usability. Incorporation of more functions and extending the database to include products classified according to the healthy school lunches program policy in the same database would increase the tool's utility. ", doi="10.2196/60447", url="https://formative.jmir.org/2025/1/e60447" } @Article{info:doi/10.2196/64191, author="Fan, Lok Heidi Sze and Leung, Yan Emily Tsz and Lau, Wing Ka and Wong, Ha Janet Yuen and Choi, Hang Edmond Pui and Lam, Christine and Tarrant, Marie and Ngan, Sheung Hextan Yuen and Ip, Patrick and Lin, Chin Chia and Lok, Wan Kris Yuet", title="A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study", journal="JMIR Form Res", year="2025", month="Jan", day="10", volume="9", pages="e64191", keywords="Baby-Friendly Community Initiative", keywords="Baby-Friendly Hospital Initiative", keywords="breastfeeding", keywords="community", keywords="stakeholders", keywords="mobile app", keywords="friendly communities", keywords="baby-friendly", keywords="well-being", keywords="mother", keywords="infant", keywords="application", keywords="mHealth", keywords="qualitative", keywords="user-friendly", keywords="self-management", abstract="Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ``bfGPS'' (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged---bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant's growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app's potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. ", doi="10.2196/64191", url="https://formative.jmir.org/2025/1/e64191" } @Article{info:doi/10.2196/59937, author="Kaur, Harleen and Tripathi, Stuti and Chalga, Singh Manjeet and Benara, K. Sudhir and Dhiman, Amit and Gupta, Shefali and Nair, Saritha and Menon, Geetha and Gulati, K. B. and Sharma, Sandeep and Sharma, Saurabh", title="Unified Mobile App for Streamlining Verbal Autopsy and Cause of Death Assignment in India: Design and Development Study", journal="JMIR Form Res", year="2025", month="Jan", day="10", volume="9", pages="e59937", keywords="verbal autopsy", keywords="cause of death", keywords="mortality", keywords="mHealth", keywords="public health", keywords="India", keywords="mobile health", abstract="Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge. Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA. Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection. Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80\%, reducing it to about 1?2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35?40 VA cases annually, while medical officers at primary health centers are projected to manage 150?200 physician-certified VAs each year. The app's data collection and transmission efficiency were further improved based on feedback from user and subject area experts. Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India. ", doi="10.2196/59937", url="https://formative.jmir.org/2025/1/e59937" } @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/10.2196/58479, author="Chen, Hui-Yu and Tu, Ming-Hsiang and Chen, Miao-Yen", title="Using a Mobile Health App (ColonClean) to Enhance the Effectiveness of Bowel Preparation: Development and Usability Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="8", volume="12", pages="e58479", keywords="mobile health app", keywords="bowel preparation", keywords="nursing guidance", keywords="technology acceptance model", keywords="mHealth", keywords="mobile health", abstract="Background: Colonoscopy is the standard diagnostic method for colorectal cancer. Patients usually receive written and verbal instructions for bowel preparation (BP) before the procedure. Failure to understand the importance of BP can lead to inadequate BP in 25\%-30\% of patients. The quality of BP impacts the success of colonoscopy in diagnostic yield and adenoma detection. We developed the ``ColonClean'' mobile health (mHealth) app for Android devices. It incorporates visual representations of dietary guidelines, steps for using bowel cleansing agents, and observations of the last bowel movement. We used the Technology Acceptance Model to investigate whether the use of the ColonClean mHealth app can improve users' attitudes and behaviors toward BP. Objective: This study aims to validate the effectiveness of the ColonClean app in enhancing user behavior and improving BP, providing safe and cost-effective outpatient colonoscopy guidance. Methods: This study uses a structured questionnaire to assess perceived usefulness, perceived ease of use, and users' attitudes and behaviors toward BP regarding the ColonClean mHealth app. A total of 40 outpatients who were physically and mentally healthy and proficient in Chinese were randomly chosen for this study. The data were analyzed using SPSS 25.0, and we used Pearson product-moment correlation and simple regression analysis to predict the perception of ColonClean. Results: The results showed that 75\% (30/40) of participants achieved an ``excellent'' or ``good'' level of BP according to the Aronchick Bowel Preparation Scale. Perceived usefulness and perceived ease of use of the ColonClean mHealth app were positively correlated with users' attitudes and behaviors (P<.05). Conclusions: The ColonClean mHealth app serves as an educational reference and enhances the effectiveness of BP. Users expressed their willingness to use the app again in the future and recommend it to family and friends, highlighting its effectiveness as an educational guide for BP. ", doi="10.2196/58479", url="https://humanfactors.jmir.org/2025/1/e58479" } @Article{info:doi/10.2196/55032, author="Duracinsky, Martin and Brown Hajdukova, Eva and P{\'e}retz, Fabienne and Sauzin, Julie and Gouider-Khouja, Neziha and Atlani, Caroline and Dalili, Djamchid", title="Collecting Feedback From Neurologists and Patients to Guide Development of a Parkinson Disease App (DigiPark): Qualitative, Noninterventional Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="31", volume="11", pages="e55032", keywords="DigiPark", keywords="Parkinson disease", keywords="patient-centered app", keywords="smartphones", keywords="usability testing", keywords="mHealth", keywords="mobile health", abstract="Background: Parkinson disease (PD) is a worldwide, fast-growing, progressive neurodegenerative condition. Its multifaceted clinical presentation includes a wide range of motor and nonmotor symptoms. Smartphones present a potential solution to better monitor and subsequently alleviate PD symptoms. Objective: The aim of this study is to explore neurologists' and patients' needs and preferences regarding the design and functionality of a new smartphone app for PD, DigiPark. Methods: This qualitative, noninterventional study gathered data through two primary methods: (1) by conducting interviews with 9 neurologists and (2) through a usability test including 5 patients with PD. Results: The neurologists affirmed the necessity for a patient-centered app, highlighting the complexities of PD management. They advocated for personalized app functionalities to improve patients' quality of life and emphasized the need for enhanced patient-provider communication. Feedback from the usability test indicated a preference for a clear, simple user interface, as well as elucidation of the app's benefits. Concerns about the app's time demands and the complexity of certain features like medication management were expressed. Furthermore, patients with PD consistently showed interest in features that could track and monitor their progress over time. This highlights the need to include clear benefits within the app to maintain user engagement and commitment. Conclusions: Neurologists' and patients' feedback on the design and functionality of the app complement each other. Collaborative efforts in shaping the app should better address genuine PD management needs. Future clinical trial inclusion can further validate the efficacy of DigiPark. ", doi="10.2196/55032", url="https://humanfactors.jmir.org/2024/1/e55032" } @Article{info:doi/10.2196/53613, author="Leijse, L. Merel M. and van Dam, Levi and Jambroes, Tijs and Timmerman, Amber and Popma, Arne", title="Using Active and Passive Smartphone Data to Enhance Adolescents' Emotional Awareness in Forensic Outpatient Setting: A Qualitative Feasibility and Usability Study", journal="JMIR Form Res", year="2024", month="Dec", day="30", volume="8", pages="e53613", keywords="emotion regulation", keywords="emotion awareness", keywords="smartphone data", keywords="forensic outpatient youth care", keywords="treatment motivation", keywords="treatment alliance", keywords="emotion", keywords="behavioral", keywords="interview", keywords="mHealth", keywords="app", keywords="forensic", keywords="usability", keywords="feasibility", keywords="delinquent", keywords="pediatrics", keywords="youth", keywords="adolescent", keywords="teenager", keywords="experience", keywords="attitude", keywords="opinion", keywords="perception", keywords="perspective", keywords="acceptance", keywords="emoji", keywords="behavioral data", keywords="mobile phone", abstract="Background: Delinquent behavior in adolescence is a prevalent issue, often associated with difficulties across multiple life domains, which in turn perpetuates negative life outcomes. While current treatment programs show partial success in improving behavioral changes and reducing recidivism, comprehensive conclusions regarding the overall efficacy of these interventions have yet to be established. In forensic outpatient settings, the discrepancy between adolescents' limited emotional awareness and the predominant emphasis on cognitive reflection, combined with low treatment adherence, may be factors that undermine treatment efficacy. New technologies, such as smartphone apps, may offer a solution by integrating real-life data into treatment to improve emotional and behavioral patterns. The low-threshold use of smartphone data can be useful in addressing these treatment challenges. Objective: This study aimed to explore the feasibility and usability of Feelee (Garage2020), a smartphone app that integrates active emoji and passive behavioral data, as a potential addition to treatment for adolescents in a forensic outpatient setting. Methods: We conducted a prepilot study with adolescents (n=4) who used the Feelee app over a 2-week period. App usage included completing a brief emoji survey 3 times a day (active data) and allowing Feelee to track the call logs, Bluetooth devices in proximity, cell tower IDs, app usage, and phone status (passive data). During treatment sessions, both adolescents and clinicians reviewed and discussed the active and passive data. Semistructured interviews were conducted with adolescents and clinicians (n=7) to gather experiences and feedback on the feasibility and usability of incorporating smartphone data into treatment. Results: The study showed that adolescents (n=3) succeeded in using Feelee for the full 2 weeks, and data were available for discussion in at least 1 session per participant. Both adolescents and clinicians (n=7) stated that Feelee was valuable for viewing, discussing, and gaining insight into their emotions, which facilitated targeted actions based on the Feelee data. However, neither adolescents nor clinicians reported increased engagement in treatment as a result of using Feelee. Despite technical issues, overall feedback on the Feelee app, in addition to treatment, was positive (n=7). However, further improvements are needed to address the high battery consumption and the inaccuracies in the accelerometer. Conclusions: This qualitative study provides an in-depth understanding of the potential benefits of integrating active and passive smartphone data for adolescents in a forensic outpatient setting. Feelee appears to contribute to a better understanding of emotions and behaviors, suggesting its potential value in enhancing emotional awareness in treatment. Further research is needed to assess Feelee's clinical effectiveness and explore how it enhances emotional awareness. Recommendations from adolescents and clinicians emphasize the need for prepilot studies to address user issues, guiding technical improvements and future research in forensic outpatient settings. ", doi="10.2196/53613", url="https://formative.jmir.org/2024/1/e53613" } @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/10.2196/47730, author="Versluis, Anke and Penfornis, M. Kristell and van der Burg, A. Sven and Scheltinga, L. Bouke and van Vliet, M. Milon H. and Albers, Nele and Meijer, Eline", title="Targeting Key Risk Factors for Cardiovascular Disease in At-Risk Individuals: Developing a Digital, Personalized, and Real-Time Intervention to Facilitate Smoking Cessation and Physical Activity", journal="JMIR Cardio", year="2024", month="Dec", day="20", volume="8", pages="e47730", keywords="smoking", keywords="physical activity", keywords="virtual coach", keywords="eHealth", keywords="development", keywords="collaboration", keywords="conversational agent", keywords="risk factor", keywords="cardiovascular disease", keywords="CVD", keywords="digital", keywords="smoking cessation", keywords="intervention", doi="10.2196/47730", url="https://cardio.jmir.org/2024/1/e47730" } @Article{info:doi/10.2196/59865, author="Supplieth, Juliana and Lech, Sonia and O'Sullivan, Lorraine Julie and Spang, Robert and Voigt-Antons, Jan?Niklas and Schuster, Johanna", title="Development of a Tablet-Based Outpatient Care Application for People With Dementia: Interview and Workshop Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="19", volume="11", pages="e59865", keywords="dementia", keywords="tablet application development", keywords="multidisciplinary health care", keywords="feasibility study", keywords="general practitioners", keywords="digital health care", abstract="Background: Dementia management presents a significant challenge for individuals affected by dementia, as well as their families, caregivers, and health care providers. Digital applications may support those living with dementia; however only a few dementia-friendly applications exist. Objective: This paper emphasizes the necessity of considering multiple perspectives to ensure the high-quality development of supportive health care applications. The findings underscore the importance of incorporating input from stakeholders and the needs of affected families into application development. Method: A qualitative approach was chosen, consisting of three interviews and an expert workshop. The interviews and the workshop were recorded and transcribed, and qualitative content analysis was carried out according to the methodology described by Kuckartz with the support of MAXQDA. Results: During the development phases of the application, team meetings and discussions took place. We found that general practitioners and family caregivers play pivotal roles in the treatment and care of people with dementia, often expressing specific preferences and suggestions regarding supportive and assistive technologies. Moreover, the successful development of a useful tablet application requires robust scientific and multidisciplinary discussions and teamwork within the health care community. Conclusion: This paper underscores the necessity of including multiple scientific, clinical, and technical perspectives to ensure the high-quality development of supportive health care applications. Furthermore, adopting a spiral development approach inclusive of feedback loops is imperative for iterative refinement and enhancement of the application. International Registered Report Identifier (IRRID): RR2-10.1024/1662-9647/a000210 ", doi="10.2196/59865", url="https://humanfactors.jmir.org/2024/1/e59865" } @Article{info:doi/10.2196/57403, author="Fletcher, Kathryn and Robert-Hendren, Dominique", title="Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study", journal="JMIR Form Res", year="2024", month="Dec", day="18", volume="8", pages="e57403", keywords="app", keywords="alcohol use", keywords="self-monitoring", keywords="tracker", keywords="digital health", abstract="Background: Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. Objective: We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. Methods: The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Results: Feasibility was demonstrated, with almost 70\% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1\% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9\%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4\%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73\% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87\% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Conclusions: Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required. ", doi="10.2196/57403", url="https://formative.jmir.org/2024/1/e57403" } @Article{info:doi/10.2196/63316, author="Lee Yoon Li, Madeline and Lee Si Min, Stephanie and S{\"u}ndermann, Oliver", title="Efficacy of the mHealth App Intellect in Improving Subclinical Obsessive-Compulsive Disorder in University Students: Randomized Controlled Trial With a 4-Week Follow-Up", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="16", volume="12", pages="e63316", keywords="mobile health app", keywords="self-guided interventions", keywords="obsessive-compulsive disorder", keywords="cognitive behavioral therapy", keywords="maladaptive perfectionism", keywords="randomized controlled trial", keywords="behavioral", keywords="efficacy", keywords="mHealth app", keywords="university students", keywords="Singapore", keywords="symptoms", abstract="Background: Obsessive-compulsive disorder (OCD) is the third most prevalent mental health disorder in Singapore, with a high degree of burden and large treatment gaps. Self-guided programs on mobile apps are accessible and affordable interventions, with the potential to address subclinical OCD before symptoms escalate. Objective: This randomized controlled trial aimed to examine the efficacy of a self-guided OCD program on the mobile health (mHealth) app Intellect in improving subclinical OCD and maladaptive perfectionism (MP) as a potential moderator of this predicted relationship. Methods: University students (N=225) were randomly assigned to an 8-day, self-guided app program on OCD (intervention group) or cooperation (active control). Self-reported measures were obtained at baseline, after the program, and at a 4-week follow-up. The primary outcome measure was OCD symptom severity (Obsessive Compulsive Inventory--Revised [OCI-R]). Baseline MP was assessed as a potential moderator. Depression, anxiety, and stress (Depression Anxiety and Stress Scales-21) were controlled for during statistical analyses. Results: The final sample included 192 participants. The intervention group reported significantly lower OCI-R scores compared with the active control group after the intervention (partial eta-squared [$\eta$p2]=0.031; P=.02) and at 4-week follow-up ($\eta$p2=0.021; P=.044). A significant, weak positive correlation was found between MP and OCI-R levels at baseline (r=0.28; P<.001). MP was not found to moderate the relationship between condition and OCI-R scores at postintervention (P=.70) and at 4-week follow-up (P=.88). Conclusions: This study provides evidence that the self-guided OCD program on the Intellect app is effective in reducing subclinical OCD among university students in Singapore. Future studies should include longer follow-up durations and study MP as a moderator in a broader spectrum of OCD symptom severity. Trial Registration: ClinicalTrials.gov NCT06202677; https://clinicaltrials.gov/study/NCT06202677 ", doi="10.2196/63316", url="https://mhealth.jmir.org/2024/1/e63316" } @Article{info:doi/10.2196/63416, author="Sourander, Saana and Westerlund, Minja and Baumel, Amit and Hinkka-Yli-Salom{\"a}ki, Susanna and Ristkari, Terja and Kurki, Marjo and Sourander, Andre", title="Web-Based Parent Training With Telephone Coaching Aimed at Treating Child Disruptive Behaviors in a Clinical Setting During the COVID-19 Pandemic: Single-Group Study With 2-Year Follow-Up", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="16", volume="7", pages="e63416", keywords="parent training", keywords="disruptive behavior", keywords="child psychopathology", keywords="child functioning", keywords="behaviors", keywords="behavioral", keywords="coaching", keywords="web-based", keywords="family counseling", keywords="child", keywords="disruptive", keywords="counseling", keywords="training", keywords="parents", keywords="parenting", keywords="telephone", keywords="telehealth", keywords="telemedicine", keywords="pediatrics", keywords="COVID-19", abstract="Background: There is a lack of studies examining the long-term outcomes of web-based parent training programs implemented in clinical settings during the COVID-19 pandemic. Objective: The aim is to study 2-year outcomes of families with 3? to 8-year-old children referred from family counseling centers to the Finnish Strongest Families Smart Website (SFSW), which provides digital parent training with telephone coaching aimed at treating child disruptive behaviors. Methods: Counseling centers in Helsinki identified fifty 3? to 8-year-old children with high levels of disruptive behavioral problems. Child psychopathology and functioning as well as parenting styles and parental mental health were collected from parents at baseline; posttreatment; and at 6-, 12-, and 24-month follow-ups. Results: The SFSW program had positive long-term changes in child psychopathology and parenting skills. Improvements in child psychopathology, including Strengths and Difficulties Questionnaire total score (Cohen d=0.47; P<.001), Strengths and Difficulties Questionnaire conduct scores (Cohen d=0.65; P<.001), and Affective Reactivity Index irritability scores (Cohen d=0.52; P<.001), were maintained until the 24-month follow-up. Similarly, changes in parenting skills measured with the Parenting Scale, including overreactivity (Cohen d=0.41; P=.001) and laxness (Cohen d=0.26; P=.02), were maintained until the 24-month follow-up. However, parental hostility changes were not maintained at long-term follow-up (Cohen d=?0.04; P=.70). Conclusions: The study shows that the SFSW parent training program can yield significant long-term benefits. Findings indicate that the benefits of the treatment may vary between different parenting styles, which is important to consider when developing more personalized parenting interventions. ", doi="10.2196/63416", url="https://pediatrics.jmir.org/2024/1/e63416" } @Article{info:doi/10.2196/66052, author="Lee, Yeonsu and Keel, Stuart and Yoon, Sangchul", title="Evaluating the Effectiveness and Scalability of the World Health Organization MyopiaEd Digital Intervention: Mixed Methods Study", journal="JMIR Public Health Surveill", year="2024", month="Dec", day="16", volume="10", pages="e66052", keywords="World Health Organization", keywords="digital intervention", keywords="MyopiaEd", keywords="behavior change", keywords="risk factor", keywords="myopia", keywords="refractive error", keywords="mobile phone", abstract="Background: The rapid rise of myopia worldwide, particularly in East and Southeast Asia, has implied environmental influences beyond genetics. To address this growing public health concern, the World Health Organization and International Telecommunication Union launched the MyopiaEd program. South Korea, with its high rates of myopia and smartphone use, presented a suitable context for implementing and evaluating the MyopiaEd program. Objective: This is the first study to date to evaluate the effectiveness and scalability of the MyopiaEd program in promoting eye health behavior change among parents of children in South Korea. Methods: Parents of children aged 7 and 8 years were recruited through an open-access website with a recruitment notice distributed to public elementary schools in Gwangju Metropolitan City. Beginning in September 2022, parents received 42 SMS text messages from the MyopiaEd program over 6 months. This digital trial used a mixed methods approach combining both quantitative and qualitative data collection. Pre- and postintervention surveys were used to assess changes in parental knowledge and behavior regarding myopia prevention. Additionally, semistructured interviews were conducted to explore participants' experiences in depth and receive feedback on program design. Prior to the intervention, the MyopiaEd program design and message libraries were adapted for the Korean context following World Health Organization and International Telecommunication Union guidelines. Results: A total of 133 parents participated in this study, including 60 parents whose children had myopia and 73 parents whose children did not. Both groups reported high engagement and satisfaction with the program. Significant increases in knowledge about myopia were observed in both groups (P<.001). While time spent on near-work activities did not change significantly, parents of children with myopia reported increased outdoor time for their children (P=.048). A substantial increase in eye checkups was observed, with 52 (86.7\%) out of 60 children with myopia and 50 (68.5\%) out of 73 children without myopia receiving eye examinations following the intervention. Qualitative analysis indicated a shift in parents' attitudes toward outdoor activities, as increased recognition of their benefits prompted positive changes in behavior. However, reducing near-work activities posed challenges due to children's preference for smartphone use during leisure periods and the demands of after-school academies. The credibility of the institution delivering the program enhanced parental engagement and children's adoption of healthy behaviors. Messages that corrected common misconceptions about eye health and provided specific behavioral guidance were regarded as impactful elements of the program. Conclusions: This study demonstrates the MyopiaEd program's potential as a scalable and innovative digital intervention to reduce myopia risk in children. The program's effectiveness provides support for broader adoption and offers valuable insights to inform future myopia prevention policies. ", doi="10.2196/66052", url="https://publichealth.jmir.org/2024/1/e66052" } @Article{info:doi/10.2196/52340, author="Knobel, J. Samuel E. and Oberson, Raphael and R{\"a}ber, Jonas and Sch{\"u}tz, Narayan and Egloff, Niklaus and Botros, Angela and Gerber, M. Stephan and Nef, Tobias and Heydrich, Lukas", title="Evaluation of a New Mobile Virtual Reality Setup to Alter Pain Perception: Pilot Development and Usability Study in Healthy Participants", journal="JMIR Serious Games", year="2024", month="Dec", day="11", volume="12", pages="e52340", keywords="immersive virtual reality", keywords="embodiment", keywords="pain management", keywords="chronic pain", keywords="full-body illusion", keywords="cardiovisual illusion", keywords="pain", keywords="virtual reality", keywords="pilot study", keywords="development", keywords="mobile virtual reality", keywords="mobile", keywords="virtual environment", keywords="usability", keywords="heart rate", keywords="mobile phone", abstract="Background: Chronic pain presents a significant treatment challenge, often leading to frustration for both patients and therapists due to the limitations of traditional methods. Research has shown that synchronous visuo-tactile stimulation, as used in the rubber hand experiment, can induce a sense of ownership over a fake body part and reduces pain perception when ownership of the fake body part is reported. The effect of the rubber hand experiment can be extended to the full body, for example, during the full-body illusion, using both visuo-tactile and cardiovisual signals. Objective: This study first aimed to evaluate the usability and accuracy of a novel, mobile virtual reality (VR) setup that displays participants' heartbeats as a flashing silhouette on a virtual avatar, a technique known as the cardiovisual full-body illusion. The second part of the study investigated the effects of synchronous cardiovisual stimulation on pain perception and ownership in 20 healthy participants as compared with asynchronous stimulation (control condition). Methods: The setup comprised a head-mounted display (HMD) and a heart rate measurement device. A smartphone-based HMD (Samsung Galaxy S8+) was selected for its mobility, and heart rates were measured using smartwatches with photoplethysmography (PPG). The accuracy of 2 smartwatch positions was compared with a 5-point electrocardiogram (ECG) standard in terms of their accuracy (number and percent of missed beats). Each participant underwent two 5-minute sessions of synchronous cardiovisual stimulation and two 5-minute sessions of asynchronous cardiovisual stimulation (total of 4 sessions), followed by pain assessments. Usability, symptoms of cybersickness, and ownership of the virtual body were measured using established questionnaires (System Usability Scale, Simulator Sickness Questionnaire, Ownership Questionnaire). Pain perception was assessed using advanced algometric methods (Algopeg and Somedic algometer). Results: Results demonstrated high usability scores (mean 4.42, SD 0.56; out of 5), indicating ease of use and acceptance, with minimal side effects (mean 1.18, SD 0.46; out of a possible 4 points on the Simulator Sickness Questionnaire). The PPG device showed high heart rate measurement precision, which improved with optimized filtering and peak detection algorithms. However, compared with previous work, no significant effects on body ownership and pain perception were observed between the synchronous and asynchronous conditions. These findings are discussed in the context of existing literature on VR interventions for chronic pain. Conclusions: In conclusion, while the new VR setup showed high usability and minimal side effects, it did not significantly affect ownership or pain perception. This highlights the need for further research to refine VR-based interventions for chronic pain management, considering factors like visual realism and perspective. ", doi="10.2196/52340", url="https://games.jmir.org/2024/1/e52340" } @Article{info:doi/10.2196/60079, author="Woods, E. Cindy and Furst, Mary-Anne and Dissanayake, Manoj and Koerner, Jane and de Miquel, Carlota and Lukersmith, Sue and Rosenberg, Sebastian and Salvador-Carulla, Luis", title="Mental Health Care Navigation Tools in Australia: Infoveillance Study", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="22", volume="10", pages="e60079", keywords="digital health", keywords="infoveillance", keywords="mental health", keywords="mental health care", keywords="navigation tools", keywords="Australia", keywords="fragmentation", keywords="digital mental healthcare", keywords="web-based digital resources", keywords="diagnostic screening", keywords="accessibility", keywords="user friendly", abstract="Background: In response to the well-documented fragmentation within its mental health system, Australia has witnessed recently rapid expansion in the availability of digital mental health care navigation tools. These tools focus on assisting consumers to identify and access appropriate mental health care services, the proliferation of such varied web-based resources risks perpetuating further fragmentation and confusion for consumers. There is a pressing need to systematically assess the characteristics, comprehensiveness, and validity of these navigation tools, especially as demand for digital resources continues to escalate. Objective: This study aims to identify and describe the current landscape of Australian digital mental health care navigation tools, with a focus on assessing their comprehensiveness, identifying potential gaps, and the extent to which they meet the needs of various stakeholders. Methods: A comprehensive infoveillance approach was used to identify Australian digital mental health care navigation tools. This process involved a systematic web-based search complemented by consultations with subject matter experts. Identified navigation tools were independently screened by 2 authors, while data extraction was conducted by 3 authors. Extracted data were mapped to key domains and subdomains relevant to navigation tools. Results: From just a handful in 2020, by February 2024 this study identified 102 mental health care navigation tools across Australia. Primary Health Networks (n=37) and state or territory governments (n=21) were the predominant developers of these tools. While the majority of navigation tools were primarily designed for consumer use, many also included resources for health professionals and caregivers. Notably, no navigation tools were specifically designed for mental health care planners. Nearly all tools (except one) featured directories of mental health care services, although their functionalities varied: 27\% (n=27) provided referral information, 20\% (n=21) offered geolocated service maps, 12\% (n=12) included diagnostic screening capabilities, and 7\% (n=7) delineated care pathways. Conclusions: The variability of navigation tools designed to facilitate consumer access to mental health services could paradoxically contribute to further confusion. Despite the significant expansion of digital navigation tools in recent years, substantial gaps and challenges remain. These include inconsistencies in tool formats, resulting in variable information quality and validity; a lack of regularly updated service information, including wait times and availability for new clients; insufficient details on program exclusion criteria; and limited accessibility and user-friendliness. Moreover, the inclusion of self-assessment screening tools is infrequent, further limiting the utility of these resources. To address these limitations, we propose the development of a national directory of mental health navigation tools as a centralized resource, alongside a system to guide users toward the most appropriate tool for their individual needs. Addressing these issues will enhance consumer confidence and contribute to the overall accessibility, reliability, and utility of digital navigation tools in Australia's mental health system. ", doi="10.2196/60079", url="https://publichealth.jmir.org/2024/1/e60079" } @Article{info:doi/10.2196/55639, author="Aldridge, Grace and Wu, Ling and Seguin, Paolo Joshua and Robinson, Jennifer and Battaglia, Elizabeth and Olivier, Patrick and Yap, H. Marie B.", title="Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study", journal="JMIR Form Res", year="2024", month="Nov", day="22", volume="8", pages="e55639", keywords="co-design", keywords="service design", keywords="intervention", keywords="digital technology", keywords="parenting", keywords="children", keywords="technology", keywords="parenting program", keywords="health care services", keywords="adverse childhood experience", keywords="ACE", keywords="mental disorder", keywords="innovate", keywords="social services", keywords="community health", keywords="evidence-based", keywords="parenting intervention", abstract="Background: Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent's capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions. Objective: This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention. Methods: Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite's design. Results: PaRK-Lite's hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents' empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents. Conclusions: The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families. ", doi="10.2196/55639", url="https://formative.jmir.org/2024/1/e55639", url="http://www.ncbi.nlm.nih.gov/pubmed/39576676" } @Article{info:doi/10.2196/56553, author="Marras, Carlos and Labarga, Mar{\'i}a and Ginard, Daniel and Carrascosa, Manuel Jose and Escudero-Contreras, Alejandro and Collantes-Estevez, Eduardo and de Mora, Fernando and Robles, Tamara and Romero, Elisa and Mart{\'i}nez, Rafael", title="An Educational Digital Tool to Improve the Implementation of Switching to a Biosimilar (Rapid Switch Trainer): Tool Development and Validation Study", journal="JMIR Form Res", year="2024", month="Nov", day="21", volume="8", pages="e56553", keywords="consumer health information", keywords="treatment switching", keywords="biosimilar pharmaceuticals", keywords="immune-mediated diseases", keywords="education", keywords="qualitative research", keywords="training", keywords="nocebo", keywords="digital tool", keywords="implementation", abstract="Background: Switching to biosimilars is an effective and safe practice in treating inflammatory diseases; however, a nocebo effect may arise as a result of the way in which the switch is communicated to a given patient. Objective: We aimed to design a gaming-based digital educational tool (including a discussion algorithm) to support the training of health care professionals in efficiently communicating the switch to biosimilars, minimizing the generation of a nocebo effect and thus serving as an implementation strategy for the recommended switch. Methods: The tool was developed based on interviews and focus group discussions with key stakeholders, both patients and health care professionals. Messages likely to either generate trust or to trigger a nocebo effect were generated on the basis of the interviews and focus group discussions. Results: A total 7 clinicians and 4 nurses specializing in rheumatology, gastroenterology, and dermatology, with balanced levels of responsibility and experience, as well as balance between geographic regions, participated in the structured direct interviews and provided a list of arguments they commonly used, or saw used, to justify the switching, and objections given by the patients they attended. Patients with immune-mediated inflammatory diseases who were taking biologic drugs with (n=4) and without (n=5) experience in switching attended the focus groups and interviews. Major topics of discussion were the reason for the change, the nature of biosimilars, and their quality, safety, efficacy, and cost. Based on these discussions, a list of objections and of potential arguments was produced. Patients and health care professionals rated the arguments for their potential to evoke trust or a nocebo effect. Two sets of arguments, related to savings and sustainability, showed discrepant ratings between patients and health care professionals. Objections and arguments were organized by categories and incorporated into the tool as algorithms. The educators then developed additional arguments (with inadequate answers) to complement the valid ones worked on in the focus groups. The tool was then developed as a collection of clinical situations or vignettes that appear randomly to the user, who then has to choose an argument to counteract the given objections. After each interaction, the tool provides feedback. The tool was further supported by accredited medical training on biosimilars and switching. Conclusions: We have developed a digital training tool to improve communication on switching to biosimilars in the clinic and prevent a nocebo effect based on broad and in-depth experiences of patients and health care professionals. The validation of this implementation strategy is ongoing. ", doi="10.2196/56553", url="https://formative.jmir.org/2024/1/e56553" } @Article{info:doi/10.2196/64681, author="Park, Jinyoung and Lee, Jungeun and Noh, Dabok", title="Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach", journal="JMIR Hum Factors", year="2024", month="Nov", day="21", volume="11", pages="e64681", keywords="out-of-home youth", keywords="mental health intervention", keywords="mobile app", keywords="intervention mapping", keywords="youth", keywords="mental health", keywords="mHealth", keywords="mobile health", keywords="app", keywords="interview", keywords="need", keywords="focus group", keywords="emotion", keywords="emotional", keywords="young adult", keywords="independent living", keywords="emotional support", keywords="tool", keywords="emotion regulation", keywords="user", keywords="app usage", abstract="Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app's adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app's impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app's effectiveness in real-world settings and refine it continuously based on user input. ", doi="10.2196/64681", url="https://humanfactors.jmir.org/2024/1/e64681" } @Article{info:doi/10.2196/54679, author="Keicher, Franca and Thomann, Julia and Erlenwein, Jana and Schottdorf, Mara and Reiter, Lennart Nils and Scholz-Schw{\"a}rzler, Patricia Nadine and Vogel, Barbara and Warlitz, Cordula and Stojanov, Silvia and Augustin, Silvia and Goldbrunner, Lola and Schanz, Linda and Dodel, Veronika and Zipper, Charlotte and Schiweck, Nicole and Jaeschke, Robert and Saramandic, Milica and Wiejaczka, Karolina and Eberhartinger, Maria and Dettmer, Kristina and Hattesohl, Ricardo Daniel Bruno and Englbrecht, Stephanie and Behrends, Uta and Spiegler, Juliane", title="Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="21", volume="13", pages="e54679", keywords="patient education", keywords="ME/CFS", keywords="children", keywords="adolescents", keywords="ModuS", keywords="parents", keywords="teachers", keywords="siblings", keywords="training", abstract="Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles. Objective: This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals. Methods: In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden. Results: The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments. Conclusions: The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS. International Registered Report Identifier (IRRID): DERR1-10.2196/54679 ", doi="10.2196/54679", url="https://www.researchprotocols.org/2024/1/e54679", url="http://www.ncbi.nlm.nih.gov/pubmed/39570662" } @Article{info:doi/10.2196/56400, author="Boege, Selina and Milne-Ives, Madison and Ananthakrishnan, Ananya and Cong, Cen and Sharma, Aditya and Anderson, David and Meinert, Edward", title="Mental Health Monitoring for Young People Through Mood Apps: Protocol for a Scoping Review and Systematic Search in App Stores", journal="JMIR Res Protoc", year="2024", month="Nov", day="19", volume="13", pages="e56400", keywords="digital health", keywords="mental health", keywords="mood apps", keywords="mobile apps", keywords="mobile phone", abstract="Background: The researchers have used mobile phones to assist in monitoring, analyzing, and managing moods to acquire insight into mood patterns. There is a lack of evidence in their use as clinical tools and interventions, which necessitates a comprehensive review and quality assessment to understand barriers and facilitators for app implementation as an impactful clinical intervention. Objective: This review aims to (1) provide an overview of the recent evidence on mobile mood-monitoring apps that are intended for facilitating self-management and support of mental health in children, adolescents, and young people; and (2) investigate the quality of publicly available apps. Methods: The study will first involve a scoping review of the literature on mood-monitoring apps for children, adolescents, and young people followed by an evaluation of features of the apps available in the marketplace. The scoping review will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and search 6 databases--- Embase, CINAHL, PubMed, ACM Digital Library, Scopus, and Springer LNCS---for relevant studies and reviews published in the last 3 years. The author will then screen the references, extract data from the included studies, and analyze them to synthesize the evidence on mood apps. Next, the Apple App Store and Google Play Store will be searched for mood apps. A total of 2 independent reviewers will screen the apps based on eligibility criteria, and disagreements will be resolved through consensus. The features of the selected apps will then be evaluated using the Mobile Health Index and Navigation framework, and descriptive analysis will be used to synthesize the findings. Results: Literature search and screening began soon after submission of the protocol and is expected to be completed by September 2024. The app evaluation will be completed by October 2024. Conclusions: Combined, the scoping literature review and app evaluation will provide an in-depth overview of the most recent scientific evidence related to mood apps and the quality of apps actually available for use. International Registered Report Identifier (IRRID): PRR1-10.2196/56400 ", doi="10.2196/56400", url="https://www.researchprotocols.org/2024/1/e56400" } @Article{info:doi/10.2196/55694, author="Slade, Christopher and Benzo, M. Roberto and Washington, Peter", title="Design Guidelines for Improving Mobile Sensing Data Collection: Prospective Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Nov", day="18", volume="26", pages="e55694", keywords="mobile health sensing", keywords="mHealth", keywords="active data collection", keywords="passive data collection", keywords="ecological momentary assessment", keywords="mobile data", keywords="mobile phone", keywords="machine learning", keywords="real-world setting", keywords="mixed method", keywords="college", keywords="student", keywords="user data", keywords="data consistency", abstract="Background: Machine learning models often use passively recorded sensor data streams as inputs to train machine learning models that predict outcomes captured through ecological momentary assessments (EMA). Despite the growth of mobile data collection, challenges in obtaining proper authorization to send notifications, receive background events, and perform background tasks persist. Objective: We investigated challenges faced by mobile sensing apps in real-world settings in order to develop design guidelines. For active data, we compared 2 prompting strategies: setup prompting, where the app requests authorization during its initial run, and contextual prompting, where authorization is requested when an event or notification occurs. Additionally, we evaluated 2 passive data collection paradigms: collection during scheduled background tasks and persistent reminders that trigger passive data collection. We investigated the following research questions (RQs): (RQ1) how do setup prompting and contextual prompting affect scheduled notification delivery and the response rate of notification-initiated EMA? (RQ2) Which authorization paradigm, setup or contextual prompting, is more successful in leading users to grant authorization to receive background events? and (RQ3) Which polling-based method, persistent reminders or scheduled background tasks, completes more background sessions? Methods: We developed mobile sensing apps for iOS and Android devices and tested them through a 30-day user study asking college students (n=145) about their stress levels. Participants responded to a daily EMA question to test active data collection. The sensing apps collected background location events, polled for passive data with persistent reminders, and scheduled background tasks to test passive data collection. Results: For RQ1, setup and contextual prompting yielded no significant difference (ANOVA F1,144=0.0227; P=.88) in EMA compliance, with an average of 23.4 (SD 7.36) out of 30 assessments completed. However, qualitative analysis revealed that contextual prompting on iOS devices resulted in inconsistent notification deliveries. For RQ2, contextual prompting for background events was 55.5\% ($\chi$21=4.4; P=.04) more effective in gaining authorization. For RQ3, users demonstrated resistance to installing the persistent reminder, but when installed, the persistent reminder performed 226.5\% more background sessions than traditional background tasks. Conclusions: We developed design guidelines for improving mobile sensing on consumer mobile devices based on our qualitative and quantitative results. Our qualitative results demonstrated that contextual prompts on iOS devices resulted in inconsistent notification deliveries, unlike setup prompting on Android devices. We therefore recommend using setup prompting for EMA when possible. We found that contextual prompting is more efficient for authorizing background events. We therefore recommend using contextual prompting for passive sensing. Finally, we conclude that developing a persistent reminder and requiring participants to install it provides an additional way to poll for sensor and user data and could improve data collection to support adaptive interventions powered by machine learning. ", doi="10.2196/55694", url="https://www.jmir.org/2024/1/e55694" } @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/10.2196/59831, author="Miller, J. Michael and Eberhart, G. Lindsay and Heliste, L. Jennifer and Tripuraneni, R. Bhaskara", title="Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Nov", day="15", volume="8", pages="e59831", keywords="digital mental health applications", keywords="DMHA", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="smartphone", keywords="user experience", keywords="engagement", keywords="implementation", keywords="Kaiser Permanente", abstract="Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7\%) completed the survey and 44 (37\%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66\%); 73\% (32/44) of the respondents were female, 73\% (32/44) of the respondents had at least a 4-year college degree, 41\% (18/44) of the respondents were Black or African American, and 39\% (17/44) of the respondents were White. Moreover, 27\% (12/44) of the respondents screened positive for anxiety symptoms, and 23\% (10/44) of the respondents screened positive for depression. Overall, 61\% (27/44) of the respondents reported DMHA use for ?6 months since referral, 36\% (16/44) reported use within the past 30 days, and 43\% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20\%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92\% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83\%). Of the 12 HCPs, 7 (58\%) were physicians and 5 (42\%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described ``typical patients'' referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. ", doi="10.2196/59831", url="https://formative.jmir.org/2024/1/e59831" } @Article{info:doi/10.2196/53340, author="Bito, Seiji and Hayashi, Yachie and Fujita, Takanori and Takahashi, Ikuo and Arai, Hiromi and Yonemura, Shigeto", title="Survey of Citizens' Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis", journal="JMIR Public Health Surveill", year="2024", month="Nov", day="14", volume="10", pages="e53340", keywords="digital contact tracing apps", keywords="infectious disease", keywords="conjoint analysis", keywords="user attitudes", keywords="public preferences", keywords="citizen values", keywords="attitude to health", keywords="COVID-19", keywords="contact tracing", keywords="privacy", keywords="questionnaires", abstract="Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public's intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. ", doi="10.2196/53340", url="https://publichealth.jmir.org/2024/1/e53340" } @Article{info:doi/10.2196/55874, author="Widianti, Dini and Mahardhika, Pribadi Zwasta and Modjo, Robiana", title="Development of a Mobile App for Occupational Stress Screening Among Female Workers: Protocol for an Exploratory Sequential Design Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="14", volume="13", pages="e55874", keywords="mobile app", keywords="study protocol", keywords="occupational stress", keywords="female workers", keywords="stress", keywords="screening", keywords="worker", keywords="app", keywords="safety hazards", keywords="technological innovation", keywords="ergonomic", keywords="psychological hazards", keywords="mobile health", keywords="digital platform", keywords="algorithm", abstract="Background: Occupational safety hazards include physical, chemical, ergonomic, biological, and psychological hazards. Technological innovation in screening for occupational stress, especially among female workers, is needed to improve their health and productivity. Objective: This research is being conducted to obtain a prediction model of work stress through a questionnaire instrument that includes stressors and symptoms based on the transactional model, as well as measurement of work stress through a mobile app that can be used anywhere. Methods: The research is conducted in 3 stages: qualitative research, quantitative research (cross-sectional), and mobile app development. Data were collected from companies located in Jakarta, Indonesia. The sample was chosen based on purposive sampling. For the quantitative research (n=430), logistic regression analysis was used. Results: We are developing a work stress screening instrument for female workers, which includes stressors and symptoms based on the transactional model, in the form of a digital platform so that female workers can undertake the examination anywhere without interfering with working hours or home duties. This research was funded in January 2024 and qualitative data collection began in February 2024. Quantitative data were obtained in March 2024; the number of respondents in the qualitative stage was 6, and in the quantitative stage it was 430. The work stress screening app is in the development stage and will be launched at the same time as the data collection is performed so we can examine the respondents' perspectives on the use of the app. Conclusions: This study analyzes the prediction of work stress to help female workers screen for work stress. Workers who are detected as experiencing work stress will be educated using an algorithm programmed in the app. International Registered Report Identifier (IRRID): PRR1-10.2196/55874 ", doi="10.2196/55874", url="https://www.researchprotocols.org/2024/1/e55874" } @Article{info:doi/10.2196/59155, author="Kissler, Katherine and Phillippi, C. Julia and Erickson, Elise and Holmes, Leah and Tilden, Ellen", title="Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e59155", keywords="patient-reported outcomes", keywords="survey methods", keywords="smartphone", keywords="labor onset", keywords="prodromal symptoms", keywords="prospective studies", abstract="Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5\%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool's usability across more diverse populations and disease states. ", doi="10.2196/59155", url="https://formative.jmir.org/2024/1/e59155" } @Article{info:doi/10.2196/53299, author="Perme, Natalie and Reid, Endia and Eluagu, Chinwenwa Macdonald and Thompson, John and Hebert, Courtney and Gabbe, Steven and Swoboda, Marie Christine", title="Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e53299", keywords="health resources", keywords="pregnancy", keywords="patient engagement", keywords="mHealth", keywords="maternal", keywords="mobile health", keywords="app", keywords="focus group", keywords="landscape analysis", keywords="birth", keywords="preterm", keywords="premature", keywords="mortality", keywords="death", keywords="pediatric", keywords="infant", keywords="neonatal", keywords="design", keywords="development", keywords="obstetric", keywords="mobile phone", abstract="Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app's intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. ", doi="10.2196/53299", url="https://formative.jmir.org/2024/1/e53299" } @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/10.2196/59158, author="Straand, J. Ingjerd and F{\o}lstad, Asbj{\o}rn and W{\"u}nsche, C. Burkhard", title="A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e59158", keywords="web-based intervention", keywords="positive psychology", keywords="mental health", keywords="user experience", keywords="persuasive design", abstract="Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named R{\O}ST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. ", doi="10.2196/59158", url="https://formative.jmir.org/2024/1/e59158" } @Article{info:doi/10.2196/51865, author="Lange-Drenth, Lukas and Schulz, Holger and Suck, Isabell and Bleich, Christiane", title="Barriers, Facilitators, and Requirements for a Telerehabilitation Aftercare Program for Patients After Occupational Injuries: Semistructured Interviews With Key Stakeholders", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e51865", keywords="telerehabilitation", keywords="rehabilitation", keywords="eHealth development", keywords="value specification", keywords="stakeholder participation", keywords="occupational injuries", keywords="vocational rehabilitation", keywords="aftercare", keywords="mobile phone", abstract="Background: Patients with occupational injuries often receive multidisciplinary rehabilitation for a rapid return to work. Rehabilitation aftercare programs give patients the opportunity to help patients apply the progress they have made during the rehabilitation to their everyday activities. Telerehabilitation aftercare programs can help reduce barriers, such as lack of time due to other commitments, because they can be used regardless of time or location. Careful identification of barriers, facilitators, and design requirements with key stakeholders is a critical step in developing a telerehabilitation aftercare program. Objective: This study aims to identify barriers, facilitators, and design requirements for a future telerehabilitation aftercare program for patients with occupational injuries from the perspective of the key stakeholders. Methods: We used a literature review and expert recommendations to identify key stakeholders. We conducted semistructured interviews in person and via real-time video calls with 27 key stakeholders to collect data. Interviews were transcribed verbatim, and thematic analysis was applied. We selected key stakeholder statements about facilitators and barriers and categorized them as individual, technical, environmental, and organizational facilitators and barriers. We identified expressions that captured aspects that the telerehabilitation aftercare program should fulfill and clustered them into attributes and overarching values. We translated the attributes into one or more requirements and grouped them into content, functional, service, user experience, and work context requirements. Results: The key stakeholders identified can be grouped into the following categories: patients, health care professionals, administrative personnel, and members of the telerehabilitation program design and development team. The most frequently reported facilitators of a future telerehabilitation aftercare program were time savings for patients, high motivation of the patients to participate in telerehabilitation aftercare program, high usability of the program, and regular in-person therapy meetings during the telerehabilitation aftercare program. The most frequently reported barriers were low digital affinity and skills of the patients and personnel, patients' lack of trust and acceptance of the telerehabilitation aftercare program, slow internet speed, program functionality problems (eg, application crashes or freezes), and inability of telerehabilitation to deliver certain elements of in-person rehabilitation aftercare such as monitoring exercise performance. In our study, the most common design requirements were reducing barriers and implementing facilitators. The 2 most frequently discussed overarching values were tailoring of telerehabilitation, such as a tailored exercise plan and tailored injury-related information, and social interaction, such as real-time psychotherapy and digital and in-person rehabilitation aftercare in a blended care approach. Conclusions: Key stakeholders reported on facilitators, barriers, and design requirements that should be considered throughout the development process. Tailoring telerehabilitation content was the key value for stakeholders to ensure the program could meet the needs of patients with different types of occupational injuries. ", doi="10.2196/51865", url="https://formative.jmir.org/2024/1/e51865" } @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/10.2196/55239, author="Zhou, Shuo and Brunetta, Paul and Silvasstar, Joshva and Feldman, Greg and Oromi, Nicolas and Bull, Sheana", title="Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2024", month="Oct", day="29", volume="12", pages="e55239", keywords="smoking cessation", keywords="tobacco", keywords="mobile phone app", keywords="mHealth", keywords="mobile health", keywords="iterative design", keywords="feasibility", keywords="acceptability", keywords="engagement", keywords="efficacy", keywords="mobile phone", abstract="Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers' preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants' app use was tracked and analyzed. The primary outcome measures were participants' 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included ``quit plan,'' ``tracking,'' ``reminders and notifications,'' ``MOtalks,'' and ``motivational quotes.'' The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58\% at 6 weeks and 52\% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5\% (odds ratio [OR] 1.05, 95\% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95\% CI 1.25-7.75) and 12 weeks (OR 4.65, 95\% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. ", doi="10.2196/55239", url="https://mhealth.jmir.org/2024/1/e55239" } @Article{info:doi/10.2196/57376, author="Marler, D. Jennifer and Fujii, A. Craig and Utley, T. MacKenzie and Balbierz, J. Daniel and Galanko, A. Joseph and Utley, S. David", title="Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study", journal="JMIR Form Res", year="2024", month="Oct", day="28", volume="8", pages="e57376", keywords="app", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="mobile apps", keywords="smartphone", keywords="vaping", keywords="vaping cessation", keywords="mobile phone", abstract="Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app--based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ?21 years who vaped daily, reported ?5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ?7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93\%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks---4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88\%) made ?1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48\% (35/73), 45\% (33/73), and 30\% (22/73), respectively. In total, 45\% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change --3.2, SD 3.9; P<.001); 48\% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72\% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79\% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90\%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. ", doi="10.2196/57376", url="https://formative.jmir.org/2024/1/e57376", url="http://www.ncbi.nlm.nih.gov/pubmed/39331522" } @Article{info:doi/10.2196/53394, author="Branitsky, Alison and Bee, Penny and Bucci, Sandra and Lovell, Karina and Foster, Simon and Whelan, Pauline", title="Co-Designing a Digital App to Support Young People's Patient and Public Involvement and Engagement (VoiceIn): Development and Usability Study", journal="JMIR Hum Factors", year="2024", month="Oct", day="24", volume="11", pages="e53394", keywords="patient and public involvement and engagement", keywords="PPIE", keywords="digital mental health", keywords="young people", keywords="co-design", keywords="mental health", abstract="Background: While patient and public involvement and engagement (PPIE) is now seen as a cornerstone of mental health research, young people's involvement in PPIE faces limitations. Work and school demands and more limited independence can make it challenging for young people to engage with PPIE. Lack of ability or desire to attend face-to-face meetings or group discussions can further compound this difficulty. The VoiceIn app and digital platform were codeveloped by a multidisciplinary team of young people, mental health researchers, and software designers, and enables young people to engage directly with PPIE opportunities via a mobile app. Objective: This paper aims to describe how VoiceIn was developed through a series of co-design workshops with relevant stakeholders, specifically (1) how the initial design of VoiceIn was informed and driven by focus groups with young people, mental health professionals, and PPIE leads; (2) how VoiceIn was refined through collaboration with the aforementioned stakeholders; (3) the priorities for an app to support PPIE; (4) the key features necessary in the PPIE app; and (5) the recommended next steps in testing and deploying the digital platform. Methods: Initial co-design workshops took place with young people, mental health professionals, and PPIE leads to identify key features of an app to support PPIE. A series of VoiceIn design prototypes were developed and iterated based on the priorities and preferences of the stakeholders. The MoSCoW (must have, should have, could have, won't have) prioritization method was used throughout the process to identify priorities across the different stakeholder groups. Results: Co-design with young people, mental health professionals, and PPIE leads supported the successful development and improvement of the VoiceIn app. As a result of this process, key features were identified, including allowing for various modes of providing feedback (eg, polls and comments), reviewing project updates, and expressing interest in categories of research. The researcher platform was developed to support multimedia uploads for project descriptions; a jargon detector; a dedicated section for providing project updates; and a visually appealing, user-friendly design. While all stakeholder groups emphasized the importance of allowing app users to engage with the app in various ways and for there to be ongoing progress updates, group differences were also noticed. Young people expressed a desire for incentives and rewards for engaging with the app (eg, to post on their public social media profiles), and mental health professionals and PPIE leads prioritized flexibility in describing the project and its PPIE needs. Conclusions: A co-design approach was pivotal to the development of the VoiceIn app. This collaborative approach enabled the app to meet the divergent needs of young people, mental health professionals, and PPIE leads. This process mirrored the aspirations of PPIE initiatives by cocreating a digital health research tool with key stakeholders. ", doi="10.2196/53394", url="https://humanfactors.jmir.org/2024/1/e53394" } @Article{info:doi/10.2196/63393, author="LeSeure, Peeranuch and Chin, Elizabeth and Zhang, Shelley", title="A Culturally Sensitive Mobile App (DiaFriend) to Improve Self-Care in Patients With Type 2 Diabetes: Development Study", journal="JMIR Diabetes", year="2024", month="Oct", day="21", volume="9", pages="e63393", keywords="cultural sensitivity", keywords="design thinking", keywords="mobile app", keywords="self-care", keywords="type 2 diabetes", keywords="mobile phone", keywords="app", keywords="design", keywords="diabetes", keywords="development", keywords="prototype", keywords="effectiveness", keywords="user engagement", keywords="blood glucose", keywords="glucose", keywords="weight", keywords="carbohydrate", keywords="exercise", keywords="Portuguese Americans", keywords="ethnic group", abstract="Background: Mobile apps designed with cultural sensitivity have demonstrated higher user acceptability and greater effectiveness in enhancing self-care skills. However, a significant gap exists in developing such apps for specific populations, such as Portuguese Americans living in southern Massachusetts, home to the second-largest Portuguese community in the United States. This group possesses unique cultural traditions, particularly in dietary practices, including a tendency toward high carbohydrate intake. Tailoring diabetes self-care apps to address these specific cultural requirements could substantially improve diabetes management within this population. Objective: The aim of this app development project was to develop a prototype diabetes management app for Portuguese Americans with type 2 diabetes mellitus using the design thinking methodology, incorporating user-centered design principles and cultural sensitivity. This paper describes the phase-2 results, focusing on app design and development. Methods: Phase 2 of this app development project adhered to the design thinking methodology delineated by the Hasso Plattner Institute of Design at Stanford University, focusing on 2 critical steps: ideation and prototyping. This phase started in March 2022 and continued until April 2024. The project was driven by a multidisciplinary team consisting of 2 nurse educators; an app development specialist; and 2 graduate research assistants from the university's Computer and Information Sciences Department, both well-versed in mobile app development. Data collected during phase 1, which will be published separately, informed the app design and development process. Results: The prototype of the DiaFriend app (version 1) was designed and developed. The app comprises five features: (1) blood glucose monitoring, (2) weight tracking, (3) carbohydrate tracking, (4) exercise log, and (5) medication reminder. The carbohydrate tracking feature was explicitly tailored to correspond to Portuguese food culture. This paper presents the front-end interface flowchart, demonstrating how the user navigates through each screen. It also discusses the challenges faced during the backend development, such as data not being able to be stored and retrieved. Conclusions: The DiaFriend app (version 1) distinguishes itself from conventional diabetes self-care apps through its emphasis on cultural sensitivity. The development of this app underscores the importance of cultural considerations in health informatics. It establishes a foundation for future research in developing and evaluating culturally sensitive mobile health apps. The adaptation of such technologies has the potential to enhance self-care practices among Portuguese Americans with type 2 diabetes mellitus, with improved glycated hemoglobin levels as a potential outcome. The last step of the design thinking methodology, testing the app, will be conducted in phase 3 and the results will be published elsewhere. ", doi="10.2196/63393", url="https://diabetes.jmir.org/2024/1/e63393" } @Article{info:doi/10.2196/50028, author="Thomson, D. Maria and Shahab, H. Guleer and Cooper-McGill, A. Chelsey and Sheppard, B. Vanessa and Hill, S. Sherrick and Preston, Michael and Keen II, Larry", title="Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention", journal="JMIR Form Res", year="2024", month="Oct", day="10", volume="8", pages="e50028", keywords="colorectal cancer", keywords="cancer screening", keywords="mHealth", keywords="screening", keywords="Black men", keywords="early detection", keywords="health disparities", keywords="design thinking", abstract="Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25\% (24/98) of them did not see a doctor and 16.3\% (16/98) of them did not have a regular doctor. Regarding CRC, 27\% (26/98) and 38\% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge--based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 ", doi="10.2196/50028", url="https://formative.jmir.org/2024/1/e50028" } @Article{info:doi/10.2196/57185, author="Grube, Lara and Petit, Pascal and Vuillerme, Nicolas and Nitschke, Marlies and Nwosu, Bertrand Obioma and Knitza, Johannes and Krusche, Martin and Seifer, Ann-Kristin and Eskofier, M. Bjoern and Schett, Georg and Morf, Harriet", title="Complementary App-Based Yoga Home Exercise Therapy for Patients With Axial Spondyloarthritis: Usability Study", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e57185", keywords="DTx", keywords="DHA", keywords="usability", keywords="Yoga", keywords="YogiTherapy", keywords="ankylosing spondylitis", keywords="axial spondylarthritis", keywords="digital health application", keywords="eHealth", keywords="self-assessment", keywords="physical exercise", keywords="patient acceptance", keywords="therapy", keywords="home exercise", keywords="exercise", keywords="patients", keywords="patient", keywords="spondyloarthritis", keywords="usability study", keywords="app", keywords="apps", keywords="rheumatic disease", keywords="chronic", keywords="spine", keywords="adjacent joints", keywords="joints", keywords="joint", keywords="correlation analysis", keywords="digital therapeutics", abstract="Background: Axial spondyloarthritis (AS) is a chronic inflammatory rheumatic disease characterized by potentially disabling inflammation of the spine and adjacent joints. Regular exercise is a cornerstone of treatment. However, patients with AS currently have little support. YogiTherapy (MaD Lab) is an app developed to support patients with AS by providing instructions for yoga-based home exercise therapy. Objective: This study aimed to evaluate the usability and acceptance of the newly designed YogiTherapy app for patients with AS. Methods: Patients completed the User Version of the Mobile Application Rating Scale (uMARS) and net promoter score (NPS) questionnaires after the app introduction. Wilcoxon Mann-Whitney rank sum test, chi-square test for count data, and correlation analysis were conducted to examine the usability of the app, acceptance, and patient characteristics. Results: A total of 65 patients with AS (33, 51\% female; age: mean 43.3, SD 13.6 years) were included in the study from May 2022 to June 2023. Subsequently, the data were analyzed. Usability was rated moderate, with a mean uMARS of 3.35 (SD 0.47) points on a scale from 0 to 5. The highest-rated uMARS dimension was information (mean 3.88, SD 0.63), followed by functionality (mean 3.84, SD 0.87). Females reported a significantly higher uMARS total score than males (mean 3.47, SD 0.48 vs mean 3.23, SD 0.45; P=.03, Vargha and Delaney A [VDA] 0.66, 95\% CI 0.53-0.77). The mean average of the NPS was 6.23 (SD 2.64) points (on a scale from 0 to 10), based on 43\% (26/65 nonpromoters, 42\% (25/65) indifferent, and 15\% (9/65) promoters. A total of 7\% (5/65) of those surveyed did not answer the question. When applying the NPS formula, the result is --26\%. The NPS showed a positive correlation with the usage of mobile apps (r=0.39; P=.02). uMARS functionality was significantly higher rated by patients younger than 41 years (mean 4.17, SD 0.55 vs mean 3.54, SD 1; P<.001; VDA 0.69, 95\% CI 0.56-0.80). Patients considering mobile apps as useful reported higher uMARS (r=0.38, P=.02). The uMARS app quality mean score was correlated with the frequency of using apps (r=--0.21, P<.001). Conclusions: The results revealed moderate acceptance and usability ratings, prompting further app improvement. Significant differences were observed between age and gender. Our results emphasize the need for further improvements in YogiTherapy. ", doi="10.2196/57185", url="https://formative.jmir.org/2024/1/e57185" } @Article{info:doi/10.2196/56486, author="Sun, Hui and Wu, Yanping and Sun, Jia and Zhou, Wu and Xu, Qian and Hu, Dandan", title="Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality", journal="JMIR Hum Factors", year="2024", month="Sep", day="12", volume="11", pages="e56486", keywords="nutrition management", keywords="WeChat mini-program", keywords="User Version of the Mobile Application Rating Scale", keywords="uMARS", keywords="function and quality evaluation", abstract="Background: With the rise in people's living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China's WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for ``nutrition,'' ``diet,'' ``food,'' and ``meal'' in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2\% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4\% (19/27) provided resources for nutrition education and classroom instruction; 59.3\% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4\% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. ", doi="10.2196/56486", url="https://humanfactors.jmir.org/2024/1/e56486" } @Article{info:doi/10.2196/57406, author="Staehelin, Dario and Dolata, Mateusz and St{\"o}ckli, Livia and Schwabe, Gerhard", title="How Patient-Generated Data Enhance Patient-Provider Communication in Chronic Care: Field Study in Design Science Research", journal="JMIR Med Inform", year="2024", month="Sep", day="10", volume="12", pages="e57406", keywords="patient-provider communication", keywords="patient-generated data", keywords="field study", keywords="chronic care", keywords="design science research", keywords="patient-centered care", keywords="integrated care", keywords="patient-provider collaboration", keywords="mobile phone", abstract="Background: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers' workflow. Objective: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. Methods: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. Results: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. Conclusions: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care. ", doi="10.2196/57406", url="https://medinform.jmir.org/2024/1/e57406" } @Article{info:doi/10.2196/55790, author="Meidani, Zahra and Omidvar, Aydine and Akbari, Hossein and Asghari, Fatemeh and Khajouei, Reza and Nazemi, Zahra and Nabovati, Ehsan and Holl, Felix", title="Evaluating the Usability and Quality of a Clinical Mobile App for Assisting Physicians in Head Computed Tomography Scan Ordering: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Sep", day="9", volume="11", pages="e55790", keywords="mobile apps", keywords="user-centered design", keywords="user-computer interface", keywords="physicians", keywords="tomography", keywords="x-ray computed", keywords="mobile phone", abstract="Background: Among the numerous factors contributing to health care providers' engagement with mobile apps, including user characteristics (eg, dexterity, anatomy, and attitude) and mobile features (eg, screen and button size), usability and quality of apps have been introduced as the most influential factors. Objective: This study aims to investigate the usability and quality of the Head Computed Tomography Scan Appropriateness Criteria (HAC) mobile app for physicians' computed tomography scan ordering. Methods: Our study design was primarily based on methodological triangulation by using mixed methods research involving quantitative and qualitative think-aloud usability testing, quantitative analysis of the Mobile Apps Rating Scale (MARS) for quality assessment, and debriefing across 3 phases. In total, 16 medical interns participated in quality assessment and testing usability characteristics, including efficiency, effectiveness, learnability, errors, and satisfaction with the HAC app. Results: The efficiency and effectiveness of the HAC app were deemed satisfactory, with ratings of 97.8\% and 96.9\%, respectively. MARS assessment scale indicated the overall favorable quality score of the HAC app (82 out of 100). Scoring 4 MARS subscales, Information (73.37 out of 100) and Engagement (73.48 out of 100) had the lowest scores, while Aesthetics had the highest score (87.86 out of 100). Analysis of the items in each MARS subscale revealed that in the Engagement subscale, the lowest score of the HAC app was ``customization'' (63.6 out of 100). In the Functionality subscale, the HAC app's lowest value was ``performance'' (67.4 out of 100). Qualitative think-aloud usability testing of the HAC app found notable usability issues grouped into 8 main categories: lack of finger-friendly touch targets, poor search capabilities, input problems, inefficient data presentation and information control, unclear control and confirmation, lack of predictive capabilities, poor assistance and support, and unclear navigation logic. Conclusions: Evaluating the quality and usability of mobile apps using a mixed methods approach provides valuable information about their functionality and disadvantages. It is highly recommended to embrace a more holistic and mixed methods strategy when evaluating mobile apps, because results from a single method imperfectly reflect trustworthy and reliable information regarding the usability and quality of apps. ", doi="10.2196/55790", url="https://humanfactors.jmir.org/2024/1/e55790" } @Article{info:doi/10.2196/54356, author="Dieter, Valerie and Janssen, Pia and Krauss, Inga", title="Efficacy of the mHealth-Based Exercise Intervention re.flex for Patients With Knee Osteoarthritis: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="9", volume="12", pages="e54356", keywords="digital app", keywords="mobile health", keywords="mHealth", keywords="knee osteoarthritis", keywords="exercise", keywords="knee brace", abstract="Background: Exercise therapy is recommended by international guidelines as a core treatment for patients with knee osteoarthritis. However, there is a significant gap between recommendations and practice in health care. Digital exercise apps are promising to help solve this undersupply. Objective: This study aims to evaluate the efficacy of a 12-week fully automated app-based exercise intervention with and without a supporting knee brace on health-related outcomes, performance measures, and adherence in patients with knee osteoarthritis. Methods: This closed user group trial included participants with moderate to severe unicondylar painful knee osteoarthritis. Randomization was 1:1:2 into an intervention group (IG) with 2 subgroups (app-based training [IG A] and app-based training and a supportive knee brace [IG AB]) and a control group (CG). The intervention included a 12-week home exercise program with 3 sessions per week. Instructions for the exercises were given via the app and monitored using 2 accelerometers placed below and above the affected knee joint. Participants in the CG did not receive any study intervention but were allowed to make use of usual care. Osteoarthritis-specific pain (Knee Injury and Osteoarthritis Outcome Score) was defined as the primary outcome, and secondary outcomes included all other Knee Injury and Osteoarthritis Outcome Score subscales, general health-related quality of life (Veterans RAND 12-item Health Survey), psychological measures (eg, exercise self-efficacy), performance measures (strength and postural control), and the monitoring of adherence and safety. Outcomes were assessed at baseline and after 12 weeks. Intervention effects were calculated using baseline-adjusted analysis of covariance for the joint comparison of IG A and IG AB versus the CG using a per-protocol approach. Subgroup analyses were conducted for each IG separately. Results: A total of 61 participants were included (IG: n=30, 49\%; CG: n=31, 51\%; male: n=31, 51\%; female: n=30, 49\%; mean age 62.9, SD 8.5 years; mean BMI 27.7, SD 4.5 kg/m2). Analysis revealed statistically significant effects in favor of the IG for pain reduction (P<.001; effect size [ES]=0.76), improvements in physical function (P<.001; ES=0.64), improvements in symptoms (P=.01; ES=0.53), improvements in sport and recreation activities (P=.02; ES=0.47), improvements in knee-related quality of life (P<.001; ES=0.76), and improvements in the physical component of general health-related quality of life (P<.001; ES=0.74). Mean differences ranged from 6.0 to 13.2 points (scale range 0-100). ESs indicated small to medium effects. No effects were found for psychological and performance measures. Participants adhered to 92.5\% (899/972) of all scheduled exercise sessions. Conclusions: Individuals with knee osteoarthritis undergoing a 12-week sensor-assisted app-based exercise intervention with or without an additional knee brace experienced clinically meaningful treatment effects regarding pain relief and improvements in physical function as well as other osteoarthritis-specific concerns compared to controls. Trial Registration: German Clinical Trials Register (DRKS) DRKS00023269; https://drks.de/search/de/trial/DRKS00023269 ", doi="10.2196/54356", url="https://mhealth.jmir.org/2024/1/e54356", url="http://www.ncbi.nlm.nih.gov/pubmed/39250181" } @Article{info:doi/10.2196/59963, author="Seretlo, James Raikane and Smuts, Hanlie and Mokgatle, Mpata Mathildah", title="Development of an mHealth App by Experts for Queer Individuals' Sexual-Reproductive Health Care Services and Needs: Nominal Group Technique Study", journal="JMIR Form Res", year="2024", month="Aug", day="21", volume="8", pages="e59963", keywords="experts", keywords="mobile health app", keywords="mHealth app", keywords="digital health care", keywords="telemedicine", keywords="digital innovation", keywords="sexual-reproductive health care services and needs", keywords="lesbian, gay, bisexual, transgender, queer, intersex, asexual individuals, and related identities", keywords="LBQTQIA+", keywords="queer individuals", keywords="nominal group technique", keywords="mobile phone", abstract="Background: Queer individuals continue to be marginalized in South Africa; they experience various health care challenges (eg, stigma, discrimination, prejudice, harassment, and humiliation), mental health issues (eg, suicide and depression), and an increased spread of HIV or AIDS and sexually transmitted illnesses (STIs; chlamydia, gonorrhea, and syphilis). Mobile health (mHealth) apps have the potential to resolve the health care deficits experienced by health care providers when managing queer individuals and by queer individuals when accessing sexual-reproductive health care services and needs, thus ensuring inclusivity and the promotion of health and well-being. Studies have proven that the nominal group technique (NGT) could be used to solve different social and health problems and develop innovative solutions. This technique ensures that different voices are represented during decision-making processes and leads to robust results. Objective: This study aims to identify important contents to include in the development of an mHealth app for addressing the sexual-reproductive health care services and needs of queer individuals. Methods: We invited a group of 13 experts from different fields, such as researchers, queer activists, sexual and reproductive health experts, private practicing health care providers, innovators, and private health care stakeholders, to take part in a face-to-face NGT. The NGT was conducted in the form of a workshop with 1 moderator, 2 research assistants, and 1 principal investigator. The workshop lasted approximately 2 hours 46 minutes and 55 seconds. We followed and applied 5 NGT steps in the workshop for experts to reach consensus. The main question that experts were expected to answer was as follows: Which content should be included in the mHealth app for addressing sexual-reproductive health care services and needs for queer individuals? This question was guided by user demographics and background, health education and information, privacy and security, accessibility and inclusivity, functionality and menu options, personalization and user engagement, service integration and partnerships, feedback and improvement, cultural sensitivity and ethical considerations, legal and regulatory compliance, and connectivity and data use. Results: Overall, experts voted and ranked the following main icons: menu options (66 points), privacy and security (39 points), user engagement (27 points), information hub (26 points), user demographics (20 points), connectivity (16 points), service integration and partnerships (10 points), functionalities (10 points), and accessibility and inclusivity (7 points). Conclusions: Conducting an NGT with experts from different fields, possessing vast skill sets, knowledge, and expertise, enabled us to obtain targeted data on the development of an mHealth app to address sexual-reproductive health care services and needs for queer individuals. This approach emphasized the usefulness of a multidisciplinary perspective to inform the development of our mHealth app and demonstrated the future need for continuity in using this approach for other digital health care innovations and interventions. ", doi="10.2196/59963", url="https://formative.jmir.org/2024/1/e59963" } @Article{info:doi/10.2196/56921, author="Klassen, A. Stephen and Jabbar, Jesica and Osborne, Jenna and Iannarelli, J. Nathaniel and Kirby, S. Emerson and O'Leary, D. Deborah and Locke, Sean", title="Examining the Light Heart Mobile Device App for Assessing Human Pulse Interval and Heart Rate Variability: Validation Study", journal="JMIR Form Res", year="2024", month="Aug", day="20", volume="8", pages="e56921", keywords="pulse interval", keywords="mobile app", keywords="validation", keywords="mHealth", keywords="mHealth app", keywords="app mobile device", keywords="mobile device app", keywords="pulse", keywords="heart", keywords="heart rate", keywords="validation study", keywords="biomarker", keywords="psychological", keywords="physiological", keywords="pulse rate", keywords="young adults", keywords="youth", keywords="linear correlation", keywords="heart rate variability", keywords="examining", keywords="examine", keywords="validity", keywords="psychological health", keywords="physiological health", keywords="interval data", keywords="mobile phone", abstract="Background: Pulse interval is a biomarker of psychological and physiological health. Pulse interval can now be assessed using mobile phone apps, which expands researchers' ability to assess pulse interval in the real world. Prior to implementation, measurement accuracy should be established. Objective: This investigation evaluated the validity of the Light Heart mobile app to measure pulse interval and pulse rate variability in healthy young adults. Methods: Validity was assessed by comparing the pulse interval and SD of normal pulse intervals obtained by Light Heart to the gold standard, electrocardiogram (ECG), in 14 young healthy individuals (mean age 24, SD 5 years; n=9, 64\% female) in a seated posture. Results: Mean pulse interval (Light Heart: 859, SD 113 ms; ECG: 857, SD 112 ms) demonstrated a strong positive linear correlation (r=0.99; P<.001) and strong agreement (intraclass correlation coefficient=1.00, 95\% CI 0.99-1.00) between techniques. The Bland-Altman plot demonstrated good agreement for the mean pulse interval measured with Light Heart and ECG with evidence of fixed bias (--1.56, SD 1.86; 95\% CI --5.2 to 2.1 ms), suggesting that Light Heart overestimates pulse interval by a small margin. When Bland-Altman plots were constructed for each participant's beat-by-beat pulse interval data, all participants demonstrated strong agreement between Light Heart and ECG with no evidence of fixed bias between measures. Heart rate variability, assessed by SD of normal pulse intervals, demonstrated strong agreement between techniques (Light Heart: mean 73, SD 23 ms; ECG: mean 73, SD 22 ms; r=0.99; P<.001; intraclass correlation coefficient=0.99, 95\% CI 0.97-1.00). Conclusions: This study provides evidence to suggest that the Light Heart mobile app provides valid measures of pulse interval and heart rate variability in healthy young adults. ", doi="10.2196/56921", url="https://formative.jmir.org/2024/1/e56921" } @Article{info:doi/10.2196/57600, author="Angelone, J. D. and Mitchell, Damon and Wells, Brooke and Korovich, Megan and Nicoletti, Alexandra and Fife, Dustin", title="Assessment of Sexual Violence Risk Perception in Men Who Have Sex With Men: Proposal for the Development and Validation of ``G-Date''", journal="JMIR Res Protoc", year="2024", month="Aug", day="19", volume="13", pages="e57600", keywords="sexual violence", keywords="risk perception", keywords="laboratory analog", keywords="dating and sexual networking apps", keywords="men who have sex with men", abstract="Background: Sexual violence (SV) is a significant problem for sexual minorities, including men who have sex with men (MSM). The limited research suggests SV is associated with a host of syndemic conditions. These factors tend to cluster and interact to worsen one another. Unfortunately, while much work has been conducted to examine these factors in heterosexual women, there is a lack of research examining MSM, especially their SV risk perception. Further, MSM are active users of dating and sexual networking (DSN) mobile apps, and this technology has demonstrated usefulness for creating safe spaces for MSM to meet and engage partners. However, mounting data demonstrate that DSN app use is associated with an increased risk for SV, especially given the higher likelihood of using alcohol and other drugs before sex. By contrast, some researchers have demonstrated that DSN technology can be harnessed as a prevention tool for HIV; unfortunately, no such work has progressed regarding SV. Objective: This study aims to (1) use qualitative and quantitative methods to tailor an existing laboratory paradigm of SV risk perception in women for MSM using a DSN mobile app framework and (2) subject this novel paradigm to a rigorous validation study to confirm its usefulness in predicting SV, with the potential for use in future prevention endeavors. Methods: To tailor the paradigm for MSM, a team of computer scientists created an initial DSN app (G-Date) and incorporated ongoing feedback about the usability, feasibility, and realism of this tool from a representative sample of MSM. We used focus groups and interviews to assist in the development of G-Date, including by identifying relevant stimuli, developing the cover story, and establishing the appropriate study language. To confirm the paradigm's usefulness, we are conducting an experimental study with web-based and face-to-face participants to determine the content, concurrent, and predictive validities of G-Date. We will evaluate whether certain correlates of SV informed by syndemics and minority stress theories (eg, history of SV and alcohol and drug use) affect the ability of MSM to detect SV risk within G-Date and how paradigm engagement influences behavior in actual DSN app use contexts. Results: This study received funding from the National Institute on Alcohol Abuse and Alcoholism on September 10, 2020, and ethics approval on October 19, 2020, and we began app development for aim 1 immediately thereafter. We began data collection for the aim 2 validation study in December 2022. Initial results from the validation study are expected to be available after December 2025. Conclusions: We hope that G-Date will enhance our understanding of factors associated with SV risk and serve as a useful step in creating prevention programs for this susceptible population. ", doi="10.2196/57600", url="https://www.researchprotocols.org/2024/1/e57600" } @Article{info:doi/10.2196/56505, author="Bendotti, Hollie and Lawler, Sheleigh and Ireland, David and Gartner, Coral and Marshall, M. Henry", title="Co-Designing a Smoking Cessation Chatbot: Focus Group Study of End Users and Smoking Cessation Professionals", journal="JMIR Hum Factors", year="2024", month="Aug", day="19", volume="11", pages="e56505", keywords="artificial intelligence", keywords="chatbot", keywords="smoking cessation", keywords="behavior change", keywords="smoking", keywords="mobile health", keywords="apps", keywords="digital interventions", keywords="smartphone", keywords="mobile phone", abstract="Background: Our prototype smoking cessation chatbot, Quin, provides evidence-based, personalized support delivered via a smartphone app to help people quit smoking. We developed Quin using a multiphase program of co-design research, part of which included focus group evaluation of Quin among stakeholders prior to clinical testing. Objective: This study aimed to gather and compare feedback on the user experience of the Quin prototype from end users and smoking cessation professionals (SCPs) via a beta testing process to inform ongoing chatbot iterations and refinements. Methods: Following active and passive recruitment, we conducted web-based focus groups with SCPs and end users from Queensland, Australia. Participants tested the app for 1-2 weeks prior to focus group discussion and could also log conversation feedback within the app. Focus groups of SCPs were completed first to review the breadth and accuracy of information, and feedback was prioritized and implemented as major updates using Agile processes prior to end user focus groups. We categorized logged in-app feedback using content analysis and thematically analyzed focus group transcripts. Results: In total, 6 focus groups were completed between August 2022 and June 2023; 3 for SCPs (n=9 participants) and 3 for end users (n=7 participants). Four SCPs had previously smoked, and most end users currently smoked cigarettes (n=5), and 2 had quit smoking. The mean duration of focus groups was 58 (SD 10.9; range 46-74) minutes. We identified four major themes from focus group feedback: (1) conversation design, (2) functionality, (3) relationality and anthropomorphism, and (4) role as a smoking cessation support tool. In response to SCPs' feedback, we made two major updates to Quin between cohorts: (1) improvements to conversation flow and (2) addition of the ``Moments of Crisis'' conversation tree. Participant feedback also informed 17 recommendations for future smoking cessation chatbot developments. Conclusions: Feedback from end users and SCPs highlighted the importance of chatbot functionality, as this underpinned Quin's conversation design and relationality. The ready accessibility of accurate cessation information and impartial support that Quin provided was recognized as a key benefit for end users, the latter of which contributed to a feeling of accountability to the chatbot. Findings will inform the ongoing development of a mature prototype for clinical testing. ", doi="10.2196/56505", url="https://humanfactors.jmir.org/2024/1/e56505" } @Article{info:doi/10.2196/52166, author="Lee, Pei-An and Yu, Wanting and Zhou, Junhong and Tsai, Timothy and Manor, Brad and Lo, On-Yee", title="A Novel Approach for Improving Gait Speed Estimation Using a Single Inertial Measurement Unit Embedded in a Smartphone: Validity and Reliability Study", journal="JMIR Mhealth Uhealth", year="2024", month="Aug", day="13", volume="12", pages="e52166", keywords="smartphone app", keywords="gait speed", keywords="dual-task walking", keywords="validity", keywords="reliability", keywords="mobile phone", abstract="Background: Gait speed is a valuable biomarker for mobility and overall health assessment. Existing methods to measure gait speed require expensive equipment or personnel assistance, limiting their use in unsupervised, daily-life conditions. The availability of smartphones equipped with a single inertial measurement unit (IMU) presents a viable and convenient method for measuring gait speed outside of laboratory and clinical settings. Previous works have used the inverted pendulum model to estimate gait speed using a non--smartphone-based IMU attached to the trunk. However, it is unclear whether and how this approach can estimate gait speed using the IMU embedded in a smartphone while being carried in a pants pocket during walking, especially under various walking conditions. Objective: This study aimed to validate and test the reliability of a smartphone IMU--based gait speed measurement placed in the user's front pants pocket in both healthy young and older adults while walking quietly (ie, normal walking) and walking while conducting a cognitive task (ie, dual-task walking). Methods: A custom-developed smartphone application (app) was used to record gait data from 12 young adults and 12 older adults during normal and dual-task walking. The validity and reliability of gait speed and step length estimations from the smartphone were compared with the gold standard GAITRite mat. A coefficient-based adjustment based upon a coefficient relative to the original estimation of step length was applied to improve the accuracy of gait speed estimation. The magnitude of error (ie, bias and limits of agreement) between the gait data from the smartphone and the GAITRite mat was calculated for each stride. The Passing-Bablok orthogonal regression model was used to provide agreement (ie, slopes and intercepts) between the smartphone and the GAITRite mat. Results: The gait speed measured by the smartphone was valid when compared to the GAITRite mat. The original limits of agreement were 0.50 m/s (an ideal value of 0 m/s), and the orthogonal regression analysis indicated a slope of 1.68 (an ideal value of 1) and an intercept of ?0.70 (an ideal value of 0). After adjustment, the accuracy of the smartphone-derived gait speed estimation improved, with limits of agreement reduced to 0.34 m/s. The adjusted slope improved to 1.00, with an intercept of 0.03. The test-retest reliability of smartphone-derived gait speed was good to excellent within supervised laboratory settings and unsupervised home conditions. The adjustment coefficients were applicable to a wide range of step lengths and gait speeds. Conclusions: The inverted pendulum approach is a valid and reliable method for estimating gait speed from a smartphone IMU placed in the pockets of younger and older adults. Adjusting step length by a coefficient derived from the original estimation of step length successfully removed bias and improved the accuracy of gait speed estimation. This novel method has potential applications in various settings and populations, though fine-tuning may be necessary for specific data sets. ", doi="10.2196/52166", url="https://mhealth.jmir.org/2024/1/e52166" } @Article{info:doi/10.2196/56250, author="Gautam, Kamal and Shrestha, Roman and Dlamini, Sihlelelwe and Razali, Belle and Paudel, Kiran and Azwa, Iskandar and Saifi, Rumana and Toh, YuHang and Justin Lim, Hazriq and Sutherland, Ryan and Restar, Arjee and Phanuphak, Nittaya and Wickersham, A. Jeffrey", title="Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study", journal="JMIR Form Res", year="2024", month="Aug", day="13", volume="8", pages="e56250", keywords="HIV", keywords="AIDS", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="mobile health", keywords="mHealth", keywords="transgender women", keywords="Malaysia", keywords="mobile phone", abstract="Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11\% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women's needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women's uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62\%) and 2 FG sessions with stakeholders (n=11, 38\%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app's features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. ", doi="10.2196/56250", url="https://formative.jmir.org/2024/1/e56250" } @Article{info:doi/10.2196/48213, author="Haq, Ul Zaeem and Naeem, Ayesha and Zaeem, Durayya and Sohail, Mohina and Pervaiz, Ain Noor ul", title="Development of a Digital Platform to Promote Mother and Child Health in Underserved Areas of a Lower-Middle-Income Country: Mixed Methods Formative Study", journal="JMIRx Med", year="2024", month="Jul", day="31", volume="5", pages="e48213", keywords="primary health care", keywords="mother and child health", keywords="community health worker", keywords="slums", keywords="digital applications", keywords="health communication.", abstract="Background: Primary health care (PHC) is the backbone of universal health coverage, with community health workers (CHWs) being one of its critical pillars in lower-middle-income countries. Most CHW functions require them to be an efficient communicator, but their program development has been deficient in this area. Can IT provide some solutions? Moreover, can some IT-based CHW-delivered innovations help mothers and children in areas not covered by PHC services? We explored these questions during the development and feasibility testing of a digital application designed to improve the communication capacity of CHWs in two underserved areas of Islamabad. Objective: This study aims to explore the perceptions, practices, and related gaps about mother and child health, and child development in an underserved area; develop and deploy a behavior change communication program to address the gaps; and assess the feasibility of the program. Methods: We carried out a mixed methods study with three steps. First, we conducted 13 in-depth interviews and two focus group discussions with stakeholders to explore the issues faced by mothers living in these underserved areas. To address these barriers, we developed Sehat Ghar, a video-based health education application to demonstrate practices mothers and families needed to adopt. Second, we trained 10 volunteer CHWs from the same community to deliver health education using the application and assessed their pre-post knowledge and skills. Third, these CHWs visited pregnant and lactating mothers in the community with random observation of their work by a supporting supervisor. Results: Initial exploration revealed a need for health-related knowledge among mothers and suboptimal utilization of public health care. Sehat Ghar used behavior change techniques, including knowledge transfer, enhancing mothers' self-efficacy, and improving family involvement in mother and child care. Volunteer CHWs were identified from the community, who after the training, showed a significant improvement in mean knowledge score (before: mean 8.00, SD 1.49; after: mean 11.40, SD 1.43; P<.001) about health. During supportive supervision, these CHWs were rated as excellent in their interaction with mothers and excellent or very good in using the application. The CHW and her community reported their satisfaction with the application and wanted its delivery regularly. Conclusions: Sehat Ghar is a simple, easy-to-use digital application for CHWs and is acceptable to the community. Mothers appreciate the content and presentation and are ready to incorporate its messages into their daily practices. The real-world effectiveness of the innovation tested on 250 mother-infant pairs will be important for its proof of effectiveness. With its usefulness and adaptability, and the rapidly spreading use of mobile phones and internet technology, this cost-effective innovation can help in delivering health communications at a large scale in a minimum amount of time. ", doi="10.2196/48213", url="https://xmed.jmir.org/2024/1/e48213" } @Article{info:doi/10.2196/51491, author="Shetty, B. Vinutha and Fried, Leanne and Roby, C. Heather and Soon, K. Wayne H. and Nguyen, Rebecca and Ong, Arthur and Jaimangal, Mohinder and Francis, Jacinta and Paramalingam, Nirubasini and Cross, Donna and Davis, Elizabeth", title="Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach", journal="JMIR Diabetes", year="2024", month="Jul", day="30", volume="9", pages="e51491", keywords="Mobile health application", keywords="Exercise", keywords="fitness", keywords="physical activity", keywords="design", keywords="co-design", keywords="focus group", keywords="focus groups", keywords="acT1ve", keywords="Type 1 diabetes", keywords="Young people", keywords="Blood glucose level", keywords="diabetic", keywords="diabetes", keywords="young", keywords="youth", keywords="type 1", keywords="prototype", keywords="develop", keywords="development", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="user-centered design", keywords="mobile phone", abstract="Background: Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting. Objective: We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals. Methods: A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app ``acT1ve'' during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of ``acT1ve'' was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers. Results: Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of ``acT1ve.'' acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. ``acT1ve'' contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users' activities and associated exercise advice provided by the app's algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels. Conclusions: The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing ``acT1ve.'' The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d ", doi="10.2196/51491", url="https://diabetes.jmir.org/2024/1/e51491", url="http://www.ncbi.nlm.nih.gov/pubmed/39078700" } @Article{info:doi/10.2196/57318, author="Bricker, B. Jonathan and Sullivan, Brianna and Mull, Kristin and Santiago-Torres, Margarita and Lavista Ferres, M. Juan", title="Conversational Chatbot for Cigarette Smoking Cessation: Results From the 11-Step User-Centered Design Development Process and Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="23", volume="12", pages="e57318", keywords="chatbot", keywords="conversational agent", keywords="conversational agents", keywords="digital therapeutics", keywords="smoking cessation", keywords="development", keywords="develop", keywords="design", keywords="smoking", keywords="smoke", keywords="smokers", keywords="quit", keywords="quitting", keywords="cessation", keywords="chatbots", keywords="large language model", keywords="LLM", keywords="LLMs", keywords="large language models", keywords="addict", keywords="addiction", keywords="addictions", keywords="mobile phone", abstract="Background: Conversational chatbots are an emerging digital intervention for smoking cessation. No studies have reported on the entire development process of a cessation chatbot. Objective: We aim to report results of the user-centered design development process and randomized controlled trial for a novel and comprehensive quit smoking conversational chatbot called QuitBot. Methods: The 4 years of formative research for developing QuitBot followed an 11-step process: (1) specifying a conceptual model; (2) conducting content analysis of existing interventions (63 hours of intervention transcripts); (3) assessing user needs; (4) developing the chat's persona (``personality''); (5) prototyping content and persona; (6) developing full functionality; (7) programming the QuitBot; (8) conducting a diary study; (9) conducting a pilot randomized controlled trial (RCT); (10) reviewing results of the RCT; and (11) adding a free-form question and answer (QnA) function, based on user feedback from pilot RCT results. The process of adding a QnA function itself involved a three-step process: (1) generating QnA pairs, (2) fine-tuning large language models (LLMs) on QnA pairs, and (3) evaluating the LLM outputs. Results: We developed a quit smoking program spanning 42 days of 2- to 3-minute conversations covering topics ranging from motivations to quit, setting a quit date, choosing Food and Drug Administration--approved cessation medications, coping with triggers, and recovering from lapses and relapses. In a pilot RCT with 96\% three-month outcome data retention, QuitBot demonstrated high user engagement and promising cessation rates compared to the National Cancer Institute's SmokefreeTXT text messaging program, particularly among those who viewed all 42 days of program content: 30-day, complete-case, point prevalence abstinence rates at 3-month follow-up were 63\% (39/62) for QuitBot versus 38.5\% (45/117) for SmokefreeTXT (odds ratio 2.58, 95\% CI 1.34-4.99; P=.005). However, Facebook Messenger intermittently blocked participants' access to QuitBot, so we transitioned from Facebook Messenger to a stand-alone smartphone app as the communication channel. Participants' frustration with QuitBot's inability to answer their open-ended questions led to us develop a core conversational feature, enabling users to ask open-ended questions about quitting cigarette smoking and for the QuitBot to respond with accurate and professional answers. To support this functionality, we developed a library of 11,000 QnA pairs on topics associated with quitting cigarette smoking. Model testing results showed that Microsoft's Azure-based QnA maker effectively handled questions that matched our library of 11,000 QnA pairs. A fine-tuned, contextualized GPT-3.5 (OpenAI) responds to questions that are not within our library of QnA pairs. Conclusions: The development process yielded the first LLM-based quit smoking program delivered as a conversational chatbot. Iterative testing led to significant enhancements, including improvements to the delivery channel. A pivotal addition was the inclusion of a core LLM--supported conversational feature allowing users to ask open-ended questions. Trial Registration: ClinicalTrials.gov NCT03585231; https://clinicaltrials.gov/study/NCT03585231 ", doi="10.2196/57318", url="https://mhealth.jmir.org/2024/1/e57318", url="http://www.ncbi.nlm.nih.gov/pubmed/38913882" } @Article{info:doi/10.2196/47578, author="Galvin, Karyn and Tomlin, Dani and Timmer, B. Barbra H. and McNeice, Zoe and Mount, Nicole and Gray, Kathleen and Short, E. Camille", title="Consumer Perspectives for a Future Mobile App to Document Real-World Listening Difficulties: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jul", day="23", volume="8", pages="e47578", keywords="adults", keywords="hearing loss", keywords="listening difficulties", keywords="digital health", keywords="app", keywords="self-management", keywords="mobile health", keywords="smartphone", keywords="mobile phone", abstract="Background: By enabling individuals with hearing loss to collect their own hearing data in their personal real-world settings, there is scope to improve clinical care, empower consumers, and support shared clinical decision-making and problem-solving. Clinician support for this approach has been established in a separate study. Objective: This study aims to explore, for consumers with hearing loss, their (1) experiences of listening difficulties, to identify the data an app could usefully collect; (2) preferences regarding the features of mobile apps in general; and (3) opinions on the potential value and desirable features of a yet-to-be designed app for documenting listening difficulties in real-world settings. Methods: A total of 3 focus groups involved 27 adults who self-reported hearing loss. Most were fitted with hearing devices. A facilitator used a topic guide to generate discussion, which was video- and audio-recorded. Verbatim transcriptions were analyzed using inductive content analysis. Results: Consumers supported the concept of a mobile app that would facilitate the documenting of listening difficulties in real-world settings important to the individual. Consumers shared valuable insights about their listening difficulties, which will help determine the data that should be collected through an app designed to document these challenges. This information included early indicators of hearing loss (eg, mishearing, difficulty communicating in groups and on the phone, and speaking overly loudly) and prompts to seek hearing devices (eg, spousal pressure and the advice or example provided by others, and needing to rely on lipreading or to constantly request others to repeat themselves). It also included the well-known factors that influence listening difficulties (eg, reverberation, background noise, group conversations) and the impacts and consequences of their difficulties (eg, negative impacts on relationships and employment, social isolation and withdrawal, and negative emotions). Consumers desired a visual-based app that provided options for how data could be collected and how the user could enter data into an app, and which enabled data sharing with a clinician. Conclusions: These findings provide directions for the future co-design and piloting of a prototype mobile app to provide data that are useful for increasing self-awareness of listening difficulties and can be shared with a clinician. ", doi="10.2196/47578", url="https://formative.jmir.org/2024/1/e47578" } @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/10.2196/54945, author="Ulrich, Sandra and Lienhard, Natascha and K{\"u}nzli, Hansj{\"o}rg and Kowatsch, Tobias", title="A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="26", volume="12", pages="e54945", keywords="conversational agent", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="stress management", keywords="lifestyle", keywords="behavior change", keywords="coaching", keywords="mobile phone", abstract="Background: Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited. Objective: This study aims to develop a conversational agent--delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance. Methods: In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations. Results: The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=?0.36 to Cohen d=?0.60), while anxiety and active coping did not change (Cohen d=?0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress ($\beta$ estimate=?0.13, 95\% CI ?0.20 to ?0.05; P<.001), depressive symptoms ($\beta$ estimate=?0.23, 95\% CI ?0.38 to ?0.08; P=.003), and psychosomatic symptoms ($\beta$ estimate=?0.16, 95\% CI ?0.27 to ?0.06; P=.003), while anxiety and active coping did not change. Overall, 60\% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high. Conclusions: Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls. Trial Registration: German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004 ", doi="10.2196/54945", url="https://mhealth.jmir.org/2024/1/e54945", url="http://www.ncbi.nlm.nih.gov/pubmed/38922677" } @Article{info:doi/10.2196/54029, author="Cho, Aram and Cha, Chiyoung and Baek, Gumhee", title="Development of an Artificial Intelligence--Based Tailored Mobile Intervention for Nurse Burnout: Single-Arm Trial", journal="J Med Internet Res", year="2024", month="Jun", day="21", volume="26", pages="e54029", keywords="artificial intelligence", keywords="burnout", keywords="mobile app", keywords="nurses", keywords="nurse", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="usability", keywords="satisfaction", keywords="effectiveness", keywords="tailored", keywords="mind-body", keywords="meditation", keywords="mindfulness", keywords="ACT", keywords="algorithm", keywords="algorithms", keywords="occupational health", keywords="digital health", keywords="recommender", keywords="optimization", keywords="acceptance and commitment therapy", keywords="job", keywords="worker", keywords="workers", keywords="stress", keywords="employee", keywords="employees", abstract="Background: Nurse burnout leads to an increase in turnover, which is a serious problem in the health care system. Although there is ample evidence of nurse burnout, interventions developed in previous studies were general and did not consider specific burnout dimensions and individual characteristics. Objective: The objectives of this study were to develop and optimize the first tailored mobile intervention for nurse burnout, which recommends programs based on artificial intelligence (AI) algorithms, and to test its usability, effectiveness, and satisfaction. Methods: In this study, an AI-based mobile intervention, Nurse Healing Space, was developed to provide tailored programs for nurse burnout. The 4-week program included mindfulness meditation, laughter therapy, storytelling, reflective writing, and acceptance and commitment therapy. The AI algorithm recommended one of these programs to participants by calculating similarity through a pretest consisting of participants' demographics, research variables, and burnout dimension scores measured with the Copenhagen Burnout Inventory. After completing a 4-week program, burnout, job stress, stress response using the Stress Response Inventory Modified Form, the usability of the app, coping strategy by the coping strategy indicator, and program satisfaction (1: very dissatisfied; 5: very satisfied) were measured. The AI recognized the recommended program as effective if the user's burnout score reduced after the 2-week program and updated the algorithm accordingly. After a pilot test (n=10), AI optimization was performed (n=300). A paired 2-tailed t test, ANOVA, and the Spearman correlation were used to test the effect of the intervention and algorithm optimization. Results: Nurse Healing Space was implemented as a mobile app equipped with a system that recommended 1 program out of 4 based on similarity between users through AI. The AI algorithm worked well in matching the program recommended to participants who were most similar using valid data. Users were satisfied with the convenience and visual quality but were dissatisfied with the absence of notifications and inability to customize the program. The overall usability score of the app was 3.4 out of 5 points. Nurses' burnout scores decreased significantly after the completion of the first 2-week program (t=7.012; P<.001) and reduced further after the second 2-week program (t=2.811; P=.01). After completing the Nurse Healing Space program, job stress (t=6.765; P<.001) and stress responses (t=5.864; P<.001) decreased significantly. During the second 2-week program, the burnout level reduced in the order of participation (r=--0.138; P=.04). User satisfaction increased for both the first (F=3.493; P=.03) and second programs (F=3.911; P=.02). Conclusions: This program effectively reduced burnout, job stress, and stress responses. Nurse managers were able to prevent nurses from resigning and maintain the quality of medical services using this AI-based program to provide tailored interventions for nurse burnout. Thus, this app could improve qualitative health care, increase employee satisfaction, reduce costs, and ultimately improve the efficiency of the health care system. ", doi="10.2196/54029", url="https://www.jmir.org/2024/1/e54029" } @Article{info:doi/10.2196/50086, author="Espinoza Chamorro, Roberto and Santos, O. Luciano H. and Mori, Yukiko and Liu, Chang and Yamamoto, Goshiro and Kuroda, Tomohiro", title="Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="14", volume="11", pages="e50086", keywords="blood donation", keywords="deferral experience", keywords="Theory of Planned Behavior", keywords="Self-Determination Theory", keywords="gamification", keywords="ICT design", keywords="motivation", keywords="patient education", keywords="prototype", keywords="feasibility", abstract="Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. ", doi="10.2196/50086", url="https://humanfactors.jmir.org/2024/1/e50086", url="http://www.ncbi.nlm.nih.gov/pubmed/38875005" } @Article{info:doi/10.2196/50939, author="Yoon, Sungwon and Goh, Hendra and Lee, Ching Phong and Tan, Chang Hong and Teh, Ming Ming and Lim, Ting Dawn Shao and Kwee, Ann and Suresh, Chandran and Carmody, David and Swee, Soon Du and Tan, Tse Sarah Ying and Wong, Jun-Wei Andy and Choo, Hui-Min Charlotte and Wee, Zongwen and Bee, Mong Yong", title="Assessing the Utility, Impact, and Adoption Challenges of an Artificial Intelligence--Enabled Prescription Advisory Tool for Type 2 Diabetes Management: Qualitative Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="13", volume="11", pages="e50939", keywords="clinical decision support system", keywords="artificial intelligence", keywords="endocrinology", keywords="diabetes management", keywords="human factors", abstract="Background: The clinical management of type 2 diabetes mellitus (T2DM) presents a significant challenge due to the constantly evolving clinical practice guidelines and growing array of drug classes available. Evidence suggests that artificial intelligence (AI)--enabled clinical decision support systems (CDSSs) have proven to be effective in assisting clinicians with informed decision-making. Despite the merits of AI-driven CDSSs, a significant research gap exists concerning the early-stage implementation and adoption of AI-enabled CDSSs in T2DM management. Objective: This study aimed to explore the perspectives of clinicians on the use and impact of the AI-enabled Prescription Advisory (APA) tool, developed using a multi-institution diabetes registry and implemented in specialist endocrinology clinics, and the challenges to its adoption and application. Methods: We conducted focus group discussions using a semistructured interview guide with purposively selected endocrinologists from a tertiary hospital. The focus group discussions were audio-recorded and transcribed verbatim. Data were thematically analyzed. Results: A total of 13 clinicians participated in 4 focus group discussions. Our findings suggest that the APA tool offered several useful features to assist clinicians in effectively managing T2DM. Specifically, clinicians viewed the AI-generated medication alterations as a good knowledge resource in supporting the clinician's decision-making on drug modifications at the point of care, particularly for patients with comorbidities. The complication risk prediction was seen as positively impacting patient care by facilitating early doctor-patient communication and initiating prompt clinical responses. However, the interpretability of the risk scores, concerns about overreliance and automation bias, and issues surrounding accountability and liability hindered the adoption of the APA tool in clinical practice. Conclusions: Although the APA tool holds great potential as a valuable resource for improving patient care, further efforts are required to address clinicians' concerns and improve the tool's acceptance and applicability in relevant contexts. ", doi="10.2196/50939", url="https://humanfactors.jmir.org/2024/1/e50939", url="http://www.ncbi.nlm.nih.gov/pubmed/38869934" } @Article{info:doi/10.2196/56373, author="Nguyen, Antony and Yu, Filmer and Park, G. Linda and Fukuoka, Yoshimi and Wong, Ching and Gildengorin, Ginny and Nguyen, T. Tung and Tsoh, Y. Janice and Jih, Jane", title="An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study", journal="JMIR Form Res", year="2024", month="Jun", day="10", volume="8", pages="e56373", keywords="physical activity", keywords="mHealth", keywords="mobile health", keywords="mobile app", keywords="Asian Americans", keywords="physical activity tracker", keywords="mobile phone", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="app-based", keywords="intervention", keywords="interventions", keywords="community-dwelling", keywords="tracker", keywords="trackers", keywords="pilot study", keywords="feasibility", keywords="acceptability", keywords="cultural", keywords="culturally", keywords="linguistic", keywords="linguistically", keywords="evidence-based", keywords="community-based", keywords="sociodemographic", keywords="lifestyle", keywords="Chinese", keywords="Vietnamese", keywords="Filipino", keywords="adult", keywords="adults", keywords="multicomponent", keywords="multilingual", abstract="Background: Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app--based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. Objective: This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. Methods: Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app's daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. Results: A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58\% (n=11) of them were female. Of the participants, 26\% (n=5) were Chinese, 32\% (n=6) were Vietnamese, and 42\% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74\% (n=14) in week 2 to 95\% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. Conclusions: This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered. ", doi="10.2196/56373", url="https://formative.jmir.org/2024/1/e56373", url="http://www.ncbi.nlm.nih.gov/pubmed/38857065" } @Article{info:doi/10.2196/55918, author="Hurtado, Lidia and Gonzalez Concepcion, Melinda and Flix-Valle, Aida and Ruiz-Romeo, Marina and Gonzalez-Rodriguez, Sonia and Pe{\~n}a, Marta and Paviglianiti, Annalisa and Pera Jambrina, Angeles Maria and Sureda, Anna and Ochoa-Arnedo, Cristian and Mussetti, Alberto", title="Telemedicine With Wearable Technologies in Patients Undergoing Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy (TEL-HEMATO Study): Prospective Noninterventional Single-Center Study", journal="JMIR Form Res", year="2024", month="Jun", day="4", volume="8", pages="e55918", keywords="hematology", keywords="hematopoietic cell transplantation", keywords="telemedicine", keywords="wearables", keywords="chimeric antigen receptor T", keywords="CART", keywords="wearable", keywords="hematopoietic", keywords="transplantation", keywords="transplant", keywords="pilot study", keywords="hematological", keywords="HCT", keywords="telehealth", keywords="therapy", keywords="device", keywords="quality of life", keywords="digital health", keywords="smartphone", keywords="app", keywords="patient", keywords="teenager", keywords="youth", keywords="noninterventional", abstract="Background: Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective: The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods: Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results: Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89\%) patients, oxygen saturation and daily steps were recorded in 9/9 (100\%) patients, and sleeping hours were recorded in 7/9 (78\%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55\%) patients. Overall, 5/9 (55\%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89\%) patients at study enrollment, which decreased to 3/9 (33\%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions: While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level. ", doi="10.2196/55918", url="https://formative.jmir.org/2024/1/e55918", url="http://www.ncbi.nlm.nih.gov/pubmed/38833696" } @Article{info:doi/10.2196/54983, author="Ilhan, I. Elif and Jola, N. Lucia and van der Zalm, M. Marieke and Bernstein, Mike and Goussard, Pierre and Redfern, Andrew and Hesseling, C. Anneke and Hoddinott, Graeme and McCollum, D. Eric and King, Carina", title="Designing a Smartphone-Based Pulse Oximeter for Children in South Africa (Phefumla Project): Qualitative Analysis of Human-Centered Design Workshops With Health Care Workers", journal="JMIR Hum Factors", year="2024", month="May", day="30", volume="11", pages="e54983", keywords="pediatrics", keywords="human-centered design", keywords="participatory design", keywords="pulse oximeter", keywords="South Africa", keywords="smartphone", keywords="mobile phone", abstract="Background: Pulse oximeters noninvasively measure blood oxygen levels, but these devices have rarely been designed for low-resource settings and are inconsistently available at outpatient clinics. Objective: The Phefumla project aims to develop and validate a pediatric smartphone-based pulse oximeter designed specifically for this context. We present the process of human-centered oximeter design with health care workers in South Africa. Methods: We purposively sampled 19 health care workers from 5 clinics in Khayelitsha, Cape Town. Using a human-centered design approach, we conducted participatory workshops with four activities with health care workers: (1) they received 3D-printed prototypes of potential oximeter designs to provide feedback; (2) we demonstrated on dolls how they would use the novel oximeter; (3) they used pile sorting to rank design features and suggest additional features they desired; and (4) they designed their preferred user interface using a whiteboard, marker, and magnetized features that could be repositioned. We audio recorded the workshops, photographed outputs, and took detailed field notes. Analysis involved iterative review of these data to describe preferences, identify key design updates, and provide modifications. Results: Participants expressed a positive sentiment toward the idea of a smartphone pulse oximeter and suggested that a pediatric device would address an important gap in outpatient care. Specifically, participants expressed a preference for the prototype that they felt enabled more diversity in the way it could be used. There was a strong tendency to prioritize pragmatic design features, such as robustness, which was largely dictated by health care worker context. They also added features that would allow the oximeter device to serve other clinical functions in addition to oxygen saturation measurement, such as temperature and respiratory rate measurements. Conclusions: Our end user--centered rapid participatory approach led to tangible design changes and prompted design discussions that the team had not previously considered. Overall, health care workers prioritized pragmatism for pediatric pulse oximeter device design. ", doi="10.2196/54983", url="https://humanfactors.jmir.org/2024/1/e54983" } @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/10.2196/50398, author="Szkodny, Dominika and Wr{\'o}blewska-Czajka, Ewa and Stryja, Miko?aj and Gara, Filip and Wyl?ga?a, Edward", title="Exploring the Potential of an Eye Tissue Donor Reporting App in Enhancing the Procurement of Corneal Donors: Mixed Methods Observational Study", journal="JMIR Form Res", year="2024", month="May", day="15", volume="8", pages="e50398", keywords="eye donor", keywords="corneal transplant", keywords="donor shortage", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="application", keywords="tissue procurement", keywords="organ", keywords="procurement", keywords="donor", keywords="donors", keywords="donation", keywords="transplant", keywords="transplantation", keywords="transplants", keywords="usability", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="acceptance", keywords="interview", keywords="interviews", keywords="survey", keywords="surveys", keywords="questionnaire", keywords="questionnaires", keywords="reporting", abstract="Background: The availability of donated eye tissue saves and enhances vision in transplant recipients; however, the current demand for tissue surpasses the available supply. Corneal donor shortages lead to increased wait times, delayed surgeries, prolonged visual impairment, and increased inconvenience to patients requiring eye tissue transplantation. A web-based application was previously developed to facilitate easy and intuitive submission of potential donor information. Objective: The primary objectives of this study were to assess health care professionals' attitudes toward the potential application and evaluate its effectiveness based on user feedback and donor registrations through the application. Methods: Researchers used a mixed methods approach, commencing with a literature review to identify challenges associated with donor procurement. Stakeholder interviews were conducted to gauge health care professionals' perspectives regarding the application. User feedback was collected through questionnaires, surveys, and interviews to assess the application's usability and impact. An assessment of the reported potential donors and questionnaire responses were analyzed. Results: The final version of the application successfully reported 24 real cornea donors. Among 64 health care providers who used the application to communicate about potential donors, 32 of them submitted trial entries exclusively for testing purposes. The remaining 8 health care professionals reported potential donors; however, these individuals did not meet the donor qualification criteria. The majority of participants found the application user-friendly and expressed their readiness to use it in the future. Positive ratings were assigned to the layout, appearance, purpose, and specific features of the application. Respondents highlighted the automatic sending of notifications via SMS text messages and the integration of all necessary documents for donor qualification and tissue collection as the most valuable functions of the application. Conclusions: The study indicates that donor reporting applications offer promising solutions to enhance tissue donor procurement. This application streamlined the reporting process, reduced paperwork, facilitated communication, and collected valuable data for analysis. ", doi="10.2196/50398", url="https://formative.jmir.org/2024/1/e50398", url="http://www.ncbi.nlm.nih.gov/pubmed/38748474" } @Article{info:doi/10.2196/53756, author="Sharma, Kant Kamal and Somasundaram, Jeeva and Sachdeva, Ashish", title="Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="May", day="6", volume="13", pages="e53756", keywords="screen time", keywords="monetary incentives", keywords="target selection", keywords="mental health", keywords="mobile phone", abstract="Background: Smartphones have become integral to people's lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. Objective: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. Methods: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10\%, 20\%, and 30\%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US \$0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US \$6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US \$60.55) for consistently sharing their mobile screen time data. Results: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. Conclusions: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. Trial Registration: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf International Registered Report Identifier (IRRID): DERR1-10.2196/53756 ", doi="10.2196/53756", url="https://www.researchprotocols.org/2024/1/e53756", url="http://www.ncbi.nlm.nih.gov/pubmed/38709546" } @Article{info:doi/10.2196/51201, author="Wunsch, Kathrin and Fiedler, Janis and Hubenschmid, Sebastian and Reiterer, Harald and Renner, Britta and Woll, Alexander", title="An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Apr", day="26", volume="12", pages="e51201", keywords="mobile app", keywords="telemedicine", keywords="behavior change", keywords="health behavior", keywords="family", keywords="primary prevention", keywords="exercise", keywords="diet", keywords="food and nutrition", keywords="randomized controlled trial", keywords="accelerometer", keywords="wearable electronic devices", keywords="social-cognitive determinants", keywords="just-in-time adaptive intervention", keywords="digital intervention", keywords="mobile phone", abstract="Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family--based setting. Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Results: Overall, 48 families (CG: n=22, 46\%, with 68 participants and IG: n=26, 54\%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2\%, with 4 participants and IG: n=1, 2\%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415 International Registered Report Identifier (IRRID): RR2-10.2196/20534 ", doi="10.2196/51201", url="https://mhealth.jmir.org/2024/1/e51201", url="http://www.ncbi.nlm.nih.gov/pubmed/38669071" } @Article{info:doi/10.2196/52090, author="Bizier, Andre and Jones, Arielle and Businelle, Michael and Kezbers, Krista and Hoeppner, B. Bettina and Giordano, P. Thomas and Thai, M. Jessica and Charles, Jacqueline and Montgomery, Audrey and Gallagher, W. Matthew and Cheney, K. Marshall and Zvolensky, Michael and Garey, Lorra", title="An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Apr", day="24", volume="13", pages="e52090", keywords="smoking cessation", keywords="Black", keywords="HIV", keywords="anxiety sensitivity", keywords="mobile health", keywords="mHealth", keywords="just-in-time adaptive intervention", keywords="mobile phone", abstract="Background: Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. Objective: This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. Methods: This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute's QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Results: Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. Conclusions: The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002 International Registered Report Identifier (IRRID): PRR1-10.2196/52090 ", doi="10.2196/52090", url="https://www.researchprotocols.org/2024/1/e52090", url="http://www.ncbi.nlm.nih.gov/pubmed/38657227" } @Article{info:doi/10.2196/49982, author="Giebel, Denk Godwin and Abels, Carina and Plescher, Felix and Speckemeier, Christian and Schrader, Frederik Nils and B{\"o}rchers, Kirstin and Wasem, J{\"u}rgen and Neusser, Silke and Blase, Nikola", title="Problems and Barriers Related to the Use of mHealth Apps From the Perspective of Patients: Focus Group and Interview Study", journal="J Med Internet Res", year="2024", month="Apr", day="23", volume="26", pages="e49982", keywords="mobile health", keywords="mHealth", keywords="mHealth app", keywords="patient", keywords="problems", keywords="barriers", keywords="digital health applications", keywords="DiGA", keywords="app", keywords="barrier", keywords="mobile app", keywords="health care system", keywords="economic outcome", keywords="context", keywords="mobile phone", abstract="Background: Since fall 2020, mobile health (mHealth) apps have become an integral part of the German health care system. The belief that mHealth apps have the potential to make the health care system more efficient, close gaps in care, and improve the economic outcomes related to health is unwavering and already partially confirmed. Nevertheless, problems and barriers in the context of mHealth apps usually remain unconsidered. Objective: The focus groups and interviews conducted in this study aim to shed light on problems and barriers in the context of mHealth apps from the perspective of patients. Methods: Guided focus groups and individual interviews were conducted with patients with a disease for which an approved mHealth app was available at the time of the interviews. Participants were recruited via self-help groups. The interviews were recorded, transcribed, and subjected to a qualitative content analysis. The content analysis was based on 10 problem categories (``validity,'' ``usability,'' ``technology,'' ``use and adherence,'' ``data privacy and security,'' ``patient-physician relationship,'' ``knowledge and skills,'' ``individuality,'' ``implementation,'' and ``costs'') identified in a previously conducted scoping review. Participants were asked to fill out an additional questionnaire about their sociodemographic data and about their use of technology. Results: A total of 38 patients were interviewed in 5 focus groups (3 onsite and 2 web-based) and 5 individual web-based interviews. The additional questionnaire was completed by 32 of the participants. Patients presented with a variety of different diseases, such as arthrosis, tinnitus, depression, or lung cancer. Overall, 16\% (5/32) of the participants had already been prescribed an app. During the interviews, all 10 problem categories were discussed and considered important by patients. A myriad of problem manifestations could be identified for each category. This study shows that there are relevant problems and barriers in the context of mHealth apps from the perspective of patients, which warrant further attention. Conclusions: There are essentially 3 different areas of problems in the context of mHealth apps that could be addressed to improve care: quality of the respective mHealth app, its integration into health care, and the expandable digital literacy of patients. ", doi="10.2196/49982", url="https://www.jmir.org/2024/1/e49982", url="http://www.ncbi.nlm.nih.gov/pubmed/38652508" } @Article{info:doi/10.2196/55132, author="Fan, Qiping and Hoang, Minh-Nguyet and DuBose, Logan and Ory, G. Marcia and Vennatt, Jeswin and Salha, Diana and Lee, Shinduk and Falohun, Tokunbo", title="The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study", journal="JMIR Aging", year="2024", month="Apr", day="17", volume="7", pages="e55132", keywords="evaluation", keywords="usability", keywords="family caregiver", keywords="Alzheimer disease", keywords="dementia", keywords="digital health", keywords="mobile phone", abstract="Background: The increasing prevalence of Alzheimer disease and Alzheimer disease--related dementia in the United States has amplified the health care burden and caregiving challenges, especially for caregivers of people living with dementia. A web-based care planning tool, Olera.care, was developed to aid caregivers in managing common challenges associated with dementia care. Objective: This study aims to preliminarily evaluate the quality and usability of the Olera.care platform and assess the preferences of using the technology and interests in learning about different older adult care services among caregivers. Methods: For interview 1, we aim to understand caregiving needs and let the participants start engaging with the platform. After they engage with the platform, we schedule the second interview and let the participants complete the Mobile Application Rating Scale. The survey also included sociodemographic characteristics, caregiving experiences, communication preferences in technology adoption, and older adult care service use and interests. Descriptive statistics were used to describe the quality and usability of the platform and characteristics of the participants. We conducted 2-sample 2-tailed t tests to examine the differences in the Mobile Application Rating Scale evaluation scores by caregiver characteristics. Results: Overall, 30 adult caregivers in Texas completed the evaluation. The majority were aged ?50 years (25/30, 83\%), women (23/30, 77\%), White (25/30, 83\%), and financially stable (20/30, 67\%). The Olera.care platform evaluation showed high satisfaction, with an overall mean rating of 4.57 (SD 0.57) of 5, and scored well in engagement (mean 4.10, SD 0.61), functionality (mean 4.46, SD 0.44), aesthetics (mean 4.58, SD 0.53), and information quality (mean 4.76, SD 0.44) consistently across all participants. A statistically significant difference (P=.02) was observed in functionality evaluation scores by duration of caregiving, with caregivers dedicating more hours to care rating it higher than those providing less care (mean 4.6, SD 0.4 vs mean 4.2, SD 0.5). In addition, caregivers with less caregiving experience reported significantly higher evaluation scores for aesthetics (P=.04) and information quality (P=.03) compared to those with longer years of caregiving. All participants expressed a willingness to recommend the app to others, and 90\% (27/30) rated the app overall positively. Most of the participants (21/30, 70\%) favored anonymous interactions before receiving personalized feedback and preferred computer browsers over mobile apps. Medical home health services were the most used, with a diverse range of services being used. Caregiver support groups, medical providers, memory care, meal services, and adult day care were among the most desired services for future exploration. Conclusions: The Olera.care web-based platform is a practical, engaging, easy-to-use, visually appealing, and informative tool for dementia caregivers. Future development and research are essential to enhance the platform and comprehensively evaluate it among a broader population. ", doi="10.2196/55132", url="https://aging.jmir.org/2024/1/e55132", url="http://www.ncbi.nlm.nih.gov/pubmed/38630527" } @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/10.2196/48793, author="Wahl, J. Kate and Brooks, Melissa and Trenaman, Logan and Desjardins-Lorimer, Kirsten and Bell, M. Carolyn and Chokmorova, Nazgul and Segall, Romy and Syring, Janelle and Williams, Aleyah and Li, C. Linda and Norman, V. Wendy and Munro, Sarah", title="User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Apr", day="16", volume="26", pages="e48793", keywords="family planning", keywords="abortion", keywords="shared decision-making", keywords="patient decision aid", keywords="qualitative", keywords="evaluation", keywords="Canada", keywords="health equity", abstract="Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive---there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (``patient'' participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100\%; health care professionals: n=22, 88\%), was not missing information (patients: n=21, 84\%; health care professionals: n=18, 72\%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92\%; health care professionals: n=23, 92\%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. ", doi="10.2196/48793", url="https://www.jmir.org/2024/1/e48793", url="http://www.ncbi.nlm.nih.gov/pubmed/38625731" } @Article{info:doi/10.2196/54214, author="Sobrinho, Silva Andressa Crystine da and Gomes, Oliveira Grace Angelica de and Bueno J{\'u}nior, Roberto Carlos", title="Developing a Multiprofessional Mobile App to Enhance Health Habits in Older Adults: User-Centered Approach", journal="JMIR Form Res", year="2024", month="Apr", day="15", volume="8", pages="e54214", keywords="information and communications technologies", keywords="ICTs", keywords="health care", keywords="digital inclusion", keywords="focus groups", keywords="health promotion", keywords="user", keywords="usability", keywords="health literacy", keywords="digital competencies", keywords="digital skills", keywords="mobile phone", abstract="Background: Although comprehensive lifestyle habits are crucial for healthy aging, their adherence tends to decline as individuals grow older. Sustaining a healthy life over time poses a motivational challenge. Some digital tools, such as smartphone apps aimed at promoting healthy habits, have been used to counteract this decline. However, a more profound investigation is necessary into the diverse experiences of users, particularly when it concerns older adults or those who are unfamiliar with information and communications technologies. Objective: We aimed to develop a mobile app focused on promoting the health of older adults based on the principles of software engineering and a user-centered design. The project respected all ethical guidelines and involved the participation of older adults at various stages of the development of the app. Methods: This study used a mixed methods approach, combining both quantitative and qualitative methodologies for data collection. The study was conducted in Ribeir{\~a}o Pr{\^e}to, S{\~a}o Paulo, Brazil, and involved 20 older adults of both genders who were aged ?60 years and enrolled in the Physical Education Program for the Elderly at the University of S{\~a}o Paulo. The research unfolded in multiple phases, encompassing the development and refinement of the app with active engagement from the participants. Results: A total of 20 participants used a mobile health app with an average age of 64.8 (SD 2.7) years. Most participants had a high school education, middle-class status, and varying health literacy (mean score 73.55, SD 26.70). Overall, 90\% (18/20) of the participants owned smartphones. However, 20\% (4/20) of the participants faced installation challenges and 30\% (6/20) struggled with web-based searches. The focus groups assessed app usability and satisfaction. Adjustments increased satisfaction scores significantly (Suitability Assessment of Materials: 34.89\% to 70.65\%; System Usability Scale: 71.23 to 87.14). Participant feedback emphasized font size, navigation, visual feedback, and personalization, and suggestions included health device integration, social interaction, and in-app communication support. Conclusions: This study contributes to the development of health care technologies tailored to the older adult population, considering their specific needs. It is anticipated that the resulting app will serve as a valuable tool for promoting healthy habits and enhancing the quality of life for older adults. ", doi="10.2196/54214", url="https://formative.jmir.org/2024/1/e54214", url="http://www.ncbi.nlm.nih.gov/pubmed/38619865" } @Article{info:doi/10.2196/49574, author="S{\'a}nchez-Qui{\~n}ones, Beatriz and Ant{\'o}n-Maldonado, Cristina and Ibarra Vega, Nataly and Martorell Marin{\'e}, Isabel and Santamaria, Amparo", title="Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study", journal="JMIR Form Res", year="2024", month="Apr", day="8", volume="8", pages="e49574", keywords="Nootric app", keywords="oncohematology patient", keywords="physical-nutritional well-being", keywords="multidisciplinary team", abstract="Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients' physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalop{\'o} University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50\%) female and 11 (50\%) male, ranging between 42 and 84 years of age. Among them, 13 (59\%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59\%) and multiple myeloma (4/22, 18\%). Moreover, 15 (68\%) out of 22 patients received immunochemotherapy, while 7 (32\%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41\%), the adherence rate was 81\%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5\% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92\% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45\% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. ", doi="10.2196/49574", url="https://formative.jmir.org/2024/1/e49574", url="http://www.ncbi.nlm.nih.gov/pubmed/38588522" } @Article{info:doi/10.2196/54658, author="Gagnon, M. Michelle and Brilz, R. Alexandra and Alberts, M. Nicole and Gordon, L. Jennifer and Risling, L. Tracie and Stinson, N. Jennifer", title="Understanding Adolescents' Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study", journal="JMIR Pediatr Parent", year="2024", month="Apr", day="8", volume="7", pages="e54658", keywords="adolescent health", keywords="endometriosis", keywords="pain management, biopsychosocial", keywords="women's health", keywords="dysmenorrhea", keywords="thematic analysis", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="applications", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", keywords="interest", keywords="intent", keywords="intention", keywords="survey", keywords="surveys", keywords="focus group", keywords="focus groups", keywords="content analysis", keywords="mindfulness", keywords="meditation", keywords="menstrual", keywords="menstruation", keywords="experience", keywords="experiences", keywords="pain", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", abstract="Background: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. Objective: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. Methods: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Results: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78\%) of participants practiced some form of mindfulness and 87\% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents' need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain--specific content, along with content relevant to typical day-to-day experiences of adolescents. Conclusions: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided. ", doi="10.2196/54658", url="https://pediatrics.jmir.org/2024/1/e54658", url="http://www.ncbi.nlm.nih.gov/pubmed/38587886" } @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/10.2196/46979, author="Dang, Ha Thu and Wickramasinghe, Nilmini and Forkan, Mohammad Abdur Rahim and Jayaraman, Prakash Prem and Burbury, Kate and O'Callaghan, Clare and Whitechurch, Ashley and Schofield, Penelope", title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach", journal="JMIR Cancer", year="2024", month="Apr", day="3", volume="10", pages="e46979", keywords="cancer", keywords="behavioral science", keywords="design science research", keywords="digital", keywords="medication adherence", keywords="mobile solution", keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology", keywords="SAMSON", keywords="mobile phone", abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ", doi="10.2196/46979", url="https://cancer.jmir.org/2024/1/e46979", url="http://www.ncbi.nlm.nih.gov/pubmed/38569178" } @Article{info:doi/10.2196/48027, author="Chaves, Antonio and Arn{\'a}ez, Sandra and Garc{\'i}a-Soriano, Gemma", title="The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study", journal="JMIR Mhealth Uhealth", year="2024", month="Mar", day="29", volume="12", pages="e48027", keywords="obsessive-compulsive disorder", keywords="OCD", keywords="mental health literacy", keywords="stigma", keywords="app", keywords="help-seeking intention", keywords="seek help", keywords="mobile phone", abstract="Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people's lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the ``stigma monster'' over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory--Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire--27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86\% (n=78) were allocated to intervention. Of these 78 participants, 79\% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69\% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90\% (56/62). Moreover, 90\% (56/62) of the participants reported that they had learned or learned a lot, and 98\% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69\%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. ", doi="10.2196/48027", url="https://mhealth.jmir.org/2024/1/e48027", url="http://www.ncbi.nlm.nih.gov/pubmed/38551629" } @Article{info:doi/10.2196/55742, author="Gerbutavicius, Rokas and Merle, A. David and Wolf, Armin and Dimopoulos, Spyridon and Kortuem, Ulrich Karsten and Kortuem, Charlotte Friederike", title="User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Mar", day="29", volume="8", pages="e55742", keywords="mHealth", keywords="mobile health", keywords="workflow optimization", keywords="patient satisfaction", keywords="health education", keywords="educational background", keywords="phacoemulsification", abstract="Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2\%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the ``Patient Journey'' app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. ", doi="10.2196/55742", url="https://formative.jmir.org/2024/1/e55742", url="http://www.ncbi.nlm.nih.gov/pubmed/38551619" } @Article{info:doi/10.2196/49808, author="Veneman, Tim and Koopman, Sophia Fieke and Oorschot, Sander and Koomen, G. Pien and Nollet, Frans and Voorn, L. Eric", title="A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="15", volume="11", pages="e49808", keywords="neuromuscular disorders", keywords="endurance training", keywords="home-based exercise", keywords="eHealth", keywords="tele-rehabilitation", keywords="app", keywords="exercise", keywords="aerobic exercise", keywords="mhealth", keywords="mobile app", keywords="neuromuscular disease", keywords="usability", abstract="Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55\%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81\%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70\%) and physiotherapists (n=6, 60\%) were satisfied with the use of the app. The median attendance rate was 88\% (IQR 63\%-98\%), with 76\% (IQR 69\%-82\%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. ", doi="10.2196/49808", url="https://humanfactors.jmir.org/2024/1/e49808", url="http://www.ncbi.nlm.nih.gov/pubmed/38488838" } @Article{info:doi/10.2196/50926, author="Anders, Carolin and Moorthy, Preetha and Svensson, Laura and M{\"u}ller, Julia and Heinze, Oliver and Knaup, Petra and Wallwiener, Markus and Deutsch, M. Thomas and Le, Thao-Vy and Weinert, Lina", title="Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking", journal="JMIR Hum Factors", year="2024", month="Mar", day="5", volume="11", pages="e50926", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="breast cancer", keywords="eye tracking", keywords="user interface", keywords="mixed methods", keywords="mobile phone", abstract="Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app's content regularly, and self-administration. In contrast to the app's current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients' feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. ", doi="10.2196/50926", url="https://humanfactors.jmir.org/2024/1/e50926", url="http://www.ncbi.nlm.nih.gov/pubmed/38441959" } @Article{info:doi/10.2196/48883, author="Demirel, Sevda and Roke, Yvette and Hoogendoorn, W. Adriaan and Hoefakker, Jamie and Hoeberichts, Kirsten and van Harten, N. Peter", title="Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study", journal="J Med Internet Res", year="2024", month="Feb", day="29", volume="26", pages="e48883", keywords="mental health", keywords="stress", keywords="coping", keywords="burnout", keywords="stress management", keywords="digital intervention", keywords="health promotion", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="mental health professionals", abstract="Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=--0.38, 95\% CI --0.67 to --0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=--0.31, 95\% CI --0.51 to --0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95\% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. ", doi="10.2196/48883", url="https://www.jmir.org/2024/1/e48883", url="http://www.ncbi.nlm.nih.gov/pubmed/38275128" } @Article{info:doi/10.2196/52337, author="Kwa, Yin Zhi and Li, Jinqiu and Loh, Lincoln Dale and Lee, Yang Yang and Liu, Guangyu and Zhu, Lixia and Pikkarainen, Minna and He, Honggu and Mali, Padmakar Vidyadhar", title="An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation", journal="JMIR Form Res", year="2024", month="Feb", day="16", volume="8", pages="e52337", keywords="circumcision", keywords="self-efficacy", keywords="perioperative anxiety", keywords="postoperative pain", keywords="mobile phone", keywords="postoperative", keywords="pain", keywords="anxiety", keywords="distractions", keywords="distraction", keywords="perioperative", keywords="interview", keywords="interviews", keywords="child", keywords="children", keywords="surgery", keywords="surgical", keywords="recovery", keywords="health outcome", keywords="health outcomes", keywords="pediatric", keywords="pediatrics", keywords="content analysis", keywords="emotional", keywords="mobile health", keywords="app", keywords="apps", abstract="Background: Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. Objective: This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. Methods: Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. Results: The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. Conclusions: ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404 ", doi="10.2196/52337", url="https://formative.jmir.org/2024/1/e52337", url="http://www.ncbi.nlm.nih.gov/pubmed/38363589" } @Article{info:doi/10.2196/49549, author="Lund-Jacobsen, Trine and Schwarz, Peter and Martino, Gabriella and Pappot, Helle and Piil, Karin", title="Development of an App for Symptom Management in Women With Breast Cancer Receiving Maintenance Aromatase Inhibitors: Protocol for a Mixed Methods Feasibility Study", journal="JMIR Res Protoc", year="2024", month="Feb", day="15", volume="13", pages="e49549", keywords="acceptability", keywords="aromatase inhibitors", keywords="breast cancer", keywords="cancer", keywords="chemotherapy", keywords="disease", keywords="feasibility", keywords="inhibitor", keywords="management", keywords="mHealth", keywords="postmenopausal", keywords="psychosocial", keywords="QoL", keywords="quality of life", keywords="radiation therapy", keywords="symptom management", keywords="symptom", keywords="tool", keywords="treatment", keywords="usability", keywords="user-friendliness", abstract="Background: Patients with postmenopausal nonmetastatic estrogen receptor--positive breast cancer often experience a reduced quality of life after primary treatment. The disease and treatment trajectory consists of surgery followed by chemotherapy or radiation therapy. Upon this, maintenance hormone therapy with an aromatase inhibitor can result in several physical and psychosocial symptoms. Optimal symptom control during maintenance therapy is central to maintaining the patient's quality of life. Objective: This study aims to (1) develop an electronic symptom management tool for patients with postmenopausal early breast cancer receiving maintenance aromatase inhibitors with an endocrine aspect and (2) assess the feasibility, acceptability, and usability of the pilot version of the Bone@BC app. Furthermore, longitudinally, symptom prevalence and quality of life for patients with postmenopausal nonmetastatic estrogen receptor--positive breast cancer will be explored. Methods: This study follows a multistage research plan. In stage 1, a systematic literature review to establish an overview of aromatase inhibitor--related symptoms reported by postmenopausal women with nonmetastatic estrogen receptor--positive breast cancer will be completed. In stage 2, a comprehensive overview of symptoms related to aromatase inhibitors (letrozole, exemestane, and anastrozole) will be performed (eg, by reviewing medical leaflets and guidelines). In stage 3, an electronic app with a user-friendly Patient Concern Inventory list to comprise symptoms and concerns will be developed. Last, in stage 4, a convergent mixed methods feasibility study of the pilot version of the Bone@BC app will be conducted. A total of 45 patients with postmenopausal nonmetastatic estrogen receptor--positive breast cancer will use the app daily for symptom identification and respond to 6 serial patient-reported outcome measurements for 12 weeks. Finally, semistructured interviews will be performed. The primary outcome includes consent rate, attrition rate, retention rates, technical issues, and adherence, assessed using preestablished criteria on feasibility and a mixed methods approach for exploring acceptability. A patient advisory board consisting of 5 women with breast cancer is recruited to include their perspectives and experiences in the planning, organization, implementation, and dissemination of the research throughout the project. Results: At the time of submitting this paper (January 2024), a total of 23 patients have been included in the stage 2 medical audit over the recruitment period of 3 months (November 2022 to February 2023), and 19 patients have been enrolled in stage 2, the semistructured patient interviews. Conclusions: This protocol describes a study investigating the feasibility, acceptability, and usability of the symptom management tool Bone@BC developed for patients with breast cancer with an endocrine aspect. Trial Registration: ClinicalTrails.gov NCT05367830; https://clinicaltrials.gov/ct2/show/NCT05367830 International Registered Report Identifier (IRRID): DERR1-10.2196/49549 ", doi="10.2196/49549", url="https://www.researchprotocols.org/2024/1/e49549", url="http://www.ncbi.nlm.nih.gov/pubmed/38358787" } @Article{info:doi/10.2196/50196, author="Ock{\'e}, Marga and Dinnissen, Simone Ceciel and van den Bogaard, Coline and Beukers, Marja and Drijvers, Jos{\'e} and Sanderman-Nawijn, Eline and van Rossum, Caroline and Toxopeus, Ido", title="A Smartphone Food Record App Developed for the Dutch National Food Consumption Survey: Relative Validity Study", journal="JMIR Mhealth Uhealth", year="2024", month="Feb", day="9", volume="12", pages="e50196", keywords="relative validity", keywords="smartphone food record", keywords="24-hour dietary recall", keywords="mobile app", keywords="national food consumption surveys", keywords="smartphone", keywords="food", keywords="food consumption", keywords="app", keywords="diet", keywords="dietary intake", keywords="nutrients", keywords="survey", keywords="mobile phone", abstract="Background: In the Dutch National Food Consumption Survey, dietary intake has been assessed since 2003 through 24-hour dietary recalls using the GloboDiet software. A new self-administered smartphone food record app called DitEetIk! was developed for potential use in future surveys. Objective: This study aims to evaluate the data collected using the DitEetIk! app and its relative validity for food group, energy, and nutrient intake compared with the previous dietary assessment method (GloboDiet 24-hour dietary recalls). Methods: A total of 300 participants aged 18 to 79 years were recruited from a consumer panel. Participants were asked to keep a record of their consumption using the DitEetIk! app on 3 nonconsecutive days. Trained dietitians conducted a 24-hour dietary recall interview by telephone using the GloboDiet software (International Agency for Research on Cancer) regarding 1 of 3 DitEetIk! recording days. Nutrient intake was calculated using the NEVO database (version 2021/7.0). Relative validity was studied by comparing data from GloboDiet 24-hour dietary recalls and the DitEetIk app for the same day. Participants with implausible records, defined as days with energy intake of <0.6 or >3.0 basal metabolic rate, were excluded from the analyses. For 19 food groups and 29 nutrients, differences in median intake were assessed using the Wilcoxon signed rank test, and Spearman correlation coefficients were calculated. Bland-Altman plots with mean differences and 95\% limits of agreement were created for energy intake and the contribution to energy intake from fat, carbohydrates, and protein. Results: A total of 227 participants completed a combination of a DitEetIk! app recording day and a 24-hour dietary recall interview for the same day. Of this group, 211 participants (n=104, 49.3\% men and n=107, 50.7\% women) had plausible recording days. Of all recorded food items, 12.8\% (114/894) were entered via food barcode scanning, and 18.9\% (169/894) were searched at the brand level. For 31\% (5/16) of the food groups, the median intake assessed using the DitEetIk! app was >10\% lower than that assessed using 24-hour dietary recalls; this was the case for fruit (P=.005), added fats (P=.001), milk and milk products (P=.02), cereal products (P=.01), and sauces (P<.001). This was also the case for 14\% (4/29) of the nutrients (all P<.001). Regarding mean intake, differences were generally smaller. Regarding energy intake, the mean difference and 95\% limits of agreement were 14 kcal (?1096 to 1124). Spearman correlation coefficients between intake assessed using the DitEetIk! app and 24-hour dietary recalls ranged from 0.48 to 0.88 (median 0.78) for food groups and from 0.58 to 0.90 (median 0.72) for nutrients. Conclusions: Compared with GloboDiet 24-hour dietary recalls, the DitEetIk! app assessed similar mean energy intake levels but somewhat lower median intake levels for several food groups and nutrients. ", doi="10.2196/50196", url="https://mhealth.jmir.org/2024/1/e50196", url="http://www.ncbi.nlm.nih.gov/pubmed/38335009" } @Article{info:doi/10.2196/47177, author="Gunsilius, Zimmerman Chloe and Heffner, Joseph and Bruinsma, Sienna and Corinha, Madison and Cortinez, Maria and Dalton, Hadley and Duong, Ellen and Lu, Joshua and Omar, Aisulu and Owen, Whittington Lucy Long and Roarr, Nazario Bradford and Tang, Kevin and Petzschner, H. Frederike", title="SOMAScience: A Novel Platform for Multidimensional, Longitudinal Pain Assessment", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="12", volume="12", pages="e47177", keywords="acute pain", keywords="acute-chronic pain transition", keywords="chronic pain", keywords="clinical outcome measurement", keywords="digital health", keywords="ecological momentary assessment", keywords="EMA", keywords="ESM", keywords="experience sampling methodology", keywords="mHealth", keywords="mobile health", keywords="pain management", keywords="pain self-management", keywords="patient reported outcomes", keywords="smartphone app", doi="10.2196/47177", url="https://mhealth.jmir.org/2024/1/e47177", url="http://www.ncbi.nlm.nih.gov/pubmed/38214952" } @Article{info:doi/10.2196/45854, author="Piernas, Carmen and Lee, Charlotte and Hobson, Alice and Harmer, Georgina and Payne Riches, Sarah and Noreik, Michaela and Jebb, A. Susan", title="A Behaviorally Informed Mobile App to Improve the Nutritional Quality of Grocery Shopping (SwapSHOP): Feasibility Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="11", volume="12", pages="e45854", keywords="swaps", keywords="mobile app", keywords="supermarket", keywords="food purchases", keywords="diet", keywords="randomized controlled trial", keywords="mobile phone", abstract="Background: Interventions targeting the nutritional quality of grocery shopping have the potential to help improve diet and health outcomes. Objective: This study aims to assess the feasibility and acceptability of receiving advice on healthier food purchases through SwapSHOP, a behaviorally informed smartphone app that allows users to scan barcodes of grocery products from the United Kingdom, providing nutritional information and personalized swap suggestions to encourage healthier purchases. Methods: We randomized adult volunteers in a 6-arm parallel-group controlled feasibility trial. Participants used the SwapSHOP app to record their grocery shopping during a 2-week run-in period and were individually randomized in a 3:1 ratio to either intervention or control arms within 3 strata related to a nutrient of concern of their choice: saturated fat (SFA), sugar, or salt. Participants randomized to the intervention received the SwapSHOP app with a healthier swap function, goal setting, and personalized feedback. Participants in the control group were instructed to use a simpler version of the app to log all their food purchases without receiving any guidance or advice. The primary outcome was the feasibility of progression to a full trial, including app use and follow-up rates at 6 weeks. The secondary outcomes included other feasibility outcomes, process and qualitative measures, and exploratory effectiveness outcomes to assess changes in the nutrient content of the purchased foods. Results: A total of 112 participants were randomized into 3 groups: SFA (n=38 intervention and n=13 control), sugar (n=40 intervention and n=15 control), and salt (n=5 intervention and n=1 control, not analyzed). The 2 progression criteria were met for SFA and sugar: 81\% (30/37) and 87\% (34/39) of intervention participants in the SFA and sugar groups, respectively, used the app to obtain healthier swaps, and 89\% (68/76) of intervention participants and 96\% (23/24) of control participants completed follow-up by scanning all purchases over the follow-up period. The process and qualitative outcomes suggested that the intervention was acceptable and has the potential to influence shopping behaviors. There were reductions of ?0.56 g per 100 g (95\% CI ?1.02 to ?0.19) in SFA and ?1 g per 100 g (95\% CI ?1.97 to ?0.03) in total sugars across all food purchases in the intervention groups. Conclusions: People were willing to use the SwapSHOP app to help reduce sugar and SFA (but not salt) in their grocery shopping. Adherence and follow-up rates suggest that a full trial is feasible. Given the suggestive evidence indicating that the intervention resulted in reductions in sugars and SFA, a definitive trial is necessary to target improvements in health outcomes. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN13022312; https://doi.org/10.1186/ISRCTN13022312 ", doi="10.2196/45854", url="https://mhealth.jmir.org/2024/1/e45854", url="http://www.ncbi.nlm.nih.gov/pubmed/38206671" } @Article{info:doi/10.2196/46284, author="Gill, Roopan and Ogilvie, Gina and Norman, V. Wendy and Fitzsimmons, Brian and Maher, Ciana and Renner, Regina", title="Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study", journal="JMIR Form Res", year="2024", month="Jan", day="9", volume="8", pages="e46284", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="abortion", keywords="human-centered design", keywords="sexual and reproductive health", keywords="qualitative research", keywords="mixed methods", abstract="Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women's and Children's Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40\% (25/62) of the participants completed the exit surveys, and 24\% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88\% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80\%, with a click rate of 36\%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. ", doi="10.2196/46284", url="https://formative.jmir.org/2024/1/e46284", url="http://www.ncbi.nlm.nih.gov/pubmed/38194252" } @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/10.2196/47755, author="Albrink, Klara and Schr{\"o}der, Dominik and Joos, Carla and M{\"u}ller, Frank and Noack, Maria Eva", title="Usability of an App for Medical History Taking in General Practice From the Patients' Perspective: Cross-Sectional Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="5", volume="11", pages="e47755", keywords="digitization", keywords="application software", keywords="usability", keywords="mHealth", keywords="history of present illness", keywords="medical history taking", abstract="Background: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients' medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice's electronic medical record, allowing for the general practitioner to review structured information of the patients' complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. Objective: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients' perspective. Methods: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. Results: We analyzed data from 397 patients (56.7\% female, 43.3\% male). The mean total SUS score was 77.8 points; 54.4\% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. Conclusions: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. Trial Registration: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659 ", doi="10.2196/47755", url="https://humanfactors.jmir.org/2024/1/e47755", url="http://www.ncbi.nlm.nih.gov/pubmed/38180798" } @Article{info:doi/10.2196/47361, author="Cooray, Nipuna and Ho, Catherine and Bestman, Amy and Adams, Susan and Nassar, Natasha and Keay, Lisa and Brown, Julie", title="Exploring the Potential of a Behavior Theory--Informed Digital Intervention for Infant Fall Prevention: Mixed Methods Longitudinal Study", journal="JMIR Pediatr Parent", year="2024", month="Jan", day="3", volume="7", pages="e47361", keywords="child injury", keywords="digital behavior change interventions", keywords="user experience", keywords="falls", keywords="infant fall", keywords="injury", keywords="mobile app", keywords="digital intervention", keywords="users", keywords="mixed methods longitudinal study", keywords="behavior", keywords="development", keywords="fall risk", keywords="fall prevention", keywords="acceptability", keywords="app", keywords="children", keywords="internet", keywords="parents", keywords="maternal, paternal", keywords="accidents", keywords="infancy", keywords="infant", keywords="accidental fall", keywords="accidental falls", keywords="infant behavior", keywords="longitudinal design", keywords="mixed methods", keywords="parent", keywords="mobile phone", abstract="Background: Falls are the most common hospitalized injury mechanism in children aged ?1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. Objective: This study aims to evaluate a behavior theory--informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. Methods: Parents of infants aged <1 year were recruited and asked to use the intervention for 3 months. A pre-post longitudinal design was used to examine the change in the potential to reduce the risk of falls after a 3-month exposure to the intervention. Postintervention data on behavioral drivers for fall prevention, user acceptability, and engagement with the app were also collected. Interviews were conducted to explore user experiences and identify areas for further improvement of the intervention. Results: A total of 62 parents participated in the study. A statistically significant effect on the potential to reduce falls was observed after the intervention. This effect was higher for new parents. Parents agreed that the intervention targeted most of the target behavior drivers. The impact of behavior drivers and intervention on the potential for fall prevention had a positive correlation. The intervention demonstrated good levels of acceptability. Feedback from participants was mostly positive, and the primary area identified for further improvement was widening the scope of the intervention. Conclusions: This study demonstrated the promise of a newly developed digital intervention to reduce the risk of infant falls, particularly among new parents. It also showed a positive influence of the DBCI on the drivers of parental behaviors that are important for fall reduction among infants. The acceptability of the app was high, and important insights were gained from users about how to further improve the app. ", doi="10.2196/47361", url="https://pediatrics.jmir.org/2024/1/e47361", url="http://www.ncbi.nlm.nih.gov/pubmed/38170580" } @Article{info:doi/10.2196/49353, author="Young, Karen and Xiong, Ting and Lee, Rachel and Banerjee, Tina Ananya and Leslie, Myles and Ko, Yu Wellam and Pham, Quynh", title="User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study", journal="JMIR Hum Factors", year="2024", month="Jan", day="1", volume="11", pages="e49353", keywords="digital health", keywords="virtual care", keywords="digital therapeutics", keywords="prostate cancer", keywords="cancer survivorship", keywords="user-centred design", keywords="usability", keywords="supportive care", keywords="cultural adaptation", keywords="Chinese Canadians", abstract="Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants' desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. ", doi="10.2196/49353", url="https://humanfactors.jmir.org/2024/1/e49353", url="http://www.ncbi.nlm.nih.gov/pubmed/38163295" } @Article{info:doi/10.2196/48335, author="Folkvord, Frans and Bol, Nadine and Stazi, Giacomo and Peschke, Lutz and Lupi{\'a}{\~n}ez-Villanueva, Francisco", title="Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e48335", keywords="mHealth adoption", keywords="discrete choice task", keywords="mobile apps", keywords="self-monitoring", keywords="willingness", keywords="mobile health app", keywords="mobile app", keywords="mobile health", keywords="mHealth", keywords="adoption", keywords="mHealth tools", keywords="health care cost", keywords="effectiveness", keywords="mobile phone", abstract="Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals' preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: {\texteuro}1.99 vs {\texteuro}4.99 [a currency exchange rate of {\texteuro}1=US \$1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients' association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. ", doi="10.2196/48335", url="https://formative.jmir.org/2023/1/e48335", url="http://www.ncbi.nlm.nih.gov/pubmed/38145470" } @Article{info:doi/10.2196/46910, author="Hao, Jie and Yang, Lin and Wang, Yaxin and Lan, Yushan and Xu, Xiaowei and Wang, Ziyang and Li, Zanmei and Ma, Liangkun and Li, Jiao and Zhang, Suhan and Sun, Yin", title="Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="20", volume="11", pages="e46910", keywords="adverse pregnancy outcome", keywords="mobile prenatal education", keywords="pregnancy", keywords="real-world study", keywords="retrospective study", abstract="Background: Pregnancy is a pivotal phase in a woman's life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86\% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. ", doi="10.2196/46910", url="https://mhealth.jmir.org/2023/1/e46910", url="http://www.ncbi.nlm.nih.gov/pubmed/38117555" } @Article{info:doi/10.2196/41974, author="Tacey, Alexander and Behne, Jack and Patten, K. Rhiannon and Ngo, Truc Minh and Thomas, Rees and Ancilleri, Jessica and Bone, Chelsea and Paredes Castro, Angela and McCarthy, Helen and Harkin, Katherine and Gilmartin-Thomas, FM Julia and Takla, Amir and Downie, Calum and Mulcahy, Jane and Ball, Michelle and Sharples, Jenny and Dash, Sarah and Lawton, Amy and Wright, Breanna and Sleeth, Peter and Kostecki, Tina and Sonn, Christopher and McKenna, J. Michael and Apostolopoulos, Vasso and Lane, Rebecca and Said, M. Catherine and De Gori, Mary and McAinch, Andrew and Tran, Phong and Levinger, Itamar and Parker, Alexandra and Woessner, N. Mary and Pascoe, Michaela", title="Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study", journal="JMIR Form Res", year="2023", month="Dec", day="8", volume="7", pages="e41974", keywords="osteoarthritis", keywords="web intervention", keywords="eHealth", keywords="orthopedic waitlist", keywords="human-centered design", keywords="self-management", keywords="knee pain", keywords="hip pain", keywords="mobile phone", abstract="Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63\%; male: n=6, 38\%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64\%; male: n=4, 36\%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80\%; male: n=3, 20\%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial. ", doi="10.2196/41974", url="https://formative.jmir.org/2023/1/e41974", url="http://www.ncbi.nlm.nih.gov/pubmed/38064257" } @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/10.2196/51423, author="Pozuelo, R. Julia and Moffett, D. Bianca and Davis, Meghan and Stein, Alan and Cohen, Halley and Craske, G. Michelle and Maritze, Meriam and Makhubela, Princess and Nabulumba, Christine and Sikoti, Doreen and Kahn, Kathleen and Sodi, Tholene and and van Heerden, Alastair and O'Mahen, A. Heather", title="User-Centered Design of a Gamified Mental Health App for Adolescents in Sub-Saharan Africa: Multicycle Usability Testing Study", journal="JMIR Form Res", year="2023", month="Nov", day="30", volume="7", pages="e51423", keywords="depression", keywords="adolescents", keywords="mental health app", keywords="behavioral activation", keywords="user-centered design", keywords="low- and middle-income countries", keywords="mobile phone", abstract="Background: There is an urgent need for scalable psychological treatments to address adolescent depression in low-resource settings. Digital mental health interventions have many potential advantages, but few have been specifically designed for or rigorously evaluated with adolescents in sub-Saharan Africa. Objective: This study had 2 main objectives. The first was to describe the user-centered development of a smartphone app that delivers behavioral activation (BA) to treat depression among adolescents in rural South Africa and Uganda. The second was to summarize the findings from multicycle usability testing. Methods: An iterative user-centered agile design approach was used to co-design the app to ensure that it was engaging, culturally relevant, and usable for the target populations. An array of qualitative methods, including focus group discussions, in-depth individual interviews, participatory workshops, usability testing, and extensive expert consultation, was used to iteratively refine the app throughout each phase of development. Results: A total of 160 adolescents from rural South Africa and Uganda were involved in the development process. The app was built to be consistent with the principles of BA and supported by brief weekly phone calls from peer mentors who would help users overcome barriers to engagement. Drawing on the findings of the formative work, we applied a narrative game format to develop the Kuamsha app. This approach taught the principles of BA using storytelling techniques and game design elements. The stories were developed collaboratively with adolescents from the study sites and included decision points that allowed users to shape the narrative, character personalization, in-app points, and notifications. Each story consists of 6 modules (``episodes'') played in sequential order, and each covers different BA skills. Between modules, users were encouraged to work on weekly activities and report on their progress and mood as they completed these activities. The results of the multicycle usability testing showed that the Kuamsha app was acceptable in terms of usability and engagement. Conclusions: The Kuamsha app uniquely delivered BA for adolescent depression via an interactive narrative game format tailored to the South African and Ugandan contexts. Further studies are currently underway to examine the intervention's feasibility, acceptability, and efficacy in reducing depressive symptoms. ", doi="10.2196/51423", url="https://formative.jmir.org/2023/1/e51423", url="http://www.ncbi.nlm.nih.gov/pubmed/38032691" } @Article{info:doi/10.2196/41551, author="Khalemsky, Michael and Khalemsky, Anna and Lankenau, Stephen and Ataiants, Janna and Roth, Alexis and Marcu, Gabriela and Schwartz, G. David", title="Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation", journal="JMIR Mhealth Uhealth", year="2023", month="Nov", day="28", volume="11", pages="e41551", keywords="volunteer", keywords="emergency", keywords="dispatch", keywords="responder", keywords="smartphone", keywords="emergency response", keywords="smartphone-based apps", keywords="mobile phone apps", keywords="first responders", keywords="medical emergency", keywords="dispatch algorithms", keywords="dispatch decisions", keywords="dispatch prediction", keywords="smartphone app", keywords="decision-making", keywords="algorithm", keywords="mobile health", keywords="mHealth intervention", keywords="mobile phone", abstract="Background: Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17\% to 47\%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. Objective: This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. Methods: We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. Results: The highest accuracy (260/329, 79.1\%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4\%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2\%) of ignored alerts but a low-accuracy prediction (153/329, 46.5\%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. Conclusions: VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives. ", doi="10.2196/41551", url="https://mhealth.jmir.org/2023/1/e41551", url="http://www.ncbi.nlm.nih.gov/pubmed/38015602" } @Article{info:doi/10.2196/48040, author="Mallafr{\'e}-Larrosa, Meritxell and Papi, Ginevra and Trilla, Antoni and Ritchie, David", title="Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study", journal="JMIR Cancer", year="2023", month="Nov", day="28", volume="9", pages="e48040", keywords="adolescent health", keywords="cancer prevention", keywords="digital health", keywords="ECAC", keywords="European Code Against Cancer", keywords="health promotion", keywords="mHealth", keywords="mobile app", keywords="mobile health", keywords="NCD", keywords="noncommunicable disease", keywords="primary prevention", abstract="Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion,?app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7\%). Most app users identified themselves as nonsmokers (689/748, 92.1\%), reported either no or infrequent alcohol consumption (432/748, 57.8\% and 250/748, 33.4\%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5\%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8\% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95\% CI 0.809-0.954 and odds ratio 0.835, 95\% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. ", doi="10.2196/48040", url="https://cancer.jmir.org/2023/1/e48040", url="http://www.ncbi.nlm.nih.gov/pubmed/38015612" } @Article{info:doi/10.2196/48950, author="Lunde, Pernille and Skoglund, Gyri and Olsen, Fromholt Cecilie and Hilde, Gunvor and Bong, Kiat Way and Nilsson, Blakstad Birgitta", title="Think Aloud Testing of a Smartphone App for Lifestyle Change Among Persons at Risk of Type 2 Diabetes: Usability Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="15", volume="10", pages="e48950", keywords="mHealth", keywords="mobile phone app", keywords="smartphone", keywords="lifestyle", keywords="usability", keywords="diabetes", keywords="diabetic", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="think-aloud", keywords="think aloud", keywords="user experience", keywords="mobile phone", abstract="Background: Type 2 diabetes mellitus (DM2) is a leading cause of morbidity and mortality worldwide and is considered a global epidemic. Despite the growing evidence on the effectiveness of mobile health interventions in the management of DM2, the evidence on the effect of mobile health interventions in prevention of DM2 is sparse. Therefore, we have developed an app aiming to promote initiation of behavioral change and adherence to healthy behavior. Before commencing a small-scale randomized controlled trial to assess the feasibility of using an app for initiation and adherence of healthy behavior in people at risk of DM2, testing the usability of the app in the target population is warranted. Objective: The aim of this study was to assess the usability of an app among people at risk of DM2. Methods: A qualitative study with the use of a think aloud (TA) procedure was conducted from April to November 2022. The TA procedure consisted of 10 problem-solving tasks and a semistructured interview which was carried out after the tasks. These interviews served to gain more in-depth knowledge of the users experience of the problem-solving tasks. The TA-sessions and the postactivity interviews were recorded and transcribed verbatim, and the data were coded and analyzed following the principles of thematic analysis. Results: In total, 7 people at risk of DM2 with a median age of 66 (range 41-75) years participated in this study. The analysis resulted in the following themes: (1) user interface design; and (2) suggestions for improvements of the functionality of the app. Conclusions: Overall, the participants were satisfied with the usability of the app. Through the TA-sessions, real time perspective on the appeal, relevance, and utility of the app were gained. Only minor changes to the functionality of the prototype app were reported as necessary to improve the usability of the app. Points of guidance from the participants in this study have been adopted and incorporated into the final design of the app now being assessed for feasibility in a small-scale randomized controlled trial. ", doi="10.2196/48950", url="https://humanfactors.jmir.org/2023/1/e48950", url="http://www.ncbi.nlm.nih.gov/pubmed/37966894" } @Article{info:doi/10.2196/48671, author="Feldacker, Caryl and Mugwanya, Raymond and Irongo, Daniel and Kathumba, Daneck and Chiwoko, Jane and Kitsao, Emmanuel and Sippell, Kenn and Wasunna, Beatrice and Jonas, Kingsley and Samala, Bernadette and Mwakanema, Daniel and Oni, Femi and Jafa, Krishna and Tweya, Hannock", title="A Community-Based, Mobile Electronic Medical Record System App for High-Quality, Integrated Antiretroviral Therapy in Lilongwe, Malawi: Design Process and Pilot Implementation", journal="JMIR Form Res", year="2023", month="Nov", day="10", volume="7", pages="e48671", keywords="antiretroviral therapy", keywords="differentiated service delivery", keywords="digital innovations", keywords="Malawi", keywords="mobile electronic medical record systems", keywords="monitoring and evaluation", abstract="Background: Differentiated service delivery (DSD) increases antiretroviral therapy (ART) access in sub-Saharan Africa by moving clients out of congested ART clinics to communities for care. However, DSD settings challenge provider adherence to complex, chronic care treatment guidelines and have burdensome systems for client monitoring and evaluation (M\&E), reducing data for decision-making. Electronic medical record systems (EMRS) improve client outcomes and reduce M\&E workload. Traditional EMRS cannot operate in most DSD settings with unreliable power and poor connectivity. Objective: This study aims to detail the human-centered design (HCD) process of developing a mobile EMRS for community-based DSD services in Lilongwe, Malawi. Methods: Lighthouse Trust (LT) operates 2 Ministry of Health (MoH) clinics in Lilongwe, Malawi, with a combined total of >35,000 ART clients. LT's real-time, point-of-care EMRS collects complex client M\&E data and provides decision-making support, ensuring adherence to integrated HIV and tuberculosis guidelines that optimize client and program outcomes. LT's EMRS scaled to all large MoH ART clinics. LT also implements a nurse-led community-based ART program (NCAP), a DSD model to provide ART and rapid assessment for 2400 stable LT clients in the community. LT, alongside collaborators, from the University of Washington's International Training and Education Center for Health and technology partner, Medic, used the open-source Community Health Toolkit (CHT) and HCD to develop an open-source, offline-first, mobile EMRS-like app, ``community-based ART retention and suppression'' (CARES). CARES aims to bring EMRS-like provider benefits to NCAP's DSD clients. Results: CARES design took approximately 12 months and used an iterative process of highly participatory feedback sessions with provider, data manager, and M\&E team inputs to ensure CARES optimization for the NCAP and LT settings. The CARES mobile EMRS prototype supports NCAP providers with embedded prompts and alerts to ensure adherence to integrated MoH ART guidelines, aiming to improve the quality of client care. CARES facilitates improved data quality and flow for NCAP M\&E, aiming to reduce data gaps between community and clinic settings. The CARES pilot demonstrates the potential of a mobile, point-of-care EMRS-like app that could benefit NCAP clients, providers, and program teams with integrated client care and complete M\&E data for decision-making. CARES challenges include app speed, search features to align longitudinal records, and CARES to EMRS integration that supports timely care alerts. Conclusions: Leveraging the CHT and HCD processes facilitated the design of a locally specified and optimized mobile app with the promise to bring EMRS-like benefits to DSD settings. Moving from the CARES prototype to routine NCAP implementation should result in improved client care and strengthened M\&E while reducing workload. Our transparent and descriptive process shares the progress and pitfalls of the CARES design and development, helping others in this digital innovation area to learn from our experiences at this stage. ", doi="10.2196/48671", url="https://formative.jmir.org/2023/1/e48671", url="http://www.ncbi.nlm.nih.gov/pubmed/37948102" } @Article{info:doi/10.2196/50038, author="Premanandan, Shweta and Ahmad, Awais and Cajander, {\AA}sa and {\AA}gerfalk, P{\"a}r and Dolezel, Michal and van Gemert-Pijnen, Lisette", title="Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model", journal="JMIR Mhealth Uhealth", year="2023", month="Nov", day="9", volume="11", pages="e50038", keywords="e-coaching", keywords="mobile health", keywords="mHealth", keywords="immigrant informal caregivers", keywords="designing app", keywords="persuasive system design", keywords="user needs", keywords="caregiver", keywords="app", keywords="design", keywords="users", keywords="aging", keywords="development", keywords="diversity", keywords="language barrier", keywords="inclusion", keywords="training", keywords="mental health", keywords="mobile phone", abstract="Background: Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. Objective: This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. Methods: The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Results: Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding ``facilitating conditions'' and ``verbal encouragement'' as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. Conclusions: This study revealed important immigrant informal caregivers' needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving. ", doi="10.2196/50038", url="https://mhealth.jmir.org/2023/1/e50038", url="http://www.ncbi.nlm.nih.gov/pubmed/37943598" } @Article{info:doi/10.2196/50304, author="Soehnchen, Clarissa and Rietz, Annika and Weirauch, Vera and Meister, Sven and Henningsen, Maike", title="Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis", journal="JMIR Form Res", year="2023", month="Nov", day="3", volume="7", pages="e50304", keywords="sexual health information", keywords="sexual health education", keywords="sub-Saharan Africa", keywords="women", keywords="semistructured interviews", keywords="requirements engineering analysis", keywords="user-centered design", keywords="youth, slum", keywords="health education", keywords="sexual health", keywords="digital health", keywords="stigmatization", keywords="reproductive health services", abstract="Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. ", doi="10.2196/50304", url="https://formative.jmir.org/2023/1/e50304", url="http://www.ncbi.nlm.nih.gov/pubmed/37921860" } @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/10.2196/49471, author="Abahussin, A. Asma and West, M. Robert and Wong, C. David and Ziegler, E. Lucy and Allsop, J. Matthew", title="Supporting Pain Self-Management in Patients With Cancer: App Development Based on a Theoretical and Evidence-Driven Approach", journal="JMIR Cancer", year="2023", month="Oct", day="9", volume="9", pages="e49471", keywords="pain", keywords="cancer", keywords="behavior change", keywords="capability, opportunity, motivation, and behavior model", keywords="COM-B model", keywords="Behavior Change Wheel", keywords="BCW", keywords="mobile health", keywords="mHealth", keywords="app", keywords="pain self-management", keywords="evidence-based", keywords="intervention design", keywords="theory", abstract="Background: To inform the development of an intervention, it is essential to have a well-developed theoretical understanding of how an intervention causes change, as stated in the UK Medical Research Council guidelines for developing complex interventions. Theoretical foundations are often ignored in the development of mobile health apps intended to support pain self-management for patients with cancer. Objective: This study aims to systematically set a theory- and evidence-driven design for a pain self-management app and specify the app's active features. Methods: The Behavior Change Wheel (BCW) framework, a step-by-step theoretical approach to the development of interventions, was adopted to achieve the aim of this study. This started by understanding and identifying sources of behavior that could be targeted to support better pain management. Ultimately, the application of the BCW framework guided the identification of the active contents of the app, which were characterized using the Behavior Change Technique Taxonomy version 1. Results: The theoretical analysis revealed that patients may have deficits in their capability, opportunity, and motivation that prevent them from performing pain self-management. The app needs to use education, persuasion, training, and enablement intervention functions because, based on the analysis, they were found the most likely to address the specified factors. Eighteen behavior change techniques were selected to describe precisely how the intervention functions can be presented to induce the desired change regarding the intervention context. In other words, they were selected to form the active contents of the app, potentially reducing barriers and serving to support patients in the self-management of pain while using the app. Conclusions: This study fully reports the design and development of a pain self-management app underpinned by theory and evidence and intended for patients with cancer. It provides a model example of the BCW framework application for health app development. The work presented in this study is the first systematic theory- and evidence-driven design for a pain app for patients with cancer. This systematic approach can support clarity in evaluating the intervention's underlying mechanisms and support future replication. ", doi="10.2196/49471", url="https://cancer.jmir.org/2023/1/e49471", url="http://www.ncbi.nlm.nih.gov/pubmed/37812491" } @Article{info:doi/10.2196/48395, author="Metzler-Baddeley, Claudia and Busse, Monica and Drew, Cheney and Pallmann, Philip and Cantera, Jaime and Ioakeimidis, Vasileios and Rosser, Anne", title="HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study", journal="JMIR Form Res", year="2023", month="Oct", day="6", volume="7", pages="e48395", keywords="Huntington disease", keywords="electronic health", keywords="intervention", keywords="training application", keywords="rhythm", keywords="timing", keywords="drumming", keywords="movement", keywords="cognition", keywords="integrated knowledge translation", keywords="gamification", keywords="Template for Intervention Description and Replication (TIDieR)", keywords="TIDieR", keywords="mobile phone", abstract="Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users' performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. ", doi="10.2196/48395", url="https://formative.jmir.org/2023/1/e48395", url="http://www.ncbi.nlm.nih.gov/pubmed/37801351" } @Article{info:doi/10.2196/48372, author="Young, P. Nathan and Ridgeway, L. Jennifer and Haddad, C. Tufia and Harper, B. Sarah and Philpot, M. Lindsey and Christopherson, A. Laura and McColley, M. Samantha and Phillips, A. Sarah and Brown, K. Julie and Zimmerman, S. Kelly and Ebbert, O. Jon", title="Feasibility and Usability of a Mobile App--Based Interactive Care Plan for Migraine in a Community Neurology Practice: Development and Pilot Implementation Study", journal="JMIR Form Res", year="2023", month="Oct", day="5", volume="7", pages="e48372", keywords="migraine", keywords="mobile app", keywords="smartphone", keywords="care model", keywords="feasibility", keywords="usability", keywords="digital health", keywords="remote monitoring", keywords="care plan", keywords="pilot", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="patient-reported outcomes", abstract="Background: Migraine is a common and major cause of disability, poor quality of life, and high health care use. Access to evidence-based migraine care is limited and projected to worsen. Novel mobile health app--based tools may effectively deliver migraine patient education to support self-management, facilitate remote monitoring and treatment, and improve access to care. The risk that such an intervention may increase the care team workload is a potential implementation barrier. Objective: This study aims to describe a novel electronic health record--integrated mobile app--based Migraine Interactive Care Plan (MICP) and evaluate its feasibility, usability, and impact on care teams in a community neurology practice. Methods: Consecutive enrollees between September 1, 2020, and February 16, 2022, were assessed in a single-arm observational study of usability, defined by 74.3\% (127/171) completing ?1 assigned task. Task response rates, rate and type of care team escalations, and patient-reported outcomes were summarized. Patients were prospectively recruited and randomly assigned to routine care with or without the MICP from September 1, 2020, to September 1, 2021. Feasibility was defined by equal to or fewer downstream face-to-face visits, telephone contacts, and electronic messages in the MICP cohort. The Wilcoxon rank-sum test was used to compare continuous variables, and the chi-square test was used for categorical variables for those with at least 3 months of follow-up. Results: A total of 171 patients were enrolled, and of these, 127 (74.3\%) patients completed ?1 MICP-assigned task. Mean escalations per patient per month was 0.9 (SD 0.37; range 0-1.7). Patient-confirmed understanding of the educational materials ranged from 26.6\% (45/169) to 56.2\% (95/169). Initial mean headache days per week was 4.54 (SD 2.06) days and declined to 2.86 (SD 1.87) days at week 26. The percentage of patients reporting favorable satisfaction increased from a baseline of 35\% (20/57) to 83\% (15/18; response rate of 42/136, 30.9\% to 28/68, 41\%) over the first 6 months. A total of 121 patients with MICP were compared with 62 patients in the control group. No differences were observed in the rate of telephone contacts or electronic messages. Fewer face-to-face visits were observed in the MICP cohort (13/121, 10.7\%) compared with controls (26/62, 42\%; P<.001). Conclusions: We describe the successful implementation of an electronic health record--integrated mobile app--based care plan for migraine in a community neurology practice. We observed fewer downstream face-to-face visits without increasing telephone calls, medication refills, or electronic messages. Our findings suggest that the MICP has the potential to improve patient access without increasing care team workload and the need for patient input from diverse populations to improve and sustain patient engagement. Additional studies are needed to assess its impact in primary care. ", doi="10.2196/48372", url="https://formative.jmir.org/2023/1/e48372", url="http://www.ncbi.nlm.nih.gov/pubmed/37796560" } @Article{info:doi/10.2196/49998, author="Giovanelli, Alison and Sanchez Karver, Tahilin and Roundfield, D. Katrina and Woodruff, Sean and Wierzba, Catherine and Wolny, J. and Kaufman, R. Michelle", title="The Appa Health App for Youth Mental Health: Development and Usability Study", journal="JMIR Form Res", year="2023", month="Oct", day="4", volume="7", pages="e49998", keywords="digital mental health", keywords="youth mentoring", keywords="cognitive behavioral therapy", keywords="teenager", keywords="adolescent", keywords="mobile phone", abstract="Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa's 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers' characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100\% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85\% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. ", doi="10.2196/49998", url="https://formative.jmir.org/2023/1/e49998", url="http://www.ncbi.nlm.nih.gov/pubmed/37792468" } @Article{info:doi/10.2196/42851, author="Min, Beomjun and Park, Heyeon and Kim, Inhyang Johanna and Lee, Sungmin and Back, Soyoung and Lee, Eunhwa and Oh, Sohee and Yun, Je-Yeon and Kim, Bung-Nyun and Kim, Yonghoon and Hwang, JungHyun and Lee, Sanghyop and Kim, Jeong-Hyun", title="The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Oct", day="3", volume="11", pages="e42851", keywords="mindfulness", keywords="neurofeedback", keywords="stress", keywords="resilience", keywords="mobile app", keywords="employee", abstract="Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study's core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald $\chi$22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time {\texttimes} group, Wald $\chi$42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time {\texttimes} group, Wald $\chi$22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM --0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 ", doi="10.2196/42851", url="https://mhealth.jmir.org/2023/1/e42851", url="http://www.ncbi.nlm.nih.gov/pubmed/37788060" } @Article{info:doi/10.2196/44696, author="Holuszko, May Olivia and Abdulcadir, Jasmine and Abbott, Daisy and Clancy, Jennifer", title="Health Care Providers' Readiness to Adopt an Interactive 3D Web App in Consultations About Female Genital Mutilation/Cutting: Qualitative Evaluation of a Prototype", journal="JMIR Form Res", year="2023", month="Sep", day="28", volume="7", pages="e44696", keywords="FGM/C", keywords="3D", keywords="interactive", keywords="patients", keywords="consultation", keywords="web app", keywords="health care provider", keywords="female genital mutilation or cutting", keywords="vulva", keywords="anatomy", abstract="Background: Comprehensive and appropriate health care provision to women and girls with female genital mutilation or cutting (FGM/C) is lacking. Use of visuals in health care provider (HCP) consultations facilitates the communication of health information and its comprehension by patients. A web app featuring a 3D visualization of the genitourinary anatomy was developed to support HCPs in conferring clinical information about FGM/C to patients. Objective: The aim of this study was to explore HCP perspectives on the use of visuals in discussion about FGM/C with their patients as well as to obtain their feedback on whether an interactive 3D web app showing the genitourinary anatomy would be helpful in patient consultations about FGM/C, identifying key features that are relevant to their clinical practice. Methods: We evaluated the web app through a semistructured interview protocol with seven HCPs from various disciplines experienced in care for women and girls with FGM/C in migration-destination settings. Interviews were audio- and video-recorded for transcription, and were then analyzed thematically for contextualized data regarding HCPs' willingness to use a 3D web app visualizing anatomy in FGM/C consultations with patients. Results: All but one of the seven participants expressed keen interest in using this web app and its 3D visuals of anatomy in FGM/C consultations with patients. Participants shared the common contexts for the use of visuals in health care for FGM/C and the concepts they are used to support, such as to help describe a patient's genitals after FGM/C and reinforce an understanding of clitoral anatomy, to illustrate the process of defibulation, or to explain the physiological effects of FGM/C. Participants also highlighted the benefit of using visuals that patients can relate to, expressing approval for the ability to customize the vulva by FGM/C subtype, skin tone, and complexity of the visual shown in the web app. Despite critiques that the visualization may serve to perpetuate idealistic standards for how a vulva should look, participants largely agreed on the web app's perceived usefulness to clinical practice and beyond. Conclusions: Evaluation of the web app developed in this study identified that digital tools with 3D models of the genitourinary anatomy that are accessible, informative, and customizable to any specific patient are likely to aid HCPs in communicating clinical information about FGM/C in consultations. Universal access to the web app may be particularly useful for HCPs with less experience in FGM/C. The app also prompts options for applications such as for personal use, in medical education, in patient medical records, or in legal settings. Further qualitative research with patients is required to confirm that adoption of the web app by HCPs in a consultation setting will indeed benefit patient care for women and girls with FGM/C. ", doi="10.2196/44696", url="https://formative.jmir.org/2023/1/e44696", url="http://www.ncbi.nlm.nih.gov/pubmed/37768712" } @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/10.2196/49668, author="Sideropoulos, Vassilis and Vangeli, Eleni and Naughton, Felix and Cox, Sharon and Frings, Daniel and Notley, Caitlin and Brown, Jamie and Kimber, Catherine and Dawkins, Lynne", title="Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study", journal="JMIR Form Res", year="2023", month="Sep", day="27", volume="7", pages="e49668", keywords="coproduction", keywords="SMS text messages", keywords="e-cigarette", keywords="smoking", keywords="eHealth", keywords="vaping", keywords="mobile phone", keywords="codevelopment", keywords="text message", abstract="Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation--Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7\% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2\% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5\% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8\% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found ($\chi$21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28\%) and encouraging (6/47, 13\%) and the 2 most common negative themes were too frequent (9/47, 19\%) and annoying (4/47, 9\%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. ", doi="10.2196/49668", url="https://formative.jmir.org/2023/1/e49668", url="http://www.ncbi.nlm.nih.gov/pubmed/37756034" } @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/10.2196/46738, author="B{\"o}ttinger, J. Melissa and Litz, Elena and Gordt-Oesterwind, Katharina and Jansen, Carl-Philipp and Memmer, Nicole and Mychajliw, Christian and Radeck, Leon and Bauer, M. J{\"u}rgen and Becker, Clemens", title="Co-Creating a Digital Life-Integrated Self-Assessment for Older Adults: User Experience Study", journal="JMIR Aging", year="2023", month="Sep", day="26", volume="6", pages="e46738", keywords="aged", keywords="self-assessment", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="community-based participatory research", keywords="co-creation", keywords="comprehensive geriatric assessment", keywords="mobile phone", abstract="Background: Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a preclinical stage, thereby facilitating preventive efforts and targeted intervention. For this purpose, a Life-integrated Self-Assessment (LiSA) tablet system will be developed through a structured co-creation process. Objective: This study aims to investigate older adults' perceptions of different self-assessment domains, components affecting user experience, risks and benefits associated with LiSA, characteristics of potential LiSA users, and the LiSA concept in general. Methods: A total of 10 community-dwelling older adults aged ?70 years were recruited. In total, 6 co-creation workshops were held and started with expert input followed by semistructured discussion rounds. Participants performed hands-on activities with a tablet, including testing of preinstalled self-assessment apps. All workshops were audio recorded and additionally documented by the researchers using flipcharts, notes, and photos. Qualitative content analysis was used to analyze the data following a deductive-inductive approach guided by the Optimized Honeycomb Model for user experience. Results: The group (mean age 77.8, SD 5.1 years) was heterogeneous in terms of previous technology experience and health status. The mean workshop duration was 2 hours (122.5, SD 4.43 min), and an average of 8 (SD 1.15) participants attended each workshop. A total of 11 thematic categories were identified, covering results on all research questions. Participants emphasized a strong interest in conducting a digital self-assessment of physical activity and function and sensory and cognitive functions and requested additional features such as recommendations for actions or reminders. LiSA was perceived as empowering and a motivator to engage in active health care planning as well as enabling shared and informed decision-making. Concerns and barriers included the lack of technical competence, feelings of frustration, and fear of being left alone, with negative assessment results. In essence, participants expressed a positive attitude toward using LiSA repeatedly and identified it as an option to increase the chances of maintaining independence when growing older. Conclusions: The co-creation participants supported the LiSA approach and were interested in performing regular self-assessments on a long-term basis. In their opinion, LiSA should include relevant assessments capturing physical activity and function and sensory and cognitive functions as well as recommendations for actions. It should be customizable to individual needs. These results will form the basis for a prototype. Iterative development and validation will aim to make LiSA accessible in the public domain as a reliable tablet-based system for self-assessment. ", doi="10.2196/46738", url="https://aging.jmir.org/2023/1/e46738", url="http://www.ncbi.nlm.nih.gov/pubmed/37751274" } @Article{info:doi/10.2196/43186, author="Gomez-Hernandez, Miguel and Ferre, Xavier and Moral, Cristian and Villalba-Mora, Elena", title="Design Guidelines of Mobile Apps for Older Adults: Systematic Review and Thematic Analysis", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="21", volume="11", pages="e43186", keywords="tablet", keywords="smartphone", keywords="older user", keywords="design recommendations", keywords="usability testing", keywords="user experience design", keywords="UX design", keywords="design", keywords="mobile app", keywords="tool", keywords="quality of life", keywords="software", keywords="training", keywords="visual design", keywords="older adults", keywords="mobile phone", abstract="Background: Mobile apps are fundamental tools in today's society for practical and social endeavors. However, these technologies are often not usable for older users. Given the increased use of mobile apps by this group of users and the impact that certain services may have on their quality of life, such as mobile health, personal finance, or online administrative procedures, a clear set of guidelines for mobile app designers is needed. Existing recommendations for older adults focus on investigations with certain groups of older adults or have not been extracted from experimental results. Objective: In this research work, we systematically reviewed the scientific literature that provided recommendations for the design of mobile apps based on usability testing with older adults and organized such recommendations into a meaningful set of design guidelines. Methods: We conducted a systematic literature review of journal and conference articles from 2010 to 2021. We included articles that carried out usability tests with populations aged >60 years and presented transferable guidelines on mobile software design, resulting in a final set of 40 articles. We then carried out a thematic analysis with 3 rounds of analysis to provide meaning to an otherwise diverse set of recommendations. At this stage, we discarded recommendations that were made by just 1 article, were based on a specific mobile app and were therefore nontransferrable, were based on other authors' literature (as opposed to recommendations based on the results of usability tests), or were not sufficiently argued. With the remaining recommendations, we identified commonalities, wrote a faithful statement for each guideline, used a common language for the entire set, and organized the guidelines into categories, thereby giving shape to an otherwise diverse set of recommendations. Results: Among the 27 resulting guidelines, the rules Simplify and Increase the size and distance between interactive controls were transversal and of the greatest significance. The rest of the guidelines were divided into 5 categories (Help \& Training, Navigation, Visual Design, Cognitive Load, and Interaction) and consequent subcategories in Visual Design (Layout, Icons, and Appearance) and Interaction (Input and Output). The recommendations were structured, explained in detail, and illustrated with applied examples extracted from the selected studies, where appropriate. We discussed the design implications of applying these guidelines, contextualized with relevant studies. We also discussed the limitations of the approach followed, stressing the need for further experimentation to gain a better understanding of how older adults use mobile apps and how to better design such apps with these users in mind. Conclusions: The compiled guidelines support the design of mobile apps that cater to the needs of older adults because they are based on the results of actual usability tests with users aged >60 years. ", doi="10.2196/43186", url="https://mhealth.jmir.org/2023/1/e43186", url="http://www.ncbi.nlm.nih.gov/pubmed/37733401" } @Article{info:doi/10.2196/51055, author="Jones, Jeb and Butler, Gareth and Woody, Meaghan and Castel, D. Amanda and Kulie, Paige and Sheets, Martha and Scheim, I. Ayden and Reisner, L. Sari and Valencia, Rachel and Wang, Minglun and Stekler, D. Joanne and Sullivan, S. Patrick and Stephenson, Rob", title="Preferences for and Experiences of an HIV-Prevention Mobile App Designed for Transmasculine People: Pilot Feasibility Trial and Qualitative Investigation", journal="JMIR Form Res", year="2023", month="Sep", day="21", volume="7", pages="e51055", keywords="transmasculine", keywords="HIV", keywords="mHealth", keywords="preference", keywords="prevention", keywords="mobile app", keywords="transgender", keywords="STI", keywords="meta-analyses", keywords="app-based intervention", keywords="cisgender", keywords="sexual health", keywords="sexual risk behavior", keywords="smartphone", abstract="Background: Transmasculine people are at risk for HIV; yet few HIV prevention interventions have been developed for this population. We adapted an existing HIV prevention smartphone app for cisgender men who have sex with men to meet the sexual health needs of transmasculine people. Objective: This study aims to assess the acceptability of the adapted app, Transpire, among transmasculine people living in Atlanta, Georgia, and Washington, DC, via in-depth interviews of participants in a pilot feasibility trial. Methods: Participants used the Transpire app for 3 months as part of a pilot study of the app. Eligible participants were aged 18-34 years. There were no eligibility criteria with respect to race and ethnicity, and most participants were non-Hispanic White. At the end of the follow-up, participants were invited to participate in web-based in-depth interviews to discuss their experiences using the app and feedback on design and content. Interviews were transcribed and coded using a constant comparative approach. Three main themes were identified: sexual behavior, app experiences and feedback, and pre-exposure prophylaxis. Results: Overall, participants found the app acceptable and thought that it would be a useful tool for themselves and their peers. Participants reported appreciating having a comprehensive information source available to them on their phones and reported learning more about HIV, sexually transmitted infections, and pre-exposure prophylaxis via the app. They also reported appreciating the inclusive language that was used throughout the app. Although the app included some resources on mental health and substance use, participants reported that they would have appreciated more resources and information in these areas as well as more comprehensive information about other health concerns, including hormone therapy. Representative quotes are presented for each of the identified themes. Conclusions: There is a desire to have greater access to reliable sexual health information among transmasculine people. Mobile apps like Transpire are an acceptable intervention to increase access to this information and other resources. More evidence is needed, however, from more racially and ethnically diverse samples of transmasculine people. ", doi="10.2196/51055", url="https://formative.jmir.org/2023/1/e51055", url="http://www.ncbi.nlm.nih.gov/pubmed/37733430" } @Article{info:doi/10.2196/45490, author="Pienkowska, Anita and Ang, Chin-Siang and Mammadova, Maleyka and Mahadzir, Azlan Muhammad Daniel and Car, Josip", title="A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study", journal="JMIR Form Res", year="2023", month="Sep", day="18", volume="7", pages="e45490", keywords="diabetes", keywords="health apps", keywords="co-design", keywords="chatbot", keywords="type 2 diabetes", keywords="self-management", keywords="mobile health", keywords="mHealth", keywords="chronic disease", keywords="digital education", keywords="mobile phone", abstract="Background: Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. Objective: The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. Methods: A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. Results: Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. Conclusions: Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life. ", doi="10.2196/45490", url="https://formative.jmir.org/2023/1/e45490", url="http://www.ncbi.nlm.nih.gov/pubmed/37721799" } @Article{info:doi/10.2196/45957, author="Wagner, Liliana and Corona, Laura and Khan, Nibraas and Hooper, Madison and Dixon, Alexa and Munoz Lavanderos, Ambar and Zheng, Zhaobo and Sarkar, Nandan and Sarkar, Nilanjan and Warren, Zachary", title="Development of an App for Tracking Family Engagement With Early Intervention Services: Focus Groups and Pilot Evaluation Study", journal="JMIR Hum Factors", year="2023", month="Sep", day="12", volume="10", pages="e45957", keywords="mobile health", keywords="early intervention", keywords="families", keywords="mobile phone", keywords="autism", keywords="focus groups", abstract="Background: Expedient access to early intervention (EI) systems has been identified as a priority for children with developmental delays, identified disabilities, and other special health care needs. Despite the mandated availability of EI, it remains challenging for families to navigate referral processes and establish appropriate services. Such challenges disproportionately affect families from traditionally underserved communities. Mobile health apps can improve clinical outcomes, increase accessibility to health services, and promote adherence to health-related interventions. Though promising, the implementation of apps within routine care is in its infancy, with limited research examining the components of what makes an effective app or how to reach families most impacted by inequities in health care delivery. Objective: In study 1, we conducted focus groups to access a broad range of perspectives on the process of navigating the EI system, with the dual goals of identifying ways in which a patient-facing app might facilitate this process and identifying barriers to use with traditionally underrepresented and underserved groups. In study 2, focus group findings informed the development of a patient-facing app, which was subsequently tested with a pilot sample of 5 families. Methods: In study 1, the focus groups included 29 participants from 4 shareholder groups. Targeted sampling was used to recruit participants from traditionally underrepresented groups. Focus group questions sought information about barriers families experience as they navigate the EI system, ideal features of a patient-facing app designed to track family engagement with the EI system, and potential barriers. Focus group procedures were informed by the Consolidated Framework for Implementation Research framework. In study 2, a pilot app was developed. The app was tested with a sample of 5 families of young children involved in the EI system. Families provided information on app functionality and usability. Results: Qualitative analysis revealed a desire for increased communication and information about the process of accessing EI services, potential utility of an app for communication purposes, and clear recommendations for app features. Insights from focus groups were used to inform the development of the Family on Track app and related implementation supports. App features included survey customization, timing and delivery of prompts, and questions related to barriers and service satisfaction. Implementation supports include a visual guide for app installation, resources related to common family questions, and availability of study personnel to guide families through installation and provide ongoing support. Field testing provided preliminary information about app usability, including identifying future directions. Conclusions: The results of this study could support the development of a new way for the EI system to communicate and connect with families, provide families with a means to communicate satisfaction and frustration, and access the supports they need to be active participants in their child's care. ", doi="10.2196/45957", url="https://humanfactors.jmir.org/2023/1/e45957", url="http://www.ncbi.nlm.nih.gov/pubmed/37698912" } @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/10.2196/47183, author="Prochaska, J. Judith and Wang, Yixin and Bowdring, A. Molly and Chieng, Amy and Chaudhary, P. Neha and Ramo, E. Danielle", title="Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study", journal="JMIR Mhealth Uhealth", year="2023", month="Aug", day="28", volume="11", pages="e47183", keywords="adolescents", keywords="mobile app", keywords="depression", keywords="anxiety", keywords="resilience", keywords="digital intervention", keywords="digital mental health", keywords="mobile phone", abstract="Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people's mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents' mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72\% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization--Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe's content (12,270/13,421, 91.42\%), mood ratings (13,094/13,421, 97.56\%), and interactive skills (10,098/13,421, 75.24\%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92\%), clinical resources (2411/13,421, 17.96\%), and crisis support resources (2499/13,421, 18.62\%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8\% rated as helpful and 1044/1139, 91.66\% improved coping self-efficacy), activities (5362/8468, 63.32\% helpful and 4408/6072, 72.6\% useful in coping with big feelings), and coaching (747/894, 83.6\% helpful and 747/894, 83.6\% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe's content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. ", doi="10.2196/47183", url="https://mhealth.jmir.org/2023/1/e47183", url="http://www.ncbi.nlm.nih.gov/pubmed/37639293" } @Article{info:doi/10.2196/45694, author="An, Qingfan and Kelley, M. Marjorie and Hanners, Audra and Yen, Po-Yin", title="Sustainable Development for Mobile Health Apps Using the Human-Centered Design Process", journal="JMIR Form Res", year="2023", month="Aug", day="25", volume="7", pages="e45694", keywords="mHealth", keywords="mobile health", keywords="apps", keywords="human-centered design", keywords="sociotechnical", keywords="sustainability", keywords="mobile technology", keywords="speculative design", keywords="mobile phone", doi="10.2196/45694", url="https://formative.jmir.org/2023/1/e45694", url="http://www.ncbi.nlm.nih.gov/pubmed/37624639" } @Article{info:doi/10.2196/47220, author="Vial, St{\'e}phane and Boudhra{\^a}, Sana and Dumont, Mathieu and Tremblay, Melanie and Riendeau, Sophie", title="Developing A Mobile App With a Human-Centered Design Lens to Improve Access to Mental Health Care (Mentallys Project): Protocol for an Initial Co-Design Process", journal="JMIR Res Protoc", year="2023", month="Aug", day="22", volume="12", pages="e47220", keywords="co-design", keywords="human-centered design", keywords="e-mental health", keywords="design expertise", keywords="user engagement", keywords="patient-centered design", keywords="imaginary prototype", abstract="Background: Co-design is one of the human-centered design approaches that allows end users to significantly and positively impact the design of mental health technologies. It is a promising approach to foster user acceptance and engagement in digital mental health solutions. Surprisingly, there is a lack of understanding of what co-design is in this field. In this paper, co-design is approached as a cocreation process involving persons with a lived experience of mental health problems, health professionals, and design experts who lead and facilitate the overall creative process. Objective: This paper describes an initial co-design research protocol for the development of a mobile app that aims to improve access to mental health care. It highlights the characteristics of a co-design approach in e--mental health rooted in human-centered design and led by design experts alongside health experts. The paper focuses on the first steps (phase 1) of the co-design process of the ongoing Mentallys project. Methods: This Mentallys project will be located in Montr{\'e}al (Quebec, Canada). The method approach will be based on the ``method stories,'' depicting the ``making of'' this project and reflecting adjustments needed to the protocol throughout the project in specific situations. Phase 1 of the process will focus on the desirability of the app. Targeted participants will include people with a lived experience of mental health problems, peer support workers and clinicians, and 3 facilitators (all design experts or researchers). Web-based sessions will be organized because of the COVID-19 pandemic, using Miro (RealtimeBoard Inc) and Zoom (Zoom Video Communications, Inc). Data collection will be based on the comments, thoughts, and new ideas of participants around the imaginary prototypes. Thematic analysis will be carried out after each session to inform a new version of the prototype. Results: We conducted 2 stages in phase 1 of the process. During stage 1, we explored ideas through group co-design workshops (divergent thinking). Six co-design workshops were held: 2 with only clinicians (n=7), 2 with peer support workers (n=5) and people with a lived experience of mental health problems (n=2), and 2 with all of them (n=14). A total of 6 facilitators participated in conducting activities in subgroups. During stage 2, ideas were refined through 10 dyad co-design sessions (convergent thinking). Stage 2 involved 3 participants (n=3) and 1 facilitator. Thematic analysis was performed after stage 1, while analytic questioning is being performed for stage 2. Both stages allowed several iterations of the prototypes. Conclusions: The design of the co-design process, the leadership of the design expertise throughout the process, and the different forms of co-design activities are key elements in this project. We highly recommend that health researchers partner with professional designers or design researchers who are familiar with co-design. International Registered Report Identifier (IRRID): DERR1-10.2196/47220 ", doi="10.2196/47220", url="https://www.researchprotocols.org/2023/1/e47220", url="http://www.ncbi.nlm.nih.gov/pubmed/37606978" } @Article{info:doi/10.2196/45418, author="Xiao, Jin and Kopycka-Kedzierawski, Dorota and Ragusa, Patricia and Mendez Chagoya, Alberto Luis and Funkhouser, Kimberly and Lischka, Tamara and Wu, Tong Tong and Fiscella, Kevin and Kar, Saswati Kumari and Al Jallad, Nisreen and Rashwan, Noha and Ren, Johana and Meyerowitz, Cyril and ", title="Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="18", volume="10", pages="e45418", keywords="teledentistry", keywords="mDentistry", keywords="oral diseases", keywords="virtual visit", keywords="intraoral camera", keywords="COVID-19", keywords="pandemic response", keywords="mobile phone", abstract="Background: Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP). Objective: This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic. Methods: This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model. Results: A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos.?Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients' conditions. Conclusions: The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health--promoting behaviors. ", doi="10.2196/45418", url="https://humanfactors.jmir.org/2023/1/e45418", url="http://www.ncbi.nlm.nih.gov/pubmed/37594795" } @Article{info:doi/10.2196/45079, author="Severinsen, Frida and Andersen, Frost Lene and Paulsen, Mohn Mari", title="The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study", journal="JMIR Mhealth Uhealth", year="2023", month="Aug", day="3", volume="11", pages="e45079", keywords="dietary assessment", keywords="malnutrition", keywords="eHealth", keywords="validation study", keywords="older adults", keywords="mobile phone", abstract="Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ?65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ?65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants' experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ?80\% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60\% of the participants had ?80\% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74\% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants' dietary intake compared with the 24-hour recalls at both the individual and group levels. The app's ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. ", doi="10.2196/45079", url="https://mhealth.jmir.org/2023/1/e45079", url="http://www.ncbi.nlm.nih.gov/pubmed/37535420" } @Article{info:doi/10.2196/40891, author="Weis, Joachim and Wolf, Raphaela Lucy and Boerries, Melanie and Kassahn, Daniela and Boeker, Martin and Dresch, Carolin", title="Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study", journal="JMIR Cancer", year="2023", month="Jul", day="27", volume="9", pages="e40891", keywords="cancer", keywords="mobile app", keywords="mHealth", keywords="mobile health", keywords="needs assessment", keywords="patient-centered care", keywords="PROM", keywords="patient-reported outcome measures", keywords="qualitative methods", abstract="Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients' needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients' perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 ", doi="10.2196/40891", url="https://cancer.jmir.org/2023/1/e40891", url="http://www.ncbi.nlm.nih.gov/pubmed/37498653" } @Article{info:doi/10.2196/40219, author="O'Connor, Antonia and Tai, Andrew and Brinn, Malcolm and Hoang, Hien Amy Nguyen Thuc and Cataldi, Daniele and Carson-Chahhoud, Kristin", title="Co-design of an Augmented Reality Asthma Inhaler Educational Intervention for Children: Development and Usability Study", journal="JMIR Pediatr Parent", year="2023", month="Jul", day="25", volume="6", pages="e40219", keywords="asthma", keywords="asthma education", keywords="pediatric", keywords="pediatric asthma", keywords="co-design", keywords="usability", keywords="development", keywords="smartphone", keywords="tablet", keywords="augmented reality", keywords="health education", keywords="mobile app", keywords="mobile phone", abstract="Background: Smartphone and tablet apps that deliver health care education have been identified as effective in improving patient knowledge and treatment adherence in asthma populations. Despite asthma being the most common chronic disease in pediatrics, there are few apps that are targeted specifically for children. Only half of children with asthma have acceptable control of their symptoms, and 40\%-98\% do not use their inhalers correctly. With children being increasingly connected to technology, there is an opportunity to improve asthma inhaler technique education by delivery via smartphone or tablet apps. Augmented reality (AR) technology was used in this study to capitalize on growing technological innovations. Digital health interventions that use a co-design process for development have the highest likelihood of successful uptake and effectiveness on their intended outcomes. Perceived usability also has been shown to improve the effectiveness of education as well as the acceptance of the intervention. Objective: The aims of this study were to describe the co-design process, development, and design outcomes of a smartphone or tablet app that incorporates AR technology to deliver asthma inhaler technique education to children with asthma. This study also aimed to provide a usability evaluation, using the System Usability Scale to inform our work and future research, and recommendations for others performing similar work. Methods: The development of the AR asthma inhaler technique education app was based on an iterative co-design process with likely end users (children with asthma, their caregivers, and health care professionals). This involved multiple stages: recruitment of end users for qualitative interviews and usability testing with a previously designed educational intervention, which used an AR-embedded smartphone or tablet app; ideation of content for a specific asthma inhaler technique education intervention with end users; development of the specific asthma inhaler intervention; and 2 further rounds of interviews and usability testing with the redesign of the initial prototype. Results: We included 16 participants aged 9-45 years. Using the co-design process, the AR asthma inhaler technique education app was designed, incorporating the preferences of end users. After iteration 1, animation was included based on the feedback provided. Iteration 2 feedback resulted in increased AR experiences and the removal of the requirement of a paper-based resource to trigger AR in the third iteration. Throughout all rounds, the ease of use of the app and the novel nature of the intervention were frequently described. The usability of the intervention overall was perceived to be excellent, and the mean System Usability Scale score of the intervention was found to be highest in the final round of evaluation (90.14). Conclusions: The results from this co-design process and usability evaluation will be used to develop a final AR asthma inhaler technique educational intervention, which will be evaluated in the clinical setting. International Registered Report Identifier (IRRID): RR2-10.1177/16094069211042229 ", doi="10.2196/40219", url="https://pediatrics.jmir.org/2023/1/e40219", url="http://www.ncbi.nlm.nih.gov/pubmed/37490325" } @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/10.2196/42970, author="Rosen, Barthlow Claire and Roberts, Eugene Sanford and Syvyk, Solomiya and Finn, Caitlin and Tong, Jason and Wirtalla, Christopher and Spinks, Hunter and Kelz, Rapaport Rachel", title="A Novel Mobile App to Identify Patients With Multimorbidity in the Emergency Setting: Development of an App and Feasibility Trial", journal="JMIR Form Res", year="2023", month="Jul", day="13", volume="7", pages="e42970", keywords="clinical operationalization", keywords="delphi", keywords="development", keywords="emergency", keywords="general surgery", keywords="mHealth", keywords="mobile app", keywords="mobile health", keywords="morbidity", keywords="multimorbidity", keywords="qualifying comorbidity set", keywords="surgery", keywords="usability", abstract="Background: Multimorbidity is associated with an increased risk of poor surgical outcomes among older adults; however, identifying multimorbidity in the clinical setting can be a challenge. Objective: We created the Multimorbid Patient Identifier App (MMApp) to easily identify patients with multimorbidity identified by the presence of a Qualifying Comorbidity Set and tested its feasibility for use in future clinical research, validation, and eventually to guide clinical decision-making. Methods: We adapted the Qualifying Comorbidity Sets' claims-based definition of multimorbidity for clinical use through a modified Delphi approach and developed MMApp. A total of 10 residents input 5 hypothetical emergency general surgery patient scenarios, common among older adults, into the MMApp and examined MMApp test characteristics for a total of 50 trials. For MMApp, comorbidities selected for each scenario were recorded, along with the number of comorbidities correctly chosen, incorrectly chosen, and missed for each scenario. The sensitivity and specificity of identifying a patient as multimorbid using MMApp were calculated using composite data from all scenarios. To assess model feasibility, we compared the mean task completion by scenario to that of the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator (ACS-NSQIP-SRC) using paired t tests. Usability and satisfaction with MMApp were assessed using an 18-item questionnaire administered immediately after completing all 5 scenarios. Results: There was no significant difference in the task completion time between the MMApp and the ACS-NSQIP-SRC for scenarios A (86.3 seconds vs 74.3 seconds, P=.85) or C (58.4 seconds vs 68.9 seconds,P=.064), MMapp took less time for scenarios B (76.1 seconds vs 87.4 seconds, P=.03) and E (20.7 seconds vs 73 seconds, P<.001), and more time for scenario D (78.8 seconds vs 58.5 seconds, P=.02). The MMApp identified multimorbidity with 96.7\% (29/30) sensitivity and 95\% (19/20) specificity. User feedback was positive regarding MMApp's usability, efficiency, and usefulness. Conclusions: The MMApp identified multimorbidity with high sensitivity and specificity and did not require significantly more time to complete than a commonly used web-based risk-stratification tool for most scenarios. Mean user times were well under 2 minutes. Feedback was overall positive from residents regarding the usability and usefulness of this app, even in the emergency general surgery setting. It would be feasible to use MMApp to identify patients with multimorbidity in the emergency general surgery setting for validation, research, and eventual clinical use. This type of mobile app could serve as a template for other research teams to create a tool to easily screen participants for potential enrollment. ", doi="10.2196/42970", url="https://formative.jmir.org/2023/1/e42970", url="http://www.ncbi.nlm.nih.gov/pubmed/37440310" } @Article{info:doi/10.2196/46286, author="Kim, Hyungsook and Lee, Kikwang and Lee, Hoon Ye and Park, Yoonjung and Park, Yonghyun and Yu, Yeonwoo and Park, Jaeyoung and Noh, Sihyeon", title="The Effectiveness of a Mobile Phone--Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study", journal="JMIR Mhealth Uhealth", year="2023", month="Jun", day="26", volume="11", pages="e46286", keywords="depressive symptoms", keywords="mobile intervention", keywords="exercise", keywords="internet-based fitness", keywords="mental health", abstract="Background: Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7\% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility. Objective: To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone--based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea. Methods: Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program's impact, a 2 (condition) {\texttimes} 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements. Results: The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60\%) were randomly assigned to the treatment group and 27 (40\%) to the waitlist group. The attrition rate was 10.2\% after 4 weeks. The findings indicated that there is a significant main effect of time (F1,60=15.63; P=.003; $\eta$p2=0.21) in participants' depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15). Conclusions: This study provided experimental evidence that mobile phone--based physical activity program affects depression significantly. By exploring the potential of mobile phone--based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress. ", doi="10.2196/46286", url="https://mhealth.jmir.org/2023/1/e46286", url="http://www.ncbi.nlm.nih.gov/pubmed/37358905" } @Article{info:doi/10.2196/45852, author="Palermo, H. Emma and Young, V. Amanda and Deswert, Sky and Brown, Alyssa and Goldberg, Miranda and Sultanik, Evan and Tan, Jessica and Mazefsky, A. Carla and Brookman-Frazee, Lauren and McPartland, C. James and Goodwin, S. Matthew and Pennington, Jeffrey and Marcus, C. Steven and Beidas, S. Rinad and Mandell, S. David and Nuske, J. Heather", title="A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2023", month="Jun", day="26", volume="12", pages="e45852", keywords="digital mental health", keywords="just-in-time adaptive intervention augmentation", keywords="JITAI", keywords="autism", keywords="heart rate tracking", keywords="emotion dysregulation", keywords="challenging behavior", keywords="evidence-based strategies", keywords="student progress monitoring", keywords="mobile phone", abstract="Background: As much as 80\% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. Objective: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children's stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child's educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). Methods: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. Results: The pilot trial will begin by September 2023. Conclusions: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. Trial Registration: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194 International Registered Report Identifier (IRRID): PRR1-10.2196/45852 ", doi="10.2196/45852", url="https://www.researchprotocols.org/2023/1/e45852", url="http://www.ncbi.nlm.nih.gov/pubmed/37358908" } @Article{info:doi/10.2196/42382, author="Morse, Brad and Soares, Andrey and Kwan, M. Bethany and Allen, Marvyn and Lee, S. Rita and Desanto, Kristen and Holliman, Dorsey Brooke and Ytell, Kate and Schilling, M. Lisa", title="A Transgender Health Information Resource: Participatory Design Study", journal="JMIR Hum Factors", year="2023", month="Jun", day="15", volume="10", pages="e42382", keywords="lesbian, gay, bisexual, transgender, and queer", keywords="LGBTQ", keywords="transgender", keywords="mobile app", keywords="health information", keywords="participatory design", keywords="agile development", keywords="mobile phone", abstract="Background: Despite the abundance of health information on the internet for people who identify as transgender and gender diverse (TGD), much of the content used is found on social media channels, requiring individuals to vet the information for relevance and quality. Objective: We developed a prototype transgender health information resource (TGHIR) delivered via a mobile app to provide credible health and wellness information for people who are TGD. Methods: We partnered with the TGD community and used a participatory design approach that included focus groups and co-design sessions to identify users' needs and priorities. We used the Agile software development methodology to build the prototype. A medical librarian and physicians with expertise in transgender health curated a set of 97 information resources that constituted the foundational content of the prototype. To evaluate the prototype TGHIR app, we assessed the app with test users, using a single item from the System Usability Scale to assess feature usability, cognitive walk-throughs, and the user version of the Mobile Application Rating Scale to evaluate the app's objective and subjective quality. Results: A total of 13 people who identified as TGD or TGD allies rated their satisfaction with 9 of 10 (90\%) app features as good to excellent, and 1 (10\%) of the features---the ability to filter to narrow TGHIR resources---was rated as okay. The overall quality score on the user version of the Mobile Application Rating Scale was 4.25 out of 5 after 4 weeks of use, indicating a good-quality mobile app. The information subscore received the highest rating, at 4.75 out of 5. Conclusions: Community partnership and participatory design were effective in the development of the TGHIR app, resulting in an information resource app with satisfactory features and overall high-quality ratings. Test users felt that the TGHIR app would be helpful for people who are TGD and their care partners. ", doi="10.2196/42382", url="https://humanfactors.jmir.org/2023/1/e42382", url="http://www.ncbi.nlm.nih.gov/pubmed/37318836" } @Article{info:doi/10.2196/44500, author="Varma, S. Deepthi and Mualem, Maya and Goodin, Amie and Gurka, K. Kelly and Wen, Soo-Tung Tony and Gurka, J. Matthew and Roussos-Ross, Kay", title="Acceptability of an mHealth App for Monitoring Perinatal and Postpartum Mental Health: Qualitative Study With Women and Providers", journal="JMIR Form Res", year="2023", month="Jun", day="7", volume="7", pages="e44500", keywords="perinatal mental health", keywords="mobile health", keywords="mHealth", keywords="mobile apps", keywords="ecological momentary assessment", keywords="EMA", keywords="mobile phone", abstract="Background: Up to 15\% of pregnant and postpartum women commonly experience undiagnosed and untreated mental health conditions, such as depression and anxiety, which may result in serious health complications. Mobile health (mHealth) apps related to mental health have been previously used for early diagnosis and intervention but not among pregnant and postpartum women. Objective: This study aims to assess the acceptability of using mHealth to monitor and assess perinatal and postpartum depression and anxiety. Methods: Focus group discussions with pregnant and postpartum women (n=20) and individual interviews with health care providers (n=8) were conducted to inform the acceptability of mHealth and determine its utility for assessing perinatal and postpartum mood symptoms. Participants were recruited via purposive sampling from obstetric clinics and the surrounding community. A semistructured interview guide was developed by an epidemiologist with qualitative research training in consultation with an obstetrician. The first author conducted all focus group discussions and provider interviews either in person or via Zoom (Zoom Video Communications, Inc) depending on the COVID-19 protocol that was in place during the study period. All interviews were audio recorded with consent; transcribed; and uploaded for coding to ATLAS.ti 8 (ATLAS.ti Scientific Software Development Gmb H), a qualitative data analysis and retrieval software. Data were analyzed using the deductive content analysis method using a set of a priori codes developed based on the interview guide. Methodological rigor and quality were ensured by adopting a systematic approach during the implementation, data collection, data analysis, and reporting of the data. Results: Almost all women and providers had downloaded and used at least 1 health app. The respondents suggested offering short questions in layperson language that could be understood by women of all educational levels and offering no more than 2 to 3 assessments per day at preferred timings decided by the women themselves. They also suggested that the women themselves receive the alerts first, with other options being family members, spouses, or friends if the women themselves did not respond within 24 to 72 hours. Customization and snooze features were strongly endorsed by women and providers to improve acceptability and utility. Women mentioned competing demands on their time during the postpartum period, fatigue, privacy, and the security of mental health data as concerns. Health care professionals highlighted the long-term sustainability of app-based mood assessment and monitoring as an important challenge. Conclusions: The findings from this study show that mHealth would be acceptable to pregnant and postpartum women for monitoring mood symptoms. This could inform the development of clinically meaningful and inexpensive tools for facilitating the continuous monitoring of, the early diagnosis of, and an early intervention for mood disorders in this vulnerable population. ", doi="10.2196/44500", url="https://formative.jmir.org/2023/1/e44500", url="http://www.ncbi.nlm.nih.gov/pubmed/37285185" } @Article{info:doi/10.2196/44945, author="Clouse, Kate and Noholoza, Sandisiwe and Madwayi, Sindiswa and Mrubata, Megan and Camlin, S. Carol and Myer, Landon and Phillips, K. Tamsin", title="The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="May", day="19", volume="11", pages="e44945", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="HIV/AIDS", keywords="South Africa", keywords="pregnancy", abstract="Background: Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app---CareConekta---that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user's location to map nearby clinics. Objective: We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods: We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results: A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3\%) or changing to an unsuitable phone (1/200, 0.50\%). During the study period, no participant's smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2\%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app's purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions: Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4190-x ", doi="10.2196/44945", url="https://mhealth.jmir.org/2023/1/e44945", url="http://www.ncbi.nlm.nih.gov/pubmed/37204838" } @Article{info:doi/10.2196/44855, author="He, Ying and Tang, Zhijie and Sun, Guozhen and Cai, Cheng and Wang, Yao and Yang, Gang and Bao, ZhiPeng", title="Effectiveness of a Mindfulness Meditation App Based on an Electroencephalography-Based Brain-Computer Interface in Radiofrequency Catheter Ablation for Patients With Atrial Fibrillation: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="May", day="3", volume="11", pages="e44855", keywords="atrial fibrillation", keywords="radiofrequency catheter ablation", keywords="mindfulness meditation", keywords="brain computer interface", keywords="mHealth", keywords="smartphone app", keywords="randomized controlled trial", abstract="Background: Radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF) can generate considerable physical and psychological discomfort under conscious sedation. App-based mindfulness meditation combined with an electroencephalography (EEG)-based brain-computer interface (BCI) shows promise as effective and accessible adjuncts in medical practice. Objective: This study aimed to investigate the effectiveness of a BCI-based mindfulness meditation app in improving the experience of patients with AF during RFCA. Methods: This single-center pilot randomized controlled trial involved 84 eligible patients with AF scheduled for RFCA, who were randomized 1:1 to the intervention and control groups. Both groups received a standardized RFCA procedure and a conscious sedative regimen. Patients in the control group were administered conventional care, while those in the intervention group received BCI-based app--delivered mindfulness meditation from a research nurse. The primary outcomes were the changes in the numeric rating scale, State Anxiety Inventory, and Brief Fatigue Inventory scores. Secondary outcomes were the differences in hemodynamic parameters (heart rate, blood pressure, and peripheral oxygen saturation), adverse events, patient-reported pain, and the doses of sedative drugs used in ablation. Results: BCI-based app--delivered mindfulness meditation, compared to conventional care, resulted in a significantly lower mean numeric rating scale (mean 4.6, SD 1.7 [app-based mindfulness meditation] vs mean 5.7, SD 2.1 [conventional care]; P=.008), State Anxiety Inventory (mean 36.7, SD 5.5 vs mean 42.3, SD 7.2; P<.001), and Brief Fatigue Inventory (mean 3.4, SD 2.3 vs mean 4.7, SD 2.2; P=.01) scores. No significant differences were observed in hemodynamic parameters or the amounts of parecoxib and dexmedetomidine used in RFCA between the 2 groups. The intervention group exhibited a significant decrease in fentanyl use compared to the control group, with a mean dose of 3.96 (SD 1.37) mcg/kg versus 4.85 (SD 1.25) mcg/kg in the control group (P=.003).The incidence of adverse events was lower in the intervention group (5/40) than in the control group (10/40), though this difference was not significant (P=.15). Conclusions: BCI-based app--delivered mindfulness meditation effectively relieved physical and psychological discomfort and may reduce the doses of sedative medication used in RFCA for patients with AF. Trial Registration: ClinicalTrials.gov NCT05306015; https://clinicaltrials.gov/ct2/show/NCT05306015 ", doi="10.2196/44855", url="https://mhealth.jmir.org/2023/1/e44855", url="http://www.ncbi.nlm.nih.gov/pubmed/37133926" } @Article{info:doi/10.2196/44462, author="Johansen, Kristoffer Simon and Kanstrup, Marie Anne and Haseli, Kian and Stenmo, Hildebrandt Visti and Thomsen, Laust Janus and Rathleff, Skovdal Michael", title="Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="28", volume="10", pages="e44462", keywords="mobile health", keywords="mHealth", keywords="design", keywords="patient physician relationship", keywords="collaborative care", keywords="shared decision-making", keywords="adolescents", keywords="parents", keywords="knee pain", keywords="patellofemoral pain", keywords="Osgood Schlatter", keywords="musculoskeletal", keywords="general practice", keywords="primary care", keywords="mobile phone", abstract="Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38\% (9/24) young adults with chronic knee pain since adolescence, 25\% (6/24) parents, and 38\% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. ", doi="10.2196/44462", url="https://humanfactors.jmir.org/2023/1/e44462", url="http://www.ncbi.nlm.nih.gov/pubmed/37115609" } @Article{info:doi/10.2196/37329, author="Sweeney, Megan and Barton, William and Nebeker, Camille", title="Evaluating Mobile Apps Targeting Older Adults: Descriptive Study", journal="JMIR Form Res", year="2023", month="Apr", day="27", volume="7", pages="e37329", keywords="older adults", keywords="mobile apps", keywords="privacy", keywords="data management, research ethics", keywords="app", keywords="aging", keywords="environment", keywords="safety", keywords="smartphone", keywords="personal information", keywords="user knowledge", keywords="user", keywords="data", keywords="data collection", keywords="storage", abstract="Background: Smartphone use has increased dramatically and, in parallel, a market for mobile apps, including health apps, has emerged. The business model of targeted mobile app advertisements allows for the collection of personal and potentially sensitive information, often without user knowledge. Older adults comprise a rapidly growing demographic that is potentially vulnerable to exploitation by those accessing data collected via these apps. Objective: This research examined apps that claimed to be useful to older adults with a goal of (1) classifying the functionality of each app, (2) identifying whether a privacy policy existed and was accessible, and (3) evaluating evidence that could support claims of value to older adults. Methods: An environmental scan was conducted using the Google search engine and typing ``apps for older adults.'' The first 25 sites that this search returned comprised the primary data for this study. Data were organized by descriptive features of purpose (eg, health, finance, and utility), the existence of an electronically accessible privacy policy, price, and evidence supporting each recommended mobile app. Results: A total of 133 mobile apps were identified and promoted as being the best ``apps for older adults.'' Of these 133 mobile apps, 83\% (n=110) included a privacy policy. Fewer apps designated in the ``medical'' category included a privacy policy than those classified otherwise. Conclusions: The results suggest that most mobile apps targeting older adults include a privacy policy. Research is needed to determine whether these privacy policies are readable, succinct, and incorporate accessible data use and sharing practices to mitigate potential risks, particularly when collecting potentially sensitive health information. ", doi="10.2196/37329", url="https://formative.jmir.org/2023/1/e37329", url="http://www.ncbi.nlm.nih.gov/pubmed/37103995" } @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/10.2196/43085, author="Shankar, Lalita and Dixit, Anvita and Howard, Susan", title="A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study", journal="JMIR Form Res", year="2023", month="Apr", day="18", volume="7", pages="e43085", keywords="Theory of Change", keywords="social behavior change", keywords="mobile game app", keywords="digital innovation", keywords="adolescent girls", keywords="sexual and reproductive health", keywords="India", abstract="Background: India has one of the largest adolescent populations in the world. Yet adolescents, particularly adolescent girls, have limited access to correct sexual and reproductive health information and services. The context in which adolescent girls live is one of gender inequity where they contend with early marriage and early pregnancy and have few opportunities for quality education and labor force participation. The digital revolution has expanded the penetration of mobile phones across India, increasingly being used by adolescent girls. Health interventions are also moving onto digital platforms. Evidence has shown that applications of game elements and game-based learning can be powerful tools in behavior change and health interventions. This provides a unique opportunity, particularly for the private sector, to reach and empower adolescent girls directly with information, products, and services in a private and fun manner. Objective: The objective of this paper is to describe how a design-led Theory of Change (ToC) was formulated for a mobile game app that is not only underpinned by theories of various behavior change models but also identifies variables and triggers for in-game behavioral intentions that can be tracked and measured within the game and validated through a rigorous post-gameplay outcome evaluation. Methods: We describe the use of a multimix methodology to formulate a ToC informing behavioral frameworks and co-design approaches in our proof-of-concept product development journey. This process created a statement of hypothesis and ``pathways to impact'' with a continuous, cumulative, and iterative design process that included key stakeholders in the production of a smartphone app. With theoretical underpinnings of social behavior and modeling frameworks, systematic research, and other creative methods, we developed a design-led ToC pathway that can delineate complex and multidisciplinary outputs for measuring impact. Results: The statement of hypothesis that emerged posits that ``If girls virtually experience the outcomes of choices that they make for their avatar in the mobile game, then they can make informed decisions that direct the course of their own life.'' Four learning pathways (DISCOVER, PLAY, DECIDE, and ACT) are scaffolded on 3 pillars of evidence, engagement, and evaluation to support the ToC-led framework. It informs decision-making and life outcomes through game-based objectives and in-game triggers that offer direct access to information, products, and services. Conclusions: This approach of using a multimix methodology for identifying varied and multidisciplinary pathways to change is of particular interest to measuring the impact of innovations, especially digital products, that do not necessarily conform with traditional behavioral change models or standard co-design approaches. We also explain the benefits of using iterative and cumulative inputs to integrate ongoing user feedback, while identifying pathways to various impacts, and not limiting it to only the design and development phase. ", doi="10.2196/43085", url="https://formative.jmir.org/2023/1/e43085", url="http://www.ncbi.nlm.nih.gov/pubmed/37071463" } @Article{info:doi/10.2196/43861, author="Davoody, Nadia and Eghdam, Aboozar and Koch, Sabine and H{\"a}gglund, Maria", title="Evaluation of an Electronic Care and Rehabilitation Planning Tool With Stroke Survivors With Aphasia: Usability Study", journal="JMIR Hum Factors", year="2023", month="Apr", day="17", volume="10", pages="e43861", keywords="usability testing", keywords="stroke", keywords="aphasia", keywords="eHealth", keywords="rehabilitation", keywords="co-design", keywords="evaluation", keywords="user-centered design", keywords="effectiveness", keywords="user satisfaction", keywords="mobile phone", abstract="Background: Patients with chronic illnesses with physical and cognitive disabilities, particularly stroke survivors with aphasia, are often not involved in design and evaluation processes. As a consequence, existing eHealth services often do not meet the needs of this group of patients, which has resulted in a digital divide. Objective: The aim of this study was to examine the effectiveness and user satisfaction of an electronic care and rehabilitation planning tool from the perspective of stroke survivors with aphasia. This would help us gain knowledge on how such a tool would need to be adapted for these patients for further development. Methods: Usability tests were conducted with 9 postdischarge stroke survivors with aphasia. Effectiveness was measured using task-based tests, and user satisfaction was studied through qualitative interviews at the end of each test. All tests were audio recorded, and each test lasted approximately 1 hour. The data were analyzed using qualitative content analysis. As the tool can be used by stroke survivors either independently or with some support from their next of kin or care professionals, the research group decided to divide the participants into 2 groups. Group 1 did not receive any support during the tests, and group 2 received some minor support from the moderator. Results: The results showed that the care and rehabilitation planning tool was not effective for stroke survivors with aphasia, as many participants in group 1 did not accomplish the tasks successfully. Despite several usability problems and challenges in using the tool because of patients' disabilities, the participants were positive toward using the tool and found it useful for their care and rehabilitation journey. Conclusions: There is a need to involve patients with chronic illnesses more in the design and evaluation processes of health information systems and eHealth services. eHealth services and health information systems designed for this group of patients should be more adaptable and flexible to provide them with appropriate functionalities and features, meet their needs, and be useful and easy to use. In addition, the design and evaluation processes should be adapted, considering the challenges of this patient group. ", doi="10.2196/43861", url="https://humanfactors.jmir.org/2023/1/e43861", url="http://www.ncbi.nlm.nih.gov/pubmed/37067848" } @Article{info:doi/10.2196/40851, author="Vos, L. Anne and de Bruijn, Gert-Jan and Klein, A. Michel C. and Lakerveld, Jeroen and Boerman, C. Sophie and Smit, G. Edith", title="SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study", journal="JMIR Form Res", year="2023", month="Apr", day="17", volume="7", pages="e40851", keywords="cardiovascular disease", keywords="physical activity", keywords="walking", keywords="smartphone", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="behavior change techniques", keywords="tailoring", keywords="intervention development", keywords="socioeconomic position", keywords="mobile phone", abstract="Background: Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools. Objective: To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp's stepwise development and pilot evaluation process. Methods: We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants). Results: SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users' behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp's coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates. Conclusions: SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial. ", doi="10.2196/40851", url="https://formative.jmir.org/2023/1/e40851", url="http://www.ncbi.nlm.nih.gov/pubmed/37067890" } @Article{info:doi/10.2196/42224, author="Dittrich, Florian and Albrecht, Urs-Vito and Scherer, Julian and Becker, L. S{\"o}ren and Landgraeber, Stefan and Back, Alexander David and Fessmann, Kai and Haversath, Marcel and Beck, Sascha and Abbara-Czardybon, Mona and Quitmann, Henning and Harren, Katharina Anna and Aitzetm{\"u}ller, Matthias and Klietz, Luise Marie", title="Development of Open Backend Structures for Health Care Professionals to Improve Participation in App Developments: Pilot Usability Study of a Medical App", journal="JMIR Form Res", year="2023", month="Apr", day="13", volume="7", pages="e42224", keywords="smartphone", keywords="mHealth", keywords="backend", keywords="usability", keywords="UX", keywords="user experience", keywords="mobile health", keywords="health app", keywords="mobile app", keywords="app development", keywords="no-code", abstract="Background: Efficient digitization in medicine still is in its infancy but undeniably has great potential for current and future challenges in health care. Thus far, the rollout of medical apps has not resulted in widespread use of smartphones in the German health care sector---the reasons for this have not been clarified so far. Nevertheless, the lack of user involvement in the development process and content creation might contribute to low acceptance of these products. Objective: This study aims to outline an approach to involve medical expertise without any coding knowledge for developing medical app content and functions. Methods: An end user--operable backend was built. Its usability was evaluated using a usability evaluation test protocol. The results of the usability tests were evaluated by the app development team, and the usability test was repeated for optimizing backend usability. In total, 40 criteria to measure the ease of app usage were defined a priori. The usability test comprised 20 tasks that had to be fulfilled. Usability tasks were analyzed for completion, dropout, and test duration. Due to the COVID-19 pandemic, digital videoconferencing platforms (Zoom and QuickTime Player) were used to complete usability questionnaires. Finally, several backend-based apps for several specialties (infectiology, plastic and reconstructive surgery, and orthopedics) were developed by health care professionals as prototypes. Results: Initial usability testing was conducted with 5 participants (4 men and 1 woman; mean age 39.2, SD 5.97 years). All of them could complete the assigned backend tasks with only a few workflow interruptions and some minor errors. After usability optimization, the workflow completion time decreased from 5.03 minutes to 3.50 minutes, indicating a time saving. The basic backend structure was clear to all test users and the handling was intuitive to learn. Some minor errors in the backend occurred during the test rounds. The apps developed using the aforementioned approach are in clinical use as a proof of concept. Conclusions: Backends offering operability for medical professionals might have great potential for app development in the mobile health sector. Sophisticated and time-saving usability are pivotal for the acceptance of medical software, as illustrated by the backend-based apps presented herein, which are in clinical use as a proof of concept. Basic interventions are essential and sufficient for adequate usability optimization. Practicable, well-structured software usability evaluation is possible based on the usability evaluation test protocol. ", doi="10.2196/42224", url="https://formative.jmir.org/2023/1/e42224", url="http://www.ncbi.nlm.nih.gov/pubmed/37052998" } @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/10.2196/45920, 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/10.2196/42967, author="Newman, Christie and Adriaens, Els and Virgilio, Nicolina and Vleminckx, Sara and de Pelsmaeker, Sara and Prawitt, Janne and F Silva, I. Catarina", title="Development of a Mobile App to Monitor the Effectiveness of a Hydrolyzed Cartilage Matrix Supplement on Joint Discomfort: Real-World Study", journal="JMIR Form Res", year="2023", month="Apr", day="3", volume="7", pages="e42967", keywords="digital tool", keywords="hydrolyzed cartilage matrix", keywords="hydrolyzed collagen", keywords="chondroitin sulfate", keywords="joint discomfort", keywords="real-world study", keywords="dietary supplement", keywords="mobile application", abstract="Background: Joint discomfort is a widespread and growing problem in active adults. The rising interest in preventative nutrition has increased the demand for supplements reducing joint discomfort. Protocols assessing the effect of a nutritional intervention on health commonly involve a series of face-to-face meetings between participants and study staff that can weigh on resources, participant availabilities, and even increase dropout rates. Digital tools are increasingly added to protocols to facilitate study conduct, but fully digitally run studies are still scarce. With the increasing interest in real-world studies, the development of health apps for mobile devices to monitor study outcomes is of great importance. Objective: The purpose of this real-world study was to develop a specific mobile app, Ingredients for Life, to conduct a 100\% digital study testing the effectiveness of a hydrolyzed cartilage matrix (HCM) supplement on joint discomfort in a heterogeneous group of healthy, active consumers. Methods: The Ingredients for Life mobile app using a visual analog scale was specifically developed to monitor the variation in joint pain after exercise by the study participants. A total of 201 healthy and physically active women and men (18-72 years old) with joint pain completed the study over a period of 16 weeks. Participants were randomly allocated to the study groups and did not receive any dietary or lifestyle advice. Each participant indicated one area of joint pain and logged the type and duration of their weekly activities. They received blinded study supplements and took a daily regimen of 1 g of HCM (HCM group) or 1 g of maltodextrin (placebo group) for 12 weeks while weekly logging joint pain scores in the app. This was followed by a 4-week washout period during which participants continued reporting their joint pain scores (until the end of week 16). Results: Joint pain was reduced within 3 weeks of taking a low dosage of HCM (1 g/day), regardless of gender, age group, and activity intensity when compared with the placebo group. After stopping supplementation, joint pain scores gradually increased but still remained significantly lower than those of the placebo group after 4 weeks of washout. The low dropout rate (<6\% of participants, mainly in the placebo group) demonstrates that the digital study was well received by the study population. Conclusions: The digital tool allowed us to measure a heterogeneous group of active adults in a real-world setting (without any lifestyle intervention), thus promoting inclusivity and diversity. With low dropout rates, it demonstrates that mobile apps can generate qualitative, quantifiable, real-world data showcasing supplement effectiveness. The study confirmed that the oral intake of a low dose (1 g/day) of HCM led to a significant reduction of joint pain from 3 weeks after starting supplementation. ", doi="10.2196/42967", url="https://formative.jmir.org/2023/1/e42967", url="http://www.ncbi.nlm.nih.gov/pubmed/36848035" } @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/10.2196/43255, author="M{\"u}ller, Frank and Schr{\"o}der, Dominik and Noack, Maria Eva", title="Overcoming Language Barriers in Paramedic Care With an App Designed to Improve Communication With Foreign-Language Patients: Nonrandomized Controlled Pilot Study", journal="JMIR Form Res", year="2023", month="Mar", day="23", volume="7", pages="e43255", keywords="app", keywords="emergency medical technicians", keywords="language barriers", keywords="limited language proficiency", keywords="migrant", keywords="paramedic", keywords="prehospital emergency care", keywords="refugee", keywords="translator", abstract="Background: Communication across language barriers is a particular challenge for health care providers. In emergency medical services, interpreters are mostly not available on rescue scenes, which jeopardizes safe and high-quality medical care. In a cocreative process together with paramedics and software designers, we developed a fixed-phrase translation app with 600 phrases and 18 supported languages that supports paramedics when providing care to foreign-language patients. This paper reports on the results of a pilot study to evaluate the app's effect on paramedic-patient communication. Objective: This study aims to gain insights into the efficacy and feasibility of a multilingual app that helps paramedics to communicate with patients who are not proficient in the local language. Methods: A 3-armed nonrandomized interventional pilot study was conducted in 4 rescue stations in the German Federal State of Lower Saxony: 3 rural areas and 1 in urban environment. The intervention group comprised rescue missions with patients with limited German language proficiency (LGP) with whom the app was used; control group 1 comprised LGP patients without app usage; and control group 2 consisted of rescue missions with German-speaking patients. For each rescue operation with LGP patients, paramedics filled out questionnaires about the communications with patients. From standardized Rescue Service Case Protocols, we extracted information on patient demographics (age and sex), clinical aspects (preliminary diagnosis and Glasgow Coma Scale), and rescue operation characteristics (time spent on emergency scene and additional dispatch of emergency physicians). The primary outcome was the paramedics' perceived quality of communication with LGP patients. The secondary outcome was the ability to obtain necessary information from patients and the ability to provide important information to patients. A linear regression model was applied to assess the impact of the app on perceived communication, controlling demographic factors, and severity of illness. Results: A total of 22 LGP patients were recruited into the intervention group and 122 into control group 1. The control group 2 included 27,212 German-speaking patients. LGP patients were more than 2 decades younger than German-speaking patients. App usage among LGP patients was associated with higher perceived overall quality of communication (0.7 points on a 5-point Likert scale, P=.03). Applying a linear regression model controlling for age, sex, and Glasgow Coma Scale, the quality of communication was associated with an increase of 0.9 points (95\% CI 0.2-1.6, P=.01). Compared to either German-speaking patients or LGP patients, paramedics spent 6-7 minutes longer on an emergency scene when the app was used (P=.24). Conclusions: The use of the app suggests a relevant improvement in communication with patients with limited proficiency in the locally spoken language in paramedic care. The small sample size and the lack of randomization reduce the generalizability of the findings. Trial Registration: German Clinical Trials Register DRKS00016719; https://drks.de/search/de/trial/DRKS00016719 ", doi="10.2196/43255", url="https://formative.jmir.org/2023/1/e43255", url="http://www.ncbi.nlm.nih.gov/pubmed/36951895" } @Article{info:doi/10.2196/45095, author="Voorheis, Paula and Bhuiya, R. Aunima and Kuluski, Kerry and Pham, Quynh and Petch, Jeremy", title="Making Sense of Theories, Models, and Frameworks in Digital Health Behavior Change Design: Qualitative Descriptive Study", journal="J Med Internet Res", year="2023", month="Mar", day="15", volume="25", pages="e45095", keywords="behavioral science", keywords="behavior change", keywords="health behavior", keywords="digital health", keywords="mobile health", keywords="theories", keywords="models", keywords="frameworks", abstract="Background: Digital health interventions are increasingly being designed to support health behaviors. Although digital health interventions informed by behavioral science theories, models, and frameworks (TMFs) are more likely to be effective than those designed without them, design teams often struggle to use these evidence-informed tools. Until now, little work has been done to clarify the ways in which behavioral science TMFs can add value to digital health design. Objective: The aim of this study was to better understand how digital health design leaders select and use TMFs in design practice. The questions that were addressed included how do design leaders perceive the value of TMFs in digital health design, what considerations do design leaders make when selecting and applying TMFs, and what do design leaders think is needed in the future to advance the utility of TMFs in digital health design? Methods: This study used a qualitative description design to understand the experiences and perspectives of digital health design leaders. The participants were identified through purposive and snowball sampling. Semistructured interviews were conducted via Zoom software. Interviews were audio-recorded and transcribed using Otter.ai software. Furthermore, 3 researchers coded a sample of interview transcripts and confirmed the coding strategy. One researcher completed the qualitative analysis using a codebook thematic analysis approach. Results: Design leaders had mixed opinions on the value of behavioral science TMFs in digital health design. Leaders suggested that TMFs added the most value when viewed as a starting point rather than the final destination for evidence-informed design. Specifically, these tools added value when they acted as a gateway drug to behavioral science, supported health behavior conceptualization, were balanced with expert knowledge and user-centered design principles, were complementary to existing design methods, and supported both individual- and systems-level thinking. Design leaders also felt that there was a considerable nuance in selecting the most value-adding TMFs. Considerations should be made regarding their source, appropriateness, complexity, accessibility, adaptability, evidence base, purpose, influence, audience, fit with team expertise, fit with team culture, and fit with external pressures. Design leaders suggested multiple opportunities to advance the use of TMFs. These included improving TMF reporting, design, and accessibility, as well as improving design teams' capacity to use TMFs appropriately in practice. Conclusions: When designing a digital health behavior change intervention, using TMFs can help design teams to systematically integrate behavioral insights. The future of digital health behavior change design demands an easier way for designers to integrate evidence-based TMFs into practice. ", doi="10.2196/45095", url="https://www.jmir.org/2023/1/e45095", url="http://www.ncbi.nlm.nih.gov/pubmed/36920442" } @Article{info:doi/10.2196/45218, author="Nagino, Ken and Okumura, Yuichi and Yamaguchi, Masahiro and Sung, Jaemyoung and Nagao, Masashi and Fujio, Kenta and Akasaki, Yasutsugu and Huang, Tianxiang and Hirosawa, Kunihiko and Iwagami, Masao and Midorikawa-Inomata, Akie and Fujimoto, Keiichi and Eguchi, Atsuko and Okajima, Yukinobu and Kakisu, Koji and Tei, Yuto and Yamaguchi, Takefumi and Tomida, Daisuke and Fukui, Masaki and Yagi-Yaguchi, Yukari and Hori, Yuichi and Shimazaki, Jun and Nojiri, Shuko and Morooka, Yuki and Yee, Alan and Miura, Maria and Ohno, Mizu and Inomata, Takenori", title="Diagnostic Ability of a Smartphone App for Dry Eye Disease: Protocol for a Multicenter, Open-Label, Prospective, and Cross-sectional Study", journal="JMIR Res Protoc", year="2023", month="Mar", day="13", volume="12", pages="e45218", keywords="digital health", keywords="digital therapeutics", keywords="dry eye disease", keywords="Japanese version of the Ocular Surface Disease Index", keywords="maximum blink interval", keywords="mobile health", keywords="smartphone", keywords="smartphone app", keywords="tear film breakup time", keywords="telemedicine", abstract="Background: Dry eye disease (DED) is one of the most common ocular surface diseases. Numerous patients with DED remain undiagnosed and inadequately treated, experiencing various subjective symptoms and a decrease in quality of life and work productivity. A mobile health smartphone app, namely, the DEA01, has been developed as a noninvasive, noncontact, and remote screening device, in the context of an ongoing paradigm shift in the health care system, to facilitate a diagnosis of DED. Objective: This study aimed to evaluate the capabilities of the DEA01 smartphone app to facilitate a DED diagnosis. Methods: In this multicenter, open-label, prospective, and cross-sectional study, the test method will involve using the DEA01 smartphone app to collect and evaluate DED symptoms, based on the Japanese version of the Ocular Surface Disease Index (J-OSDI), and to measure the maximum blink interval (MBI). The standard method will then involve a paper-based J-OSDI evaluation of subjective symptoms of DED and tear film breakup time (TFBUT) measurement in an in-person encounter. We will allocate 220 patients to DED and non-DED groups, based on the standard method. The primary outcome will be the sensitivity and specificity of the DED diagnosis according to the test method. Secondary outcomes will be the validity and reliability of the test method. The concordance rate, positive and negative predictive values, and the likelihood ratio between the test and standard methods will be assessed. The area under the curve of the test method will be evaluated using a receiver operating characteristic curve. The internal consistency of the app-based J-OSDI and the correlation between the app-based J-OSDI and paper-based J-OSDI will be assessed. A DED diagnosis cutoff value for the app-based MBI will be determined using a receiver operating characteristic curve. The app-based MBI will be assessed to determine a correlation between a slit lamp--based MBI and TFBUT. Adverse events and DEA01 failure data will be collected. Operability and usability will be assessed using a 5-point Likert scale questionnaire. Results: Patient enrollment will start in February 2023 and end in July 2023. The findings will be analyzed in August 2023, and the results will be reported from March 2024 onward. Conclusions: This study may have implications in identifying a noninvasive, noncontact route to facilitate a diagnosis of DED. The DEA01 may enable a comprehensive diagnostic evaluation within a telemedicine setting and facilitate early intervention for undiagnosed patients with DED confronting health care access barriers. Trial Registration: Japan Registry of Clinical Trials jRCTs032220524; https://jrct.niph.go.jp/latest-detail/jRCTs032220524 International Registered Report Identifier (IRRID): PRR1-10.2196/45218 ", doi="10.2196/45218", url="https://www.researchprotocols.org/2023/1/e45218", url="http://www.ncbi.nlm.nih.gov/pubmed/36912872" } @Article{info:doi/10.2196/42145, author="Kim, Chan Joo and Saguna, Saguna and {\AA}hlund, Christer", title="Acceptability of a Health Care App With 3 User Interfaces for Older Adults and Their Caregivers: Design and Evaluation Study", journal="JMIR Hum Factors", year="2023", month="Mar", day="8", volume="10", pages="e42145", keywords="Internet of Things", keywords="health monitoring", keywords="older adults", keywords="augmented reality", keywords="user experience", keywords="independent living", keywords="design study", keywords="mobile phone", abstract="Background: The older population needs solutions for independent living and reducing the burden on caregivers while maintaining the quality and dignity of life. Objective: The aim of this study was to design, develop, and evaluate an older adult health care app that supports trained caregivers (ie, formal caregivers) and relatives (ie, informal caregivers). We aimed to identify the factors that affect user acceptance of interfaces depending on the user's role. Methods: We designed and developed an app with 3 user interfaces that enable remote sensing of an older adult's daily activities and behaviors. We conducted user evaluations (N=25) with older adults and their formal and informal caregivers to obtain an overall impression of the health care monitoring app in terms of user experience and usability. In our design study, the participants had firsthand experience with our app, followed by a questionnaire and individual interview to express their opinions on the app. Through the interview, we also identified their views on each user interface and interaction modality to identify the relationship between the user's role and their acceptance of a particular interface. The questionnaire answers were statistically analyzed, and we coded the interview answers based on keywords related to a participant's experience, for example, ease of use and usefulness. Results: We obtained overall positive results in the user evaluation of our app regarding key aspects such as efficiency, perspicuity, dependability, stimulation, and novelty, with an average between 1.74 (SD 1.02) and 2.18 (SD 0.93) on a scale of ?3.0 to 3.0. The overall impression of our app was favorable, and we identified that ``simple'' and ``intuitive'' were the main factors affecting older adults' and caregivers' preference for the user interface and interaction modality. We also identified a positive user acceptance of the use of augmented reality by 91\% (10/11) of the older adults to share information with their formal and informal caregivers. Conclusions: To address the need for a study to evaluate the user experience and user acceptance by older adults as well as both formal and informal caregivers regarding the user interfaces with multimodal interaction in the context of health monitoring, we designed, developed, and conducted user evaluations with the target user groups. Our results through this design study show important implications for designing future health monitoring apps with multiple interaction modalities and intuitive user interfaces in the older adult health care domain. ", doi="10.2196/42145", url="https://humanfactors.jmir.org/2023/1/e42145", url="http://www.ncbi.nlm.nih.gov/pubmed/36884275" } @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/10.2196/41088, author="Bertholet, Nicolas and Schmutz, Elodie and Cunningham, A. John and McNeely, Jennifer and Gmel, Gerhard and Daeppen, Jean-Bernard and Grazioli, S. V{\'e}ronique", title="Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment", journal="JMIR Hum Factors", year="2023", month="Mar", day="7", volume="10", pages="e41088", keywords="app", keywords="alcohol-related secondary prevention", keywords="university students", keywords="tertiary students", keywords="qualitative", keywords="alcohol", keywords="mHealth", keywords="mobile app", keywords="smartphone", keywords="mobile phone", abstract="Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ?18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: ``General Acceptance of the App,'' ``Importance of the Targeted and Relevant App Content,'' ``Importance of Credibility,'' ``Importance of the App Usability,'' ``Importance of a Simple and Attractive Design,'' ``Importance of Notifications to Ensure App Use over Time.'' Besides a general acceptance of the app, these themes reflected participants' recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 ", doi="10.2196/41088", url="https://humanfactors.jmir.org/2023/1/e41088", url="http://www.ncbi.nlm.nih.gov/pubmed/36881448" } @Article{info:doi/10.2196/43296, author="Niemeijer, Koen and Mestdagh, Merijn and Verdonck, Stijn and Meers, Kristof and Kuppens, Peter", title="Combining Experience Sampling and Mobile Sensing for Digital Phenotyping With m-Path Sense: Performance Study", journal="JMIR Form Res", year="2023", month="Mar", day="7", volume="7", pages="e43296", keywords="digital phenotyping", keywords="mobile health", keywords="mHealth", keywords="mobile sensing", keywords="passive sensing", keywords="ambulatory assessment", keywords="experience sampling", keywords="ecological momentary assessment", keywords="smartphones", keywords="mobile phone", abstract="Background: The experience sampling methodology (ESM) has long been considered as the gold standard for gathering data in everyday life. In contrast, current smartphone technology enables us to acquire data that are much richer, more continuous, and unobtrusive than is possible via ESM. Although data obtained from smartphones, known as mobile sensing, can provide useful information, its stand-alone usefulness is limited when not combined with other sources of information such as data from ESM studies. Currently, there are few mobile apps available that allow researchers to combine the simultaneous collection of ESM and mobile sensing data. Furthermore, such apps focus mostly on passive data collection with only limited functionality for ESM data collection. Objective: In this paper, we presented and evaluated the performance of m-Path Sense, a novel, full-fledged, and secure ESM platform with background mobile sensing capabilities. Methods: To create an app with both ESM and mobile sensing capabilities, we combined m-Path, a versatile and user-friendly platform for ESM, with the Copenhagen Research Platform Mobile Sensing framework, a reactive cross-platform framework for digital phenotyping. We also developed an R package, named mpathsenser, which extracts raw data to an SQLite database and allows the user to link and inspect data from both sources. We conducted a 3-week pilot study in which we delivered ESM questionnaires while collecting mobile sensing data to evaluate the app's sampling reliability and perceived user experience. As m-Path is already widely used, the ease of use of the ESM system was not investigated. Results: Data from m-Path Sense were submitted by 104 participants, totaling 69.51 GB (430.43 GB after decompression) or approximately 37.50 files or 31.10 MB per participant per day. After binning accelerometer and gyroscope data to 1 value per second using summary statistics, the entire SQLite database contained 84,299,462 observations and was 18.30 GB in size. The reliability of sampling frequency in the pilot study was satisfactory for most sensors, based on the absolute number of collected observations. However, the relative coverage rate---the ratio between the actual and expected number of measurements---was below its target value. This could mostly be ascribed to gaps in the data caused by the operating system pushing away apps running in the background, which is a well-known issue in mobile sensing. Finally, some participants reported mild battery drain, which was not considered problematic for the assessed participants' perceived user experience. Conclusions: To better study behavior in everyday life, we developed m-Path Sense, a fusion of both m-Path for ESM and Copenhagen Research Platform Mobile Sensing. Although reliable passive data collection with mobile phones remains challenging, it is a promising approach toward digital phenotyping when combined with ESM. ", doi="10.2196/43296", url="https://formative.jmir.org/2023/1/e43296", url="http://www.ncbi.nlm.nih.gov/pubmed/36881444" } @Article{info:doi/10.2196/39055, author="Rezaee, Rita and Khashayar, Mahboobeh and Saeedinezhad, Saeed and Nasiri, Mahdi and Zare, Sahar", title="Critical Criteria and Countermeasures for Mobile Health Developers to Ensure Mobile Health Privacy and Security: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2023", month="Mar", day="2", volume="11", pages="e39055", keywords="telemedicine", keywords="mobile apps", keywords="privacy", keywords="computer security, confidentiality", keywords="mHealth", keywords="mobile health", abstract="Background: Despite the importance of the privacy and confidentiality of patients' information, mobile health (mHealth) apps can raise the risk of violating users' privacy and confidentiality. Research has shown that many apps provide an insecure infrastructure and that security is not a priority for developers. Objective: This study aims to develop and validate a comprehensive tool to be considered by developers for assessing the security and privacy of mHealth apps. Methods: A literature search was performed to identify papers on app development, and those papers reporting criteria for the security and privacy of mHealth were assessed. The criteria were extracted using content analysis and presented to experts. An expert panel was held for determining the categories and subcategories of the criteria according to meaning, repetition, and overlap; impact scores were also measured. Quantitative and qualitative methods were used for validating the criteria. The validity and reliability of the instrument were calculated to present an assessment instrument. Results: The search strategy identified 8190 papers, of which 33 (0.4\%) were deemed eligible. A total of 218 criteria were extracted based on the literature search; of these, 119 (54.6\%) criteria were removed as duplicates and 10 (4.6\%) were deemed irrelevant to the security or privacy of mHealth apps. The remaining 89 (40.8\%) criteria were presented to the expert panel. After calculating impact scores, the content validity ratio (CVR), and the content validity index (CVI), 63 (70.8\%) criteria were confirmed. The mean CVR and CVI of the instrument were 0.72 and 0.86, respectively. The criteria were grouped into 8 categories: authentication and authorization, access management, security, data storage, integrity, encryption and decryption, privacy, and privacy policy content. Conclusions: The proposed comprehensive criteria can be used as a guide for app designers, developers, and even researchers. The criteria and the countermeasures presented in this study can be considered to improve the privacy and security of mHealth apps before releasing the apps into the market. Regulators are recommended to consider an established standard using such criteria for the accreditation process, since the available self-certification of developers is not reliable enough. ", doi="10.2196/39055", url="https://mhealth.jmir.org/2023/1/e39055", url="http://www.ncbi.nlm.nih.gov/pubmed/36862494" } @Article{info:doi/10.2196/40463, author="Aune, Anders and Vartdal, Gunnar and Jimenez Diaz, Gabriela and Gierman, Marijn Lobke and Bergseng, H{\aa}kon and Darj, Elisabeth", title="Iterative Development, Validation, and Certification of a Smartphone System to Assess Neonatal Jaundice: Development and Usability Study", journal="JMIR Pediatr Parent", year="2023", month="Feb", day="28", volume="6", pages="e40463", keywords="neonatal jaundice", keywords="neonatal hyperbilirubinemia", keywords="newborns", keywords="mobile app", keywords="design", keywords="validation", keywords="regulatory processes", keywords="mobile health", keywords="mHealth", keywords="mobile phone", abstract="Background: Medical device development is an area facing multiple challenges, resulting in a high number of products not reaching the clinical setting. Neonatal hyperbilirubinemia, manifesting as neonatal jaundice (NNJ), is an important cause of newborn morbidity and mortality. It is important to identify infants with neonatal hyperbilirubinemia at an early stage, but currently there is a lack of tools that are both accurate and affordable. Objective: This study aimed to develop a novel system to assess the presence of NNJ. The device should provide accurate results, be approved as a medical device, be easy to use, and be produced at a price that is affordable even in low-resource settings. Methods: We used an iterative approach to develop a smartphone-based system to detect the presence of NNJ. We performed technical development, followed by clinical and usability testing in parallel, after which we initiated the regulatory processes for certification. We updated the system in each iteration, and the final version underwent a clinical validation study on healthy term newborns aged 1 to 15 days before all documentation was submitted for conformity assessment to obtain Conformit{\'e} Europ{\'e}enne (CE) certification. We developed a system that incorporates a smartphone app, a color calibration card, and a server. Results: Three iterations of the smartphone-based system were developed; the final version was approved as a medical device after complying with Medical Device Regulation guidelines. A total of 201 infants were included in the validation study. Bilirubin values using the system highly correlated with total serum or plasma bilirubin levels (r=0.84). The system had a high sensitivity (94\%) to detect severe jaundice, defined as total serum or plasma bilirubin >250 {\textmu}mol/L, and maintained a high specificity (71\%). Conclusions: Our smartphone-based system has a high potential as a tool for identifying NNJ. An iterative approach to product development, conducted by working on different tasks in parallel, resulted in a functional and successful product. By adhering to the requirements for regulatory approval from the beginning of the project, we were able to develop a market-ready mobile health solution. ", doi="10.2196/40463", url="https://pediatrics.jmir.org/2023/1/e40463", url="http://www.ncbi.nlm.nih.gov/pubmed/36853753" } @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/10.2196/37987, 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/10.2196/44468, author="Shrestha, Roman and Altice, L. Frederick and Khati, Antoine and Azwa, Iskandar and Gautam, Kamal and Gupta, Sana and Sullivan, Sean Patrick and Ni, Zhao and Kamarulzaman, Adeeba and Phiphatkunarnon, Panyaphon and Wickersham, A. Jeffrey", title="Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="16", volume="11", pages="e44468", keywords="men who have sex with men", keywords="mHealth", keywords="HIV prevention", keywords="pre-exposure prophylaxis", keywords="mobile phone", keywords="Malaysia", keywords="MSM", keywords="mobile health", keywords="HIV", keywords="prevention", keywords="usability", keywords="acceptability", keywords="sexual minority", keywords="gay", keywords="homosexual", abstract="Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants' mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84\%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42\%) ordered an HIVST more than once. Almost all participants (46/50, 92\%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65\%); of these, 16/46 (35\%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39\%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia. Trial Registration: ClinicalTrials.gov NCT05052411; https://clinicaltrials.gov/ct2/show/NCT05052411 International Registered Report Identifier (IRRID): RR2-10.2196/43318 ", doi="10.2196/44468", url="https://mhealth.jmir.org/2023/1/e44468", url="http://www.ncbi.nlm.nih.gov/pubmed/36795465" } @Article{info:doi/10.2196/40836, author="Yoshizaki, Arika and Murata, Emi and Yamamoto, Tomoka and Fujisawa, X. Takashi and Hanaie, Ryuzo and Hirata, Ikuko and Matsumoto, Sayuri and Mohri, Ikuko and Taniike, Masako", title="Improving Children's Sleep Habits Using an Interactive Smartphone App: Community-Based Intervention Study", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="10", volume="11", pages="e40836", keywords="infant sleep", keywords="app", keywords="mHealth", keywords="mobile health", keywords="behavioral intervention", keywords="sleep health", keywords="social implementation", keywords="mobile phone", abstract="Background: Sleep problems are quite common among young children and are often a challenge for parents and a hinderance to children's development. Although behavioral therapy has proven effective in reducing sleep problems in children, a lack of access to professionals who can provide effective support is a major barrier for many caregivers. Therefore, pediatric sleep experts have begun developing apps and web-based services for caregivers. Despite the substantial influence of cultural and familial factors on children's sleep, little effort has gone into developing cultural or family-tailored interventions. Objective: This study aimed to examine the effectiveness of the interactive smartphone app ``Nenne Navi,'' which provides culturally and family-tailored suggestions for improving sleep habits in young Japanese children through community-based long-term trials. The study also aimed to investigate the association between app-driven improvements in sleep and mental development in children. Methods: This study adopted a community-based approach to recruit individuals from the Higashi-Osaka city (Japan) who met ?1 of the following eligibility criteria for sleep problems: sleeping after 10 PM, getting <9 hours of nighttime sleep, and experiencing frequent nighttime awakenings. A total of 87 Japanese caregivers with young children (mean 19.50, SD 0.70 months) were recruited and assigned to the app use group (intervention group) or the video-only group (control group). Both groups received educational video content regarding sleep health literacy. The caregivers in the intervention group used the app, which provides family-tailored suggestions, once per month for 1 year. Results: A total of 92\% (33/36) of the caregivers in the app use group completed 1 year of the intervention. The participants' overall evaluation of the app was positive. The wake-up time was advanced (base mean 8:06 AM; post mean 7:48 AM; F1,65=6.769; P=.01 and sleep onset latency was decreased (base mean 34.45 minutes; post mean 20.05 minutes; F1,65=23.219; P<.001) significantly in the app use group at the 13th month compared with the video-only group. Moreover, multiple regression analysis showed that decreased social jetlag ($\beta$=?0.302; P=.03) and increased sleep onset latency SD ($\beta$=.426; P=.02) in children predicted a significant enhancement in the development of social relationships with adults. At 6 months after the completion of the app use, all the caregivers reported continuation of the new lifestyle. Conclusions: The present findings suggest that the app ``Nenne Navi'' has high continuity in community use and can improve sleep habits in young Japanese children and that interventions for sleep habits of young children may lead to the enhancement of children's social development. Future studies must focus on the effectiveness of the app in other regions with different regional characteristics and neuroscientific investigations on how changes in sleep impact brain development. ", doi="10.2196/40836", url="https://mhealth.jmir.org/2023/1/e40836", url="http://www.ncbi.nlm.nih.gov/pubmed/36641237" } @Article{info:doi/10.2196/38894, author="Trinidad, Brown Susan and Shane, L. Aliassa and Guinn, R. Tiffany and Apok, R. Charlene and Collier, F. Ann and Avey, P. Jaedon and Donovan, M. Dennis", title="The Cultural Adaption of a Sobriety Support App for Alaska Native and American Indian People: Qualitative Feasibility and Acceptability Study", journal="JMIR Form Res", year="2023", month="Feb", day="7", volume="7", pages="e38894", keywords="alcohol misuse", keywords="sobriety support", keywords="peer support", keywords="smartphone app", keywords="community reinforcement approach", keywords="mobile phone", abstract="Background: Despite high rates of alcohol abstinence, Alaska Native and American Indian (ANAI) people experience a disproportionate burden of alcohol-related morbidity and mortality. Multiple barriers to treatment exist for this population, including a lack of culturally relevant resources; limited access to or delays in receiving treatment; and privacy concerns. Many ANAI people in the state of Alaska, United States, live in sparsely populated rural areas, where treatment access and privacy concerns regarding peer-support programs may be particularly challenging. In addition, prior research demonstrates that many ANAI people prefer a self-management approach to sobriety, rather than formal treatment. Taken together, these factors suggest a potential role for a culturally adapted smartphone app to support ANAI people interested in changing their behavior regarding alcohol use. Objective: This study was the first phase of a feasibility and acceptability study of a culturally tailored version of an off-the-shelf smartphone app to aid ANAI people in managing or reducing their use of alcohol. The aim of this qualitative needs assessment was to gather insights and preferences from ANAI people and health care providers serving ANAI people to guide feature development, content selection, and cultural adaptation before a pilot test of the smartphone app with ANAI people. Methods: From October 2018 to September 2019, we conducted semistructured interviews with 24 ANAI patients aged ?21 years and 8 providers in a tribal health care organization in south-central Alaska. Results: Participants generally endorsed the usefulness of a smartphone app for alcohol self-management. They cited anonymity, 24/7 access, peer support, and patient choice as key attributes of an app. The desired cultural adaptations included ANAI- and land-themed design elements, cultural content (eg, stories from elders), and spiritual resources. Participants considered an app especially useful for rural-dwelling ANAI people, as well as those who lack timely access to treatment services or prefer to work toward managing their alcohol use outside the clinical setting. Conclusions: This needs assessment identified key features, content, and cultural adaptations that are being implemented in the next phase of the study. In future work, we will determine the extent to which these changes can be accommodated in a commercially available app, the feasibility of implementation, and the acceptability of the culturally adapted version of the app among ANAI users. ", doi="10.2196/38894", url="https://formative.jmir.org/2023/1/e38894", url="http://www.ncbi.nlm.nih.gov/pubmed/36473107" } @Article{info:doi/10.2196/43241, author="Baretta, Dario and Amrein, Alexandra Melanie and B{\"a}der, Carole and Ruschetti, Giacomo Gian and R{\"u}ttimann, Carole and Del Rio Carral, Maria and Fabian, Carlo and Inauen, Jennifer", title="Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="3", volume="11", pages="e43241", keywords="COVID-19", keywords="hand hygiene", keywords="behavior change intervention", keywords="Multiphase Optimization Strategy", keywords="MOST", keywords="smartphone apps", keywords="motivation", keywords="habit", keywords="social norm", keywords="mobile phone", abstract="Background: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. Objective: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. Methods: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. Results: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, ``variety and timeliness of the task load'' and ``social interaction'') were found in the thematic analysis. Conclusions: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. Trial Registration: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-055971 ", doi="10.2196/43241", url="https://mhealth.jmir.org/2023/1/e43241", url="http://www.ncbi.nlm.nih.gov/pubmed/36599056" } @Article{info:doi/10.2196/40373, author="Chen, Tianzhen and Chen, Liyu and Li, Shuo and Du, Jiang and Su, Hang and Jiang, Haifeng and Wu, Qianying and Zhang, Lei and Bao, Jiayi and Zhao, Min", title="Virtual Digital Psychotherapist App--Based Treatment in Patients With Methamphetamine Use Disorder (Echo-APP): Single-Arm Pilot Feasibility and Efficacy Study", journal="JMIR Mhealth Uhealth", year="2023", month="Jan", day="31", volume="11", pages="e40373", keywords="tablet", keywords="Android program", keywords="substance use disorder", keywords="methamphetamine use disorder", keywords="digital agent", keywords="virtual digital human", abstract="Background: Substance use disorder is one of the severe public health problems worldwide. Inequitable resources, discrimination, and physical distances limit patients' access to medical help. Automated conversational agents have the potential to provide in-home and remote therapy. However, automatic dialogue agents mostly use text and other methods to interact, which affects the interaction experience, treatment immersion, and clinical efficacy. Objective: The aim of this paper is to describe the design and development of Echo-APP, a tablet-based app with the function of a virtual digital psychotherapist, and to conduct a pilot study to explore the feasibility and preliminary efficacy results of Echo-APP for patients with methamphetamine use disorder. Methods: Echo-APP is an assessment and rehabilitation program developed for substance use disorder (SUD) by a team of clinicians, psychotherapists, and computer experts. The program is available for Android tablets. In terms of assessment, the focus is on the core characteristics of SUD, such as mood, impulsivity, treatment motivation, and craving level. In terms of treatment, Echo-APP provides 10 treatment units, involving awareness of addiction, motivation enhancement, emotion regulation, meditation, etc. A total of 47 patients with methamphetamine dependence were eventually enrolled in the pilot study to receive a single session of the Echo-APP--based motivational enhancement treatment. The outcomes were assessed before and after the patients' treatment, including treatment motivation, craving levels, self-perception on the importance of drug abstinence, and their confidence in stopping the drug use. Results: In the pilot study, scores on the Stages of Change Readiness and Treatment Eagerness Scale and the questionnaire on motivation for abstaining from drugs significantly increased after the Echo-APP--based treatment (P<.001, Cohen d=--0.60), while craving was reduced (P=.01, Cohen d=0.38). Patients' baseline Generalized Anxiety Disorder-7 assessment score ($\beta$=3.57; P<.001; 95\% CI 0.80, 2.89) and Barratt Impulsiveness Scale (BIS)--motor impulsiveness score ($\beta$=--2.10; P=.04; 95\% CI --0.94, --0.02) were predictive of changes in the patients' treatment motivation during treatment. Moreover, patients' baseline Generalized Anxiety Disorder-7 assessment score ($\beta$=--1.607; P=.03; 95\% CI --3.08, --0.14), BIS---attentional impulsivity score ($\beta$=--2.43; P=.004; 95\% CI --4.03, --0.83), and BIS---nonplanning impulsivity score ($\beta$=2.54; P=.002; 95\% CI 0.98, 4.10) were predictive of changes in craving scores during treatment. Conclusions: Echo-APP is a practical, accepted, and promising virtual digital psychotherapist program for patients with methamphetamine dependence. The preliminary findings lay a good foundation for further optimization of the program and the promotion of large-scale randomized controlled clinical studies for SUD. ", doi="10.2196/40373", url="https://mhealth.jmir.org/2023/1/e40373", url="http://www.ncbi.nlm.nih.gov/pubmed/36719727" } @Article{info:doi/10.2196/41660, author="Choi, Woohyeok and Lee, Uichin", title="Loss-Framed Adaptive Microcontingency Management for Preventing Prolonged Sedentariness: Development and Feasibility Study", journal="JMIR Mhealth Uhealth", year="2023", month="Jan", day="27", volume="11", pages="e41660", keywords="contingency management", keywords="incentive", keywords="sedentary behavior", keywords="sedentariness", keywords="behavior change", keywords="health promotion", keywords="financial incentives", keywords="health intervention", keywords="user compliance", keywords="incentive-based intervention", keywords="mobile phone", abstract="Background: A growing body of evidence shows that financial incentives can effectively reinforce individuals' positive behavior change and improve compliance with health intervention programs. A critical factor in the design of incentive-based interventions is to set a proper incentive magnitude. However, it is highly challenging to determine such magnitudes as the effects of incentive magnitude depend on personal attitudes and contexts. Objective: This study aimed to illustrate loss-framed adaptive microcontingency management (L-AMCM) and the lessons learned from a feasibility study. L-AMCM discourages an individual's adverse health behaviors by deducting particular expenses from a regularly assigned budget, where expenses are adaptively estimated based on the individual's previous responses to varying expenses and contexts. Methods: We developed a mobile health intervention app for preventing prolonged sedentary lifestyles. This app delivered a behavioral mission (ie, suggesting taking an active break for a while) with an incentive bid when 50 minutes of uninterrupted sedentary behavior happened. Participants were assigned to either the fixed (ie, deducting the monotonous expense for each mission failure) or adaptive (ie, deducting varying expenses estimated by the L-AMCM for each mission failure) incentive group. The intervention lasted 3 weeks. Results: We recruited 41 participants (n=15, 37\% women; fixed incentive group: n=20, 49\% of participants; adaptive incentive group: n=21, 51\% of participants) whose mean age was 24.0 (SD 3.8; range 19-34) years. Mission success rates did not show statistically significant differences by group (P=.54; fixed incentive group mean 0.66, SD 0.24; adaptive incentive group mean 0.61, SD 0.22). The follow-up analysis of the adaptive incentive group revealed that the influence of incentive magnitudes on mission success was not statistically significant (P=.18; odds ratio 0.98, 95\% CI 0.95-1.01). On the basis of the qualitative interviews, such results were possibly because the participants had sufficient intrinsic motivation and less sensitivity to incentive magnitudes. Conclusions: Although our L-AMCM did not significantly affect users' mission success rate, this study configures a pioneering work toward adaptively estimating incentives by considering user behaviors and contexts through leveraging mobile sensing and machine learning. We hope that this study inspires researchers to develop incentive-based interventions. ", doi="10.2196/41660", url="https://mhealth.jmir.org/2023/1/e41660", url="http://www.ncbi.nlm.nih.gov/pubmed/36705949" } @Article{info:doi/10.2196/41880, author="Venkatesan, Aarathi and Zimmermann, Gretchen and Rawlings, Kelly and Ryan, Claudia and Voelker, Louise and Edwards, Caitlyn", title="Improvements in Glycemic Control and Depressive Symptoms Among Adults With Type 2 Diabetes: Retrospective Study", journal="JMIR Form Res", year="2023", month="Jan", day="13", volume="0", pages="e0", keywords="type 2 diabetes", keywords="digital health", keywords="diabetes intervention", keywords="diabetes", keywords="diabetic", keywords="health app", keywords="coaching", keywords="patient education", keywords="mobile health", keywords="mHealth", keywords="app-based", keywords="health coaching", keywords="hemoglobin A1c", keywords="HbA1c", keywords="depression", keywords="depressive", keywords="anxiety", keywords="mental health", keywords="glycemic control", keywords="diabetes management", keywords="health management", keywords="digital health intervention", abstract="Background: The prevalence of diabetes remains high, with traditional lifestyle interventions demonstrating limited success in improving diabetes-related outcomes, particularly among individuals with diabetes-related mental health comorbidities. Digital health interventions provide the ability to ease the sustained and rigorous self-management needs associated with diabetes care and treatment. Current interventions though, are plagued by small sample sizes, underpowered pilot studies, and immense heterogeneity in program intervention, duration, and measured outcomes. Objective: Therefore, this work aimed to evaluate the effectiveness of a mobile health diabetes management program on measures of glycemic control in a high-risk population with type 2 diabetes (hemoglobin A1c [HbA1c] ?8.0\%), utilizing a sample of 1128 participants who provided baseline and follow-up data. The sustainability of this change in glycemic control was examined in a subset of participants (n=455) at 6 months and 1 year following program enrollment. A secondary analysis examined changes in glycemic control among a subset of participants with self-reported mild-to-moderate depression at baseline. Methods: This study utilized a single-arm, retrospective design. Participants were enrolled in the Vida Health Diabetes Management Program. This app-based intervention utilized one-on-one remote sessions with a health coach, registered dietitian nutritionist, and/or a certified diabetes care and education specialist and structured lessons and tools related to diabetes management and self-care. Participants provided baseline (--365 to 21 days of program enrollment) as well as follow-up (at least 90 days following program enrollment) HbA1c values. Paired t tests were used to evaluate changes in HbA1c between baseline and follow-up time points. The 8-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale were utilized to assess self-reported depressive and anxiety symptoms, respectively. Paired t tests and linear regression modeling accounting for pertinent covariates were used to evaluate changes in mental health symptom acuity and their relationship with changes in glycemic control. Results: We observed a significant decrease in HbA1c of --1.35 points between baseline (mean 9.84, SD 1.64) and follow-up (mean 8.48, SD 1.77; t=22.56, P<.001) among this large, high-risk sample. This decrease was sustained up to 1 year following program enrollment. Additionally, a significant relationship between improvements in depressive symptom acuity and improvements in HbA1c was observed ($\beta$=--0.74, P=.03). Conclusions: This study demonstrates clinically meaningful improvements in glycemic control among participants enrolled in the Vida Health Diabetes Management Program. Additionally, this work presents one of the largest studied samples of participants enrolled in a digital health diabetes management program to date. ", doi="10.2196/41880", url="https://formative.jmir.org/2023/0/e0/" } @Article{info:doi/10.2196/38078, author="Morse, Brad and Soares, Andrey and Ytell, Kate and DeSanto, Kristen and Allen, Marvyn and Holliman, Dorsey Brooke and Lee, S. Rita and Kwan, M. Bethany and Schilling, M. Lisa", title="Co-design of the Transgender Health Information Resource: Web-Based Participatory Design", journal="J Particip Med", year="2023", month="Jan", day="10", volume="15", pages="e38078", keywords="transgender", keywords="gender diverse", keywords="participatory design", keywords="web-based design", keywords="co-design", keywords="health information resource", keywords="smartphone", keywords="app", keywords="mobile phone", abstract="Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. ", doi="10.2196/38078", url="https://jopm.jmir.org/2023/1/e38078", url="http://www.ncbi.nlm.nih.gov/pubmed/36626222" } @Article{info:doi/10.2196/43263, author="Ditton, Elizabeth and Knott, Brendon and Hodyl, Nicolette and Horton, Graeme and Walker, Rohan Frederick and Nilsson, Michael", title="Medical Student Experiences of Engaging in a Psychological Flexibility Skill Training App for Burnout and Well-being: Pilot Feasibility Study", journal="JMIR Form Res", year="2023", month="Jan", day="10", volume="7", pages="e43263", keywords="medical students", keywords="burnout prevention", keywords="app", keywords="feasibility", keywords="intervention engagement", keywords="psychological flexibility", keywords="acceptance and commitment therapy", keywords="mobile phone", abstract="Background: Medical students are at higher risk of burnout than the general population. Interventions that facilitate adaptive coping behaviors (eg, Psychological Flexibility) in the context of inherent stressors associated with medical training could mitigate burnout risk and improve well-being. Delivering these interventions using smartphone apps offers advantages such as accessibility, scalability, mitigation of time and stigma barriers, and facilitation of individual tailoring (individualization). There is a need for feasibility trials with medical students in this emerging field. Formal evaluations of user experiences of app-based psychological skill training are required to identify barriers to and facilitators of engagement and optimize intervention development before implementation in efficacy trials and real-world settings. Objective: This study aimed to assess the feasibility of delivering an individualized Psychological Flexibility skill training intervention (Acceptance and Commitment Training [ACTraining]) to medical students using an app-based delivery format. We further aimed to explore how formal evaluation of user experiences might inform and guide the development of this app before implementation in an efficacy trial and future research involving app-delivered psychological skill training for medical students. Methods: This single-arm study was an early-phase feasibility trial of a stand-alone ACTraining app conducted with a sample of Australian medical students (n=11). We collected app usability and user experience data across a broad range of domains (eg, perceived helpfulness and relevance, learning experiences, and self-efficacy) using self-report questionnaires (quantitative and qualitative) and behavioral engagement outcomes. Results: Behavioral engagement data demonstrated that the app delivered the assessment procedures and individualized ACTraining intervention to medical students as intended. The subjective feedback provided by students who actively engaged with the app was generally positive across several indicators, including usability, perceived relevance and helpfulness, accessibility, maintenance of privacy, and opportunity for self-reflection. Disengagement from the app was an identified challenge throughout the trial. Participant feedback identified several factors that may have affected engagement, such as time, expectations regarding app interface functioning, and individual differences in confidence and self-efficacy when implementing skills. Conclusions: This study reports user experience data that have been largely absent from the literature on digital psychological interventions for medical students. Our findings demonstrate the preliminary feasibility of an app-delivered ACTraining intervention for medical student well-being and burnout and support the value of future assessment of the efficacy of this approach with larger samples. We consider subjective feedback from medical students in relation to observed engagement and propose how this information might be used to inform the development of this app and future research in this nascent field. ", doi="10.2196/43263", url="https://formative.jmir.org/2023/1/e43263", url="http://www.ncbi.nlm.nih.gov/pubmed/36626191" } @Article{info:doi/10.2196/42416, author="Young, Ruth Stephanie and Lattie, Gardiner Emily and Berry, L. Andrew B. and Bui, Lynn and Byrne, Joseph Greg and Yoshino Benavente, Noelani Julia and Bass, Michael and Gershon, C. Richard and Wolf, S. Michael and Nowinski, J. Cindy", title="Remote Cognitive Screening Of Healthy Older Adults for Primary Care With the MyCog Mobile App: Iterative Design and Usability Evaluation", journal="JMIR Form Res", year="2023", month="Jan", day="10", volume="7", pages="e42416", keywords="human-centered design", keywords="mobile health", keywords="mHealth", keywords="usability", keywords="cognitive screening", keywords="older adults", keywords="mobile phone", abstract="Background: Annual cognitive screening in adults aged >65 years can improve early detection of cognitive impairment, yet less than half of all cases are identified in primary care. Time constraints in primary care settings present a major barrier to routine screening. A remote cognitive screener completed on a patient's own smartphone before a visit has the potential to save primary care clinics time, encourage broader screening practices, and increase early detection of cognitive decline. Objective: We described the iterative design and proposed the implementation of a remote cognitive screening app, MyCog Mobile, to be completed on a patient's smartphone before an annual wellness visit. The research questions were as follows: What would motivate primary care clinicians and clinic administrators to implement a remote cognitive screening process? How might we design a remote cognitive screener to fit well with existing primary care workflows? What would motivate an older adult patient to complete a cognitive screener on a smartphone before a primary care visit? How might we optimize the user experience of completing a remote cognitive screener on a smartphone for older adults? Methods: To address research questions 1 and 2, we conducted individual interviews with clinicians (n=5) and clinic administrators (n=3). We also collaborated with clinic administrators to create user journey maps of their existing and proposed MyCog Mobile workflows. To address research questions 3 and 4, we conducted individual semistructured interviews with cognitively healthy older adults (n=5) and solicited feedback from a community stakeholder panel (n=11). We also tested and refined high-fidelity prototypes of the MyCog Mobile app with the older adult interview participants, who rated the usability on the Simplified System Usability Scale and After-Scenario Questionnaire. Results: Clinicians and clinic administrators were motivated to adopt a remote cognitive screening process if it saved time in their workflows. Findings from interviews and user journey mapping informed the proposed implementation and core functionality of MyCog Mobile. Older adult participants were motivated to complete cognitive screeners to ensure that they were cognitively healthy and saw additional benefits to remote screening, such as saving time during their visit and privacy. Older adults also identified potential challenges to remote smartphone screening, which informed the user experience design of the MyCog Mobile app. The average rating across prototype versions was 91 (SD 5.18) on the Simplified System Usability Scale and 6.13 (SD 8.40) on the After-Scenario Questionnaire, indicating above-average usability. Conclusions: Through an iterative, human-centered design process, we developed a viable remote cognitive screening app and proposed an implementation strategy for primary care settings that was optimized for multiple stakeholders. The next steps include validating the cognitive screener in clinical and healthy populations and piloting the finalized app in a community primary care clinic. ", doi="10.2196/42416", url="https://formative.jmir.org/2023/1/e42416", url="http://www.ncbi.nlm.nih.gov/pubmed/36626223" } @Article{info:doi/10.2196/40837, author="Sherman, Anne Kerry and Pehlivan, Jade Melissa and Singleton, Anna and Hawkey, Alexandra and Redfern, Julie and Armour, Mike and Dear, Blake and Duckworth, Jane Tanya and Ciccia, Donna and Cooper, Michael and Parry, Ann Kelly and Gandhi, Esther and Imani, A. Sara", title="Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study", journal="JMIR Form Res", year="2022", month="Dec", day="9", volume="6", number="12", pages="e40837", keywords="text message", keywords="intervention", keywords="co-design", keywords="development", keywords="endometriosis", keywords="SMS", keywords="mHealth", keywords="self-management", keywords="mobile phone", abstract="Background: Endometriosis, which affects 1 in 10 people assigned female at birth, is a chronic systemic inflammatory disease with a high symptom burden and adverse socioemotional impacts. There is a need for an accessible, cost-effective, and low-burden intervention to support individuals in managing their endometriosis condition. Objective: This study aimed to co-design and evaluate the acceptability, readability, and quality of a bank of supportive SMS text messages (EndoSMS) for individuals with endometriosis. Methods: In phase 1 of this mixed method design, 17 consumer representatives (individuals with endometriosis) participated across three 3-hour web-based (Zoom, Zoom Video Communications, Inc) focus groups. The transcripts were encoded and analyzed thematically. In phase 2, consumer representatives (n=14) and health care professionals (n=9) quantitatively rated the acceptability, readability, and appropriateness of the developed text messages in a web-based survey. All the participants initially completed a background survey assessing sociodemographic and medical factors. Results: Consumer representatives demonstrated diverse sociodemographic characteristics (Mage=33.29), varying in location (metropolitan vs rural or regional), employment, and relationship and educational statuses. Participants reached a consensus regarding the delivery of 4 SMS text messages per week, delivered randomly throughout the week and in one direction (ie, no reply), with customization for the time of day and use of personal names. Seven main areas of unmet need for which participants required assistance were identified, which subsequently became the topic areas for the developed SMS text messages: emotional health, social support, looking after and caring for your body, patient empowerment, interpersonal issues, general endometriosis information, and physical health. Through a web-based survey, 371 co-designed SMS text messages were highly rated by consumers and health care professionals as clear, useful, and appropriate for individuals with endometriosis. Readability indices (Flesch-Kincaid scale) indicated that the SMS text messages were accessible to individuals with a minimum of 7th grade high school education. Conclusions: On the basis of the needs and preferences of a diverse consumer representative group, we co-designed EndoSMS, a supportive SMS text message program for individuals with endometriosis. The initial evaluation of the SMS text messages by consumer representatives and health professionals suggested the high acceptability and suitability of the developed SMS text messages. Future studies should further evaluate the acceptability and effectiveness of EndoSMS in a broader population of individuals with endometriosis. ", doi="10.2196/40837", url="https://formative.jmir.org/2022/12/e40837", url="http://www.ncbi.nlm.nih.gov/pubmed/36485029" } @Article{info:doi/10.2196/42553, author="Tami-Maury, Irene and Klaff, Rebecca and Hussin, Allison and Smith, Grant Nathan and Chang, Shine and McNeill, Lorna and Reitzel, R. Lorraine and Shete, Sanjay and Abroms, C. Lorien", title="A Text-Based Smoking Cessation Intervention for Sexual and Gender Minority Groups: Protocol for a Feasibility Trial", journal="JMIR Res Protoc", year="2022", month="Dec", day="9", volume="11", number="12", pages="e42553", keywords="smoking cessation", keywords="sexual and gender minorities", keywords="LGBTQ+", keywords="SMS text messaging", keywords="mobile health", keywords="mHealth", abstract="Background: Smoking among sexual and gender minority (SGM) groups, which include lesbian, gay, bisexual, transgender, and queer individuals, has been reported to be highly prevalent. This is attributed to several factors, including minority-specific stress and targeted tobacco marketing. Therefore, this population is at an increased risk for tobacco-related diseases. SMS text messaging programs have been found to be effective for smoking cessation and appeal to traditionally hard-to-reach populations over other interventions. It has also been suggested that targeted and tailored interventions could be more effective among SGM smokers because they can be designed to assure a safe, validating health care environment that enhances receptivity to cessation. Objective: The aim of this study is to develop SmokefreeSGM, a text-based smoking cessation program tailored to and tested among SGM smokers. Methods: The study consists of three phases, culminating in a feasibility trial. In Phase 1, our research team will collaborate with a Community Advisory Board to develop and pretest the design of SmokefreeSGM. In Phase 2, the tailored text messaging program will be beta tested among 16 SGM smokers. Our research team will use a mixed-methods approach to collect and analyze data from participants who will inform the refinement of SmokefreeSGM. In Phase 3, a feasibility trial will be conducted among 80 SGM smokers either enrolled in SmokefreeSGM or SmokefreeTXT, the original text-based program developed by the National Cancer Institute for the general population. Our research team will examine recruitment, retention, and smoking abstinence rates at 1-, 3-, and 6-month follow-up. Additionally, a qualitative interview will be conducted among 32 participants to evaluate the feasibility and acceptability of the programs (SmokefreeSGM and SmokefreeTXT). Results: This study received approval from The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects to begin research on August 21, 2020. Recruitment for the beta testing of SmokefreeSGM (Phase 2) began in January 2022. We estimate that the feasibility trial (Phase 3) will begin in September 2022 and that results will be available in December 2023. Conclusions: Findings from this research effort will help reduce tobacco-related health disparities among SGM smokers by determining the feasibility and acceptability of SmokefreeSGM, an SGM-tailored smoking cessation intervention. Trial Registration: ClinicalTrials.gov NCT05029362; https://clinicaltrials.gov/ct2/show/NCT05029362 International Registered Report Identifier (IRRID): DERR1-10.2196/42553 ", doi="10.2196/42553", url="https://www.researchprotocols.org/2022/12/e42553", url="http://www.ncbi.nlm.nih.gov/pubmed/36485022" } @Article{info:doi/10.2196/41628, author="Barbaric, Antonia and Munteanu, Cosmin and Ross, Heather and Cafazzo, A. Joseph", title="Design of a Patient Voice App Experience for Heart Failure Management: Usability Study", journal="JMIR Form Res", year="2022", month="Dec", day="6", volume="6", number="12", pages="e41628", keywords="heart failure", keywords="self-management", keywords="digital therapeutics", keywords="voice-activated technology", keywords="smart speaker", keywords="usability study", keywords="formative evaluation", keywords="mobile phone", keywords="smartphone", abstract="Background: The use of digital therapeutics (DTx) in the prevention and management of medical conditions has increased through the years, with an estimated 44 million people using one as part of their treatment plan in 2021, nearly double the number from the previous year. DTx are commonly accessed through smartphone apps, but offering these treatments through additional platforms can improve the accessibility of these interventions. Voice apps are an emerging technology in the digital health field; not only do they have the potential to improve DTx adherence, but they can also create a better user experience for some user groups. Objective: This research aimed to identify the acceptability and feasibility of offering a voice app for a chronic disease self-management program. The objective of this project was to design, develop, and evaluate a voice app of an already-existing smartphone-based heart failure self-management program, Medly, to be used as a case study. Methods: A voice app version of Medly was designed and developed through a user-centered design process. We conducted a usability study and semistructured interviews with patients with heart failure (N=8) at the Peter Munk Cardiac Clinic in Toronto General Hospital to better understand the user experience. A Medly voice app prototype was built using a software development kit in tandem with a cloud computing platform and was verified and validated before the usability study. Data collection and analysis were guided by a mixed methods triangulation convergence design. Results: Common themes were identified in the results of the usability study, which involved 8 participants with heart failure. Almost all participants (7/8, 88\%) were satisfied with the voice app and felt confident using it, although half of the participants (4/8, 50\%) were unsure about using it in the future. Six main themes were identified: changes in physical behavior, preference between voice app and smartphone, importance of music during voice app interaction, lack of privacy concerns, desired reassurances during voice app interaction, and helpful aids during voice app interaction. These findings were triangulated with the quantitative data, and it concluded that the main area for improvement was related to the ease of use; design changes were then implemented to better improve the user experience. Conclusions: This work offered preliminary insight into the acceptability and feasibility of a Medly voice app. Given the recent emergence of voice apps in health care, we believe that this research offered invaluable insight into successfully deploying DTx for chronic disease self-management using this technology. ", doi="10.2196/41628", url="https://formative.jmir.org/2022/12/e41628", url="http://www.ncbi.nlm.nih.gov/pubmed/36472895" } @Article{info:doi/10.2196/41658, author="Marler, D. Jennifer and Fujii, A. Craig and Utley, T. MacKenzie and Balbierz, J. Daniel and Galanko, A. Joseph and Utley, S. David", title="Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="24", volume="10", number="11", pages="e41658", keywords="smoking cessation", keywords="digital health", keywords="smartphone", keywords="digital sensor", keywords="carbon monoxide", keywords="breath sensor", keywords="biofeedback", keywords="mobile apps", keywords="health promotion", keywords="app", keywords="mobile phone", abstract="Background: Cigarette smoking remains the leading cause of preventable illness and death, underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical Practice Guideline--based mobile smoking cessation program, comprises a personal carbon monoxide breath sensor; a smartphone app; in-app, text-based human-provided coaching; nicotine replacement therapy; and a moderated web-based community. Promising Pivot cohort studies have established the foundation for comparative assessment. Objective: This study aimed to compare engagement, retention, attitudes toward quitting smoking, smoking behavior, and participant feedback between Pivot and QuitGuide, a US Clinical Practice Guideline--based smoking cessation smartphone app from the National Cancer Institute. Methods: In this remote pilot randomized controlled trial, cigarette smokers in the United States were recruited on the web and randomized to Pivot or QuitGuide. Participants were offered 12 weeks of free nicotine replacement therapy. Data were self-reported via weekly web-based questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and retention, attitudes toward quitting smoking, smoking behavior, and participant feedback. The primary outcome was self-reported app openings at 12 weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence abstinence (PPA), abstinence from all tobacco products, and continuous abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated via breath carbon monoxide samples. Results: Participants comprised 188 smokers (94 Pivot and 94 QuitGuide): mean age 46.4 (SD 9.2) years, 104 (55.3\%) women, 128 (68.1\%) White individuals, and mean cigarettes per day 17.6 (SD 9.0). Engagement via mean ``total app openings through 12 weeks'' (primary outcome) was Pivot, 157.9 (SD 210.6) versus QuitGuide, 86.5 (SD 66.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was Pivot, 35\% (33/94) versus QuitGuide, 28\% (26/94; intention to treat [ITT]: P=.28) and Pivot, 36\% (34/94) versus QuitGuide, 27\% (25/94; ITT: P=.12), respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot, 29\% (27/94) versus QuitGuide, 22\% (21/94; ITT: P=.32) and Pivot, 32\% (30/94) versus QuitGuide, 22\% (21/94; ITT: P=.12), respectively. The biovalidated abstinence rate at 12 weeks was Pivot, 29\% (27/94) versus QuitGuide, 13\% (12/94; ITT: P=.008). Biovalidated continuous abstinence at 26 weeks was Pivot, 21\% (20/94) versus QuitGuide, 10\% (9/94; ITT: P=.03). Participant feedback, including ease of setup, impact on smoking, and likelihood of program recommendation were favorable for Pivot. Conclusions: In this randomized controlled trial comparing the app-based smoking cessation programs Pivot and QuitGuide, Pivot participants had higher engagement and biovalidated cessation rates and more favorable user feedback at 12 and 26 weeks. These findings support Pivot as an effective, durable mobile smoking cessation program. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 ", doi="10.2196/41658", url="https://mhealth.jmir.org/2022/11/e41658", url="http://www.ncbi.nlm.nih.gov/pubmed/36257323" } @Article{info:doi/10.2196/32757, author="Bailey, Elizabeth and Nightingale, Samantha and Thomas, Nicky and Coleby, Dawn and Deave, Toity and Goodenough, Trudy and Ginja, Samuel and Lingam, Raghu and Kendall, Sally and Day, Crispin and Coad, Jane", title="First-time Mothers' Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="21", volume="10", number="11", pages="e32757", keywords="pregnancy", keywords="antenatal support", keywords="antenatal education", keywords="communication", keywords="digital", keywords="pregnancy apps", keywords="mobile phone", abstract="Background: Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings. Objective: This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges. Methods: This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28\%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges. Results: The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app. Conclusions: Although this study included a small sample, it elicited rich data and insights into first-time mothers' app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care. International Registered Report Identifier (IRRID): RR2-10.1017/S1463423618000294 ", doi="10.2196/32757", url="https://mhealth.jmir.org/2022/11/e32757", url="http://www.ncbi.nlm.nih.gov/pubmed/36409530" } @Article{info:doi/10.2196/41455, author="Eckhoff, Randall and Boyce, Matthew and Watkins, Lee Rebecca and Kan, Marni and Scaglione, Nichole and Pound, Leah and Root, Meghan", title="Examining the Use of Mobile Technology to Deliver Tailored Sexual Assault Prevention in a Classroom Environment in the Military: Development and Usability Study", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="16", volume="10", number="11", pages="e41455", keywords="research techniques", keywords="mobile technology", keywords="tablet", keywords="iPad", keywords="restricted", keywords="resource limited", keywords="Wi-Fi", keywords="tailored learning", keywords="military", keywords="data security", abstract="Background: Advances in mobile technology over the last 10 years have expanded its use in scientific research. However, there are challenges in creating a reliable system for intervention content delivery and data collection in an environment with limited internet connectivity and limited staffing capacity. The Sexual Communication and Consent (SCC) study used tablets to provide individualized Sexual Assault Prevention and Response training in a classroom environment that was both technologically and support staff limited. Objective: We developed the SCC Basic Military Training app and a separate Sexual Assault Response Coordinator app to support individualized training within the new SCC program. This paper presents the functionality, protocols, challenges, and feasibility of deploying mobile technology in an educational environment in the military with limited resources. Methods: We developed both mobile apps targeting the Apple iOS ecosystem. The Basic Military Training app provided a screening instrument that routed the trainee into 1 of 5 specific intervention programs. Over 2 days of basic military training set 2 weeks apart, trainees received a combined 6 hours of program-specific tablet training, combined with universal, interactive classroom training, led by qualified instructors. The Sexual Assault Response Coordinator app, used to deliver supplemental content to a subgroup of trainees, was made available for voluntary and private use at the Sexual Assault Response Coordinator's office on base. All anonymous data were manually transferred onto laptops, where the data were aggregated into files and securely transferred to the project staff for analysis. The study was conducted at the Lackland Air Force Base, Joint Base San Antonio, with 9196 trainees providing the data. Results: A total of 7742 trainees completed both the sessions of the SCC program and a series of evaluative assessments. Some trainees did not receive day 2 training, and only received day 1 training because the COVID-19 pandemic shortened the study period. Of the 190 SCC classes taught, only one class was unable to complete tablet training because of Apple licensing--related technology failure. The 360 study tablets were distributed across 3 classrooms (120 per classroom) and were handled at least 16,938 times with no reports of breakage or requiring replacement. Wi-Fi access limitations exacerbated the complexity of Apple licensing revalidation and the secure transfer of data from the classroom to project personnel. The instructor staff's limited technical knowledge to perform certain technical tasks was challenging. Conclusions: The results demonstrated the feasibility of deploying a mobile app for tablet-based training in a military educational environment. Although successful, the study was not without technical challenges. This paper gives examples of technical lessons learned and recommendations for conducting the study differently, with the aim that the knowledge gained may be helpful to other researchers encountering similar requirements. ", doi="10.2196/41455", url="https://mhealth.jmir.org/2022/11/e41455", url="http://www.ncbi.nlm.nih.gov/pubmed/36383404" } @Article{info:doi/10.2196/38886, author="Oakley-Girvan, Ingrid and Docherty, P. John", title="A New Approach to Enhancing Engagement in eHealth Apps", journal="Interact J Med Res", year="2022", month="Nov", day="9", volume="11", number="2", pages="e38886", keywords="user engagement", keywords="eHealth", keywords="attrition", keywords="adherence", keywords="apps", keywords="app design", keywords="user experience", doi="10.2196/38886", url="https://www.i-jmr.org/2022/2/e38886", url="http://www.ncbi.nlm.nih.gov/pubmed/36279587" } @Article{info:doi/10.2196/33638, author="Bulzacchelli, T. Maria and Bellantoni, M. Jenna and McCue, Leigh and Dzugan, Jerry", title="The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study", journal="JMIR Form Res", year="2022", month="Nov", day="8", volume="6", number="11", pages="e33638", keywords="mobile app", keywords="mobile device", keywords="mobile phone", keywords="smartphone", keywords="safety", keywords="workplace safety", keywords="occupational safety", keywords="mobile health", keywords="mHealth", keywords="commercial fishing", keywords="cross-sectional study", abstract="Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59\%) and Android phones (n=24, 39\%). Most participants (n=53, 87\%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85\%). Over half of the participants reported that they had either safety-related apps (n=17, 28\%) or apps that help them with their work (n=35, 57\%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. ", doi="10.2196/33638", url="https://formative.jmir.org/2022/11/e33638", url="http://www.ncbi.nlm.nih.gov/pubmed/36346649" } @Article{info:doi/10.2196/38951, author="McLean, Carmen and Davis, Adrian C. and Miller, Madeleine and Ruzek, Josef and Neri, Eric", title="The Effects of an Exposure-Based Mobile App on Symptoms of Posttraumatic Stress Disorder in Veterans: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="4", volume="10", number="11", pages="e38951", keywords="posttraumatic stress disorder", keywords="veteran's health", keywords="exposure therapy", keywords="cognitive behavioral therapy", keywords="mHealth", keywords="mobile apps", keywords="self-management", abstract="Background: Barriers to accessing in-person care can prevent veterans with posttraumatic stress disorder (PTSD) from receiving trauma-focused treatments such as exposure therapy. Mobile apps may help to address unmet need for services by offering tools for users to self-manage PTSD symptoms. Renew is a mobile mental health app that focuses on exposure therapy and incorporates a social support function designed to promote user engagement. Objective: We examined the preliminary efficacy of Renew with and without support from a research staff member compared with waitlist among 93 veterans with clinically significant PTSD symptoms. We also examined the impact of study staff support on participant engagement with the app. Methods: In a pilot randomized controlled trial, we compared Renew with and without support from a research staff member (active use condition) with waitlist (delayed use condition) over 6 weeks. Participants were recruited through online advertisements. The Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) was used to measure PTSD symptoms at pre, post, and 6-week follow-up. Usage data were collected to assess engagement with Renew. Results: Results indicated a small effect size (d=--0.39) favoring those in the active use conditions relative to the delayed use condition, but the between-group difference was not significant (P=.29). There were no differences on indices of app engagement between the 2 active use conditions. Exploratory analyses found that the number of support persons users added to the app, but not the number of support messages received, was positively correlated with app engagement. Conclusions: Findings suggest Renew may hold promise as a self-management tool to reduce PTSD symptoms in veterans. Involving friends and family in mobile mental health apps may help bolster engagement with no additional cost to public health systems. Trial Registration: ClinicalTrials.gov NCT04155736; https://clinicaltrials.gov/ct2/show/NCT04155736 ", doi="10.2196/38951", url="https://mhealth.jmir.org/2022/11/e38951", url="http://www.ncbi.nlm.nih.gov/pubmed/36331540" } @Article{info:doi/10.2196/41482, author="Stefancic, Ana and Rogers, Tyler R. and Styke, Sarah and Xu, Xiaoyan and Buchsbaum, Richard and Nossel, Ilana and Cabassa, J. Leopoldo and Stroup, Scott T. and Kimhy, David", title="Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians", journal="JMIR Ment Health", year="2022", month="Nov", day="4", volume="9", number="11", pages="e41482", keywords="first-episode psychosis", keywords="early psychosis", keywords="coordinated specialty care", keywords="mental health treatment", keywords="shared decision-making", keywords="mobile health", keywords="smartphone apps", keywords="qualitative", keywords="digital psychiatry", keywords="mobile phone", abstract="Background: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective: This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods: Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications?Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. Conclusions: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients---the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6 ", doi="10.2196/41482", url="https://mental.jmir.org/2022/11/e41482", url="http://www.ncbi.nlm.nih.gov/pubmed/36331539" } @Article{info:doi/10.2196/38048, author="Isakadze, Nino and Molello, Nancy and MacFarlane, Zane and Gao, Yumin and Spaulding, M. Erin and Commodore Mensah, Yvonne and Marvel, A. Francoise and Khoury, Shireen and Marine, E. Joseph and Michos, D. Erin and Spragg, David and Berger, D. Ronald and Calkins, Hugh and Cooper, A. Lisa and Martin, S. Seth", title="The Virtual Inclusive Digital Health Intervention Design to Promote Health Equity (iDesign) Framework for Atrial Fibrillation: Co-design and Development Study", journal="JMIR Hum Factors", year="2022", month="Oct", day="31", volume="9", number="4", pages="e38048", keywords="atrial fibrillation", keywords="digital health intervention", keywords="human-centered design", keywords="health equity", keywords="smartphone", keywords="mobile application", keywords="cardiac", keywords="cardiology", keywords="virtual meeting", keywords="virtual health", keywords="medication adherence", abstract="Background: Smartphone ownership and mobile app use are steadily increasing in individuals of diverse racial and ethnic backgrounds living in the United States. Growing adoption of technology creates a perfect opportunity for digital health interventions to increase access to health care. To successfully implement digital health interventions and engage users, intervention development should be guided by user input, which is best achieved by the process of co-design. Digital health interventions co-designed with the active engagement of users have the potential to increase the uptake of guideline recommendations, which can reduce morbidity and mortality and advance health equity. Objective: We aimed to co-design a digital health intervention for patients with atrial fibrillation, the most common cardiac arrhythmia, with patient, caregiver, and clinician feedback and to describe our approach to human-centered design for building digital health interventions. Methods: We conducted virtual meetings with patients with atrial fibrillation (n=8), their caregivers, and clinicians (n=8). We used the following 7 steps in our co-design process: step 1, a virtual meeting focused on defining challenges and empathizing with problems that are faced in daily life by individuals with atrial fibrillation and clinicians; step 2, a virtual meeting focused on ideation and brainstorming the top challenges identified during the first meeting; step 3, individualized onboarding of patients with an existing minimally viable version of the atrial fibrillation app; step 4, virtual prototyping of the top 3 ideas generated during ideation; step 5, further ranking by the study investigators and engineers of the ideas that were generated during ideation but were not chosen as top-3 solutions to be prototyped in step 4; step 6, ongoing engineering work to incorporate top-priority features in the app; and step 7, obtaining further feedback from patients and testing the atrial fibrillation digital health intervention in a pilot clinical study. Results: The top challenges identified by patients and caregivers included addressing risk factor modification, medication adherence, and guidance during atrial fibrillation episodes. Challenges identified by clinicians were complementary and included patient education, addressing modifiable atrial fibrillation risk factors, and remote atrial fibrillation episode management. Patients brainstormed more than 30 ideas to address the top challenges, and the clinicians generated more than 20 ideas. Ranking of the ideas informed several novel or modified features aligned with the Theory of Health Behavior Change, features that were geared toward risk factor modification; patient education; rhythm, symptom, and trigger correlation for remote atrial fibrillation management; and social support. Conclusions: We co-designed an atrial fibrillation digital health intervention in partnership with patients, caregivers, and clinicians by virtually engaging in collaborative creation through the design process. We summarize our experience and describe a flexible approach to human-centered design for digital health intervention development that can guide innovative clinical investigators. ", doi="10.2196/38048", url="https://humanfactors.jmir.org/2022/4/e38048", url="http://www.ncbi.nlm.nih.gov/pubmed/36315217" } @Article{info:doi/10.2196/38387, author="Jarman, K. Hannah and McLean, A. Si{\^a}n and Rodgers, Rachel and Fuller-Tyszkiewicz, Matthew and Paxton, Susan and O'Gorman, Beth and Harris, Emily and Shatte, Adrian and Bishop, Katie and Baumann, Tahlia and Mahoney, Danielle and Daugelat, Melissa-Claire and Yager, Zali", title="Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches", journal="JMIR Form Res", year="2022", month="Oct", day="31", volume="6", number="10", pages="e38387", keywords="eating disorders", keywords="app-based intervention", keywords="lived experience", keywords="design thinking", keywords="interviews", keywords="young women", keywords="co-design", keywords="mobile health", keywords="mHealth", abstract="Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user's personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. ", doi="10.2196/38387", url="https://formative.jmir.org/2022/10/e38387", url="http://www.ncbi.nlm.nih.gov/pubmed/36315225" } @Article{info:doi/10.2196/39189, author="Tong, Catherine and Kernoghan, Alison and Lemmon, Kassandra and Fernandes, Paige and Elliott, Jacobi and Sacco, Veronica and Bodemer, Sheila and Stolee, Paul", title="Lessons and Reflections From an Extended Co-design Process Developing an mHealth App With and for Older Adults: Multiphase, Mixed Methods Study", journal="JMIR Aging", year="2022", month="Oct", day="28", volume="5", number="4", pages="e39189", keywords="mobile health", keywords="mHealth", keywords="older adults", keywords="health care providers", keywords="co-design", keywords="user experience or UX design", keywords="qualitative", keywords="apps", keywords="elderly", keywords="health care", keywords="care provider", abstract="Background: There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective: The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods: Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results: In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions: Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. ", doi="10.2196/39189", url="https://aging.jmir.org/2022/4/e39189", url="http://www.ncbi.nlm.nih.gov/pubmed/36306166" } @Article{info:doi/10.2196/36049, author="Lai, Byron and Vogtle, Laura and Young, Raven and Craig, Mary and Kim, Yumi and Gowey, Marissa and Swanson-Kimani, Erin and Davis, Drew and Rimmer, H. James", title="Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2022", month="Oct", day="28", volume="6", number="10", pages="e36049", keywords="exercise", keywords="developmental disability", keywords="cerebral palsy", keywords="telemedicine", keywords="telerehabilitation", keywords="therapy", keywords="mobile phone", abstract="Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children's Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84\%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68\%, starting from 90\% in week 1 and gradually declining to 43\% in week 4. Mean adherence to coaching calls was 91\%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children's Assessment of Participation and Enjoyment Active Physical Recreation--Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants' adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 ", doi="10.2196/36049", url="https://formative.jmir.org/2022/10/e36049", url="http://www.ncbi.nlm.nih.gov/pubmed/36306154" } @Article{info:doi/10.2196/40066, author="Leidman, Eva and Jatoi, Ali Muhammad and Bollemeijer, Iris and Majer, Jennifer and Doocy, Shannon", title="Accuracy of Fully Automated 3D Imaging System for Child Anthropometry in a Low-Resource Setting: Effectiveness Evaluation in Malakal, South Sudan", journal="JMIR Biomed Eng", year="2022", month="Oct", day="21", volume="7", number="2", pages="e40066", keywords="mobile health", keywords="mHealth", keywords="child nutrition", keywords="anthropometry", keywords="3D imaging", keywords="imaging", keywords="accuracy", keywords="measurement", keywords="child stature", keywords="software", keywords="algorithm", keywords="automated", keywords="device", keywords="child health", keywords="pediatric health", keywords="height", keywords="length", keywords="arm circumference", abstract="Background: Adoption of 3D imaging systems in humanitarian settings requires accuracy comparable with manual measurement notwithstanding additional constraints associated with austere settings. Objective: This study aimed to evaluate the accuracy of child stature and mid--upper arm circumference (MUAC) measurements produced by the AutoAnthro 3D imaging system (third generation) developed by Body Surface Translations Inc. Methods: A study of device accuracy was embedded within a 2-stage cluster survey at the Malakal Protection of Civilians site in South Sudan conducted between September 2021 and October 2021. All children aged 6 to 59 months within selected households were eligible. For each child, manual measurements were obtained by 2 anthropometrists following the protocol used in the 2006 World Health Organization Child Growth Standards study. Scans were then captured by a different enumerator using a Samsung Galaxy 8 phone loaded with a custom software, AutoAnthro, and an Intel RealSense 3D scanner. The scans were processed using a fully automated algorithm. A multivariate logistic regression model was fit to evaluate the adjusted odds of achieving a successful scan. The accuracy of the measurements was visually assessed using Bland-Altman plots and quantified using average bias, limits of agreement (LoAs), and the 95\% precision interval for individual differences. Key informant interviews were conducted remotely with survey enumerators and Body Surface Translations Inc developers to understand challenges in beta testing, training, data acquisition and transmission. Results: Manual measurements were obtained for 539 eligible children, and scan-derived measurements were successfully processed for 234 (43.4\%) of them. Caregivers of at least 10.4\% (56/539) of the children refused consent for scan capture; additional scans were unsuccessfully transmitted to the server. Neither the demographic characteristics of the children (age and sex), stature, nor MUAC were associated with availability of scan-derived measurements; team was significantly associated (P<.001). The average bias of scan-derived measurements in cm was ?0.5 (95\% CI ?2.0 to 1.0) for stature and 0.7 (95\% CI 0.4-1.0) for MUAC. For stature, the 95\% LoA was ?23.9 cm to 22.9 cm. For MUAC, the 95\% LoA was ?4.0 cm to 5.4 cm. All accuracy metrics varied considerably by team. The COVID-19 pandemic--related physical distancing and travel policies limited testing to validate the device algorithm and prevented developers from conducting in-person training and field oversight, negatively affecting the quality of scan capture, processing, and transmission. Conclusions: Scan-derived measurements were not sufficiently accurate for the widespread adoption of the current technology. Although the software shows promise, further investments in the software algorithms are needed to address issues with scan transmission and extreme field contexts as well as to enable improved field supervision. Differences in accuracy by team provide evidence that investment in training may also improve performance. ", doi="10.2196/40066", url="https://biomedeng.jmir.org/2022/2/e40066" } @Article{info:doi/10.2196/40452, author="Perez, Oriana and Kumar Vadathya, Anil and Beltran, Alicia and Barnett, Matthew R. and Hindera, Olivia and Garza, Tatyana and Musaad, M. Salma and Baranowski, Tom and Hughes, O. Sheryl and Mendoza, A. Jason and Sabharwal, Ashutosh and Veeraraghavan, Ashok and O'Connor, M. Teresia", title="The Family Level Assessment of Screen Use--Mobile Approach: Development of an Approach to Measure Children's Mobile Device Use", journal="JMIR Form Res", year="2022", month="Oct", day="21", volume="6", number="10", pages="e40452", keywords="screen time", keywords="mobile media apps", keywords="children", keywords="mobile phone use", keywords="tablet use", keywords="mobile phone", abstract="Background: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children's screen time has been the most common method of measuring screen time, which may be imprecise or biased. Objective: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)--mobile approach, an innovative method that leverages the existing features of the Android platform. Methods: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. Results: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90\% for smartphones and >80\% for tablets. For laboratory-based studies, a mean agreement of 73.6\% (SD 16.15\%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child's mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. Conclusions: The FLASH-mobile approach offers an important new research approach to measure children's use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children. ", doi="10.2196/40452", url="https://formative.jmir.org/2022/10/e40452", url="http://www.ncbi.nlm.nih.gov/pubmed/36269651" } @Article{info:doi/10.2196/35926, author="Abrantes, M. Ana and Meshesha, Z. Lidia and E Blevins, Claire and Battle, L. Cynthia and Lindsay, Clifford and Marsh, Eliza and Feltus, Sage and Buman, Matthew and Agu, Emmanuel and Stein, Michael", title="A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial", journal="JMIR Form Res", year="2022", month="Oct", day="19", volume="6", number="10", pages="e35926", keywords="alcohol use disorder", keywords="AUD", keywords="physical activity", keywords="smartphone app", keywords="Fitbit", keywords="feasibility study", keywords="mobile phone", abstract="Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit\&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit\&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59\% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72\% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit\&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit\&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=?0.71) and depression symptoms (Cohen d=?0.58). Conclusions: The Fit\&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit\&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit\&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 ", doi="10.2196/35926", url="https://formative.jmir.org/2022/10/e35926", url="http://www.ncbi.nlm.nih.gov/pubmed/36260381" } @Article{info:doi/10.2196/39301, author="Boccardi, Alyssa and Wu, Fangzheng and Pearlman, Jon and Mhatre, Anand", title="Older Wheelchair Users Recommend Age-Friendly Design Improvements to a Wheelchair Maintenance App: Mixed Methods Development Study", journal="JMIR Aging", year="2022", month="Oct", day="18", volume="5", number="4", pages="e39301", keywords="aging", keywords="older adults", keywords="maintenance", keywords="mobile phone", keywords="repair", keywords="smartphone", keywords="wheelchair", abstract="Background: Wheelchair part failures have doubled over the past decade. Preventative wheelchair maintenance reduces wheelchair failures and prevents user consequences. We are developing a smartphone app called WheelTrak, which alerts users when maintenance is required, to encourage maintenance practices and compliance. Objective: This mixed methods study aimed to develop a wheelchair maintenance app using broad stakeholder advice and investigate older adults' interaction experience with the app and their perceived barriers to and facilitators of maintenance. Methods: Interviews were conducted with stakeholders, including mobility device users, to generate needs statements and app specifications. The app was designed in 2 stages. Stage 1 involved the development of the app according to the specifications and evaluation of the app interface by lead users. Stage 2 included the revision of the app screens and manual functionality testing. Usability testing and semistructured interviews were conducted with older wheelchair and scooter users. The System Usability Scale was used to measure app usability. Results: Interviews with power and manual wheelchair users (37/57, 65\%), wheelchair service providers (15/57, 26\%), manufacturers (2/57, 4\%), seating and mobility researchers (1/57, 2\%), and insurance plan providers (2/57, 4\%) informed the needs and specifications of the app technology. The 2-stage development process delivered a fully functional app that met the design specifications. In total, 12 older adults (mean age 74.2, SD 9.1 years; n=10, 83\% women; and n=2, 17\% men) participated in the usability testing study. Of the 12 participants, 9 (75\%) agreed to use WheelTrak for preventative maintenance. WheelTrak scored an average System Usability Scale score of 60.25 (SD 16). Four overarching themes were identified: WheelTrak app improvements, barriers to maintenance, consequences related to mobility device failure, and smart technology use and acceptance. Older adults preferred the simplicity, readability, personalization, and availability of educational resources in the app. Barriers to maintenance pertained to health issues and lack of maintenance knowledge among older adults. Facilitators of maintenance included notification for maintenance, app connectivity with the service provider, reporting of device failure, and the presence of a caregiver for maintenance. Conclusions: This study highlighted age-friendly design improvements to the app, making it easy to be used and adopted by older wheelchair users. The WheelTrak app has close to average system usability. Additional usability testing will be conducted following app revision in the future. ", doi="10.2196/39301", url="https://aging.jmir.org/2022/4/e39301", url="http://www.ncbi.nlm.nih.gov/pubmed/36256830" } @Article{info:doi/10.2196/37772, author="Tran-Nguyen, Kevin and Berger, Caroline and Bennett, Roxanne and Wall, Michelle and Morin, N. Suzanne and Rajabiyazdi, Fateme", title="Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach", journal="JMIR Aging", year="2022", month="Oct", day="17", volume="5", number="4", pages="e37772", keywords="older adults", keywords="mobile app", keywords="skeletal fracture", keywords="usability", keywords="patient-centered", keywords="human-centered design", keywords="digital health", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="acute pain self-management", keywords="mobile phone", abstract="Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. ", doi="10.2196/37772", url="https://aging.jmir.org/2022/4/e37772", url="http://www.ncbi.nlm.nih.gov/pubmed/36251348" } @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/10.2196/39764, author="Gudmundsson, Haukur G. and M{\'e}sz{\'a}ros, Judit and Bj{\"o}rnsd{\'o}ttir, E. {\'A}g{\'u}sta and {\'A}mundad{\'o}ttir, L. Mar{\'i}a and Thorvardardottir, E. Gudrun and Magnusdottir, Erna and Helgadottir, Halla and Oddsson, Saemundur", title="Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study", journal="JMIR Form Res", year="2022", month="Oct", day="13", volume="6", number="10", pages="e39764", keywords="cancer", keywords="lifestyle", keywords="quality of life", keywords="mobile app", keywords="digital therapeutics", keywords="self-management", keywords="physical activity", keywords="mobile phone", abstract="Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97\% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72\% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72\%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96\%) were still logging their steps, with 19 (68\%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89\%) were likely to recommend the program, 23 (82\%) said the program helped them deal with the disease, and 24 (86\%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50\% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. ", doi="10.2196/39764", url="https://formative.jmir.org/2022/10/e39764", url="http://www.ncbi.nlm.nih.gov/pubmed/36227639" } @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/10.2196/36818, author="Shaw Jr, George and Nadkarni, Devaki and Phann, Eric and Sielaty, Rachel and Ledenyi, Madeleine and Abnowf, Razaan and Xu, Qian and Arredondo, Paul and Chen, Shi", title="Separating Features From Functionality in Vaccination Apps: Computational Analysis", journal="JMIR Form Res", year="2022", month="Oct", day="11", volume="6", number="10", pages="e36818", keywords="vaccines", keywords="mobile health", keywords="mHealth", keywords="principal component analysis", keywords="PCA", keywords="k-means clustering", keywords="information exchange", keywords="mobile phone", abstract="Background: Some latest estimates show that approximately 95\% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps' design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps' descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1\% (131/211) and 37.9\% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4\%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5\%) were iOS apps, 55 (46.2\%) were for the Android operating system, and 11 (9.2\%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7\% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. ", doi="10.2196/36818", url="https://formative.jmir.org/2022/10/e36818", url="http://www.ncbi.nlm.nih.gov/pubmed/36222791" } @Article{info:doi/10.2196/37605, author="Lim, Renly and Thornton, Christopher and Stanek, Jan and Ellett, Kalisch Lisa and Thiessen, Myra", title="Development of a Web-Based System to Report Medication-Related Adverse Effects: Design and Usability Study", journal="JMIR Form Res", year="2022", month="Oct", day="7", volume="6", number="10", pages="e37605", keywords="adverse drug reaction", keywords="adverse drug event", keywords="digital health", keywords="eHealth", keywords="medication safety", keywords="mHealth", keywords="participatory design", keywords="patient reported outcomes", keywords="telehealth", abstract="Background: Medicine use is the most common intervention in health care. The frequency with which medicines are used means medication-related problems are very common. One common type of medication-related problems is adverse drug events, which are unintended and harmful effects associated with use of medicines. Reporting of adverse drug events to regulatory authorities is important for evaluation of safety of medicines; however, these adverse effects are frequently unreported due to various factors, including lack of consumer-friendly reporting tools. Objective: The aim of this study was to develop a user-friendly digital tool for consumers to report medication-related adverse effects. Methods: The project consisted of 3 parts: (1) content development, including a systematic literature search; (2) iterative system development; and (3) usability testing. The project was guided by participatory design principles, which suggest involving key stakeholders throughout the design process. The first 2 versions were developed as a mobile app and were tested with end users in 2 workshops. The third version was developed as a web application and was tested with consumers who were taking regular medicines. Consumers were asked to complete a modified version of the mHealth app usability questionnaire (MAUQ), an 18-item questionnaire with each item scored using a 7-point Likert scale ranging from 0 (strongly disagree) to 7 (strongly agree). The MAUQ assessed 3 subscales including ease of use (5 items), interface and satisfaction (7 items), and usefulness (6 items). Continuous variables were reported as mean (SD) values, whereas categorical variables were presented as frequencies (percentages). Data analysis was conducted in Microsoft Excel. Results: The content for the system was based on a systematic literature search and short-listing of questions, followed by feedback from project team members and consumers. Feedback from consumers in the 2 workshops were incorporated to improve the functionality, visual design, and stability of the third (current) version. The third version of the system was tested with 26 consumers. A total of 79\% (N=307/390) of all responses on the MAUQ were scored 6 or 7, indicating that users generally strongly agree with the usability of the system. When looking at the individual domains, the system had an average score of 6.3 (SD 0.9) for ``ease of use,'' 6.3 (SD 0.8) for ``interface and satisfaction,'' and 5.2 (SD 1.4) for ``usefulness.'' Conclusions: The web-based system for medicine adverse effects reporting is a user-friendly tool developed using an iterative participatory design approach. Future research includes further improving the system, particularly the usefulness of the system, as well as testing the scalability and performance of the system in practice. ", doi="10.2196/37605", url="https://formative.jmir.org/2022/10/e37605", url="http://www.ncbi.nlm.nih.gov/pubmed/36206034" } @Article{info:doi/10.2196/37474, author="Proctor, L. Steven and Rigg, K. Khary and Tien, Y. Allen", title="Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2022", month="Oct", day="5", volume="6", number="10", pages="e37474", keywords="opioids", keywords="contingency management", keywords="mHealth", keywords="digital health", keywords="mobile app", keywords="innovation", keywords="opioid use disorder", keywords="recovery", keywords="acceptability", abstract="Background: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. Objective: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. Methods: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. Results: Participants were overwhelmingly in favor of microrewards (eg, US \$1) to incentivize treatment participation (up to US \$150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. Conclusions: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial. ", doi="10.2196/37474", url="https://formative.jmir.org/2022/10/e37474", url="http://www.ncbi.nlm.nih.gov/pubmed/36197705" } @Article{info:doi/10.2196/38740, author="Dhinagaran, Ardhithy Dhakshenya and Martinengo, Laura and Ho, Ringo Moon-Ho and Joty, Shafiq and Kowatsch, Tobias and Atun, Rifat and Tudor Car, Lorainne", title="Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER): Development of a Conceptual Framework", journal="JMIR Mhealth Uhealth", year="2022", month="Oct", day="4", volume="10", number="10", pages="e38740", keywords="conceptual framework", keywords="conversational agent", keywords="chatbot", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="mobile phone", abstract="Background: Conversational agents (CAs), also known as chatbots, are computer programs that simulate human conversations by using predetermined rule-based responses or artificial intelligence algorithms. They are increasingly used in health care, particularly via smartphones. There is, at present, no conceptual framework guiding the development of smartphone-based, rule-based CAs in health care. To fill this gap, we propose structured and tailored guidance for their design, development, evaluation, and implementation. Objective: The aim of this study was to develop a conceptual framework for the design, evaluation, and implementation of smartphone-delivered, rule-based, goal-oriented, and text-based CAs for health care. Methods: We followed the approach by Jabareen, which was based on the grounded theory method, to develop this conceptual framework. We performed 2 literature reviews focusing on health care CAs and conceptual frameworks for the development of mobile health interventions. We identified, named, categorized, integrated, and synthesized the information retrieved from the literature reviews to develop the conceptual framework. We then applied this framework by developing a CA and testing it in a feasibility study. Results: The Designing, Developing, Evaluating, and Implementing a Smartphone-Delivered, Rule-Based Conversational Agent (DISCOVER) conceptual framework includes 8 iterative steps grouped into 3 stages, as follows: design, comprising defining the goal, creating an identity, assembling the team, and selecting the delivery interface; development, including developing the content and building the conversation flow; and the evaluation and implementation of the CA. They were complemented by 2 cross-cutting considerations---user-centered design and privacy and security---that were relevant at all stages. This conceptual framework was successfully applied in the development of a CA to support lifestyle changes and prevent type 2 diabetes. Conclusions: Drawing on published evidence, the DISCOVER conceptual framework provides a step-by-step guide for developing rule-based, smartphone-delivered CAs. Further evaluation of this framework in diverse health care areas and settings and for a variety of users is needed to demonstrate its validity. Future research should aim to explore the use of CAs to deliver health care interventions, including behavior change and potential privacy and safety concerns. ", doi="10.2196/38740", url="https://mhealth.jmir.org/2022/10/e38740", url="http://www.ncbi.nlm.nih.gov/pubmed/36194462" } @Article{info:doi/10.2196/39497, author="Oh, Taek Kyue and Ko, Jisu and Shin, Jaemyung and Ko, Minsam", title="Using Wake-Up Tasks for Morning Behavior Change: Development and Usability Study", journal="JMIR Form Res", year="2022", month="Sep", day="21", volume="6", number="9", pages="e39497", keywords="health app design", keywords="morning behavior change", keywords="wake-up task", keywords="mobile alarm", keywords="productivity", abstract="Background: Early morning behaviors between waking up and beginning daily work can develop into productive habits. However, sleep inertia limits the level of human ability immediately after waking, lowering a person's motivation and available time for productive morning behavior. Objective: This study explores a design for morning behavior change using a wake-up task, a simple assignment the user needs to finish before alarm dismissal. Specifically, we set two research objectives: (1) exploring key factors that relate to morning behavior performance, including the use of wake-up tasks in an alarm app and (2) understanding the general practice of affecting morning behavior change by implementing wake-up tasks. Methods: We designed and implemented an apparatus that provides wake-up task alarms and facilities for squat exercises. We recruited 36 participants to perform squat exercises in the early morning using the wake-up tasks for 2 weeks. First, we conducted a generalized estimating equation (GEE) analysis for the first research objective. Next, we conducted a thematic analysis of the postsurvey answers to identify key themes about morning behavior change with the wake-up tasks for the second objective. Results: The use of wake-up tasks was significantly associated with both the completion of the target behavior (math task: P=.005; picture task: P<.001) and the elapsed time (picture task: P=.08); the time to alarm dismissal was significantly related to the elapsed time to completion (P<.001). Moreover, the theory of planned behavior (TPB) variables, common factors for behavior change, were significant, but their magnitudes and directions differed slightly from the other domains. Furthermore, the survey results reveal how the participants used the wake-up tasks and why they were effective for morning behavior performance. Conclusions: The results reveal the effectiveness of wake-up tasks in accomplishing the target morning behavior and address key factors for morning behavior change, such as (1) waking up on time, (2) escaping from sleep inertia, and (3) quickly starting the desired target behavior. ", doi="10.2196/39497", url="https://formative.jmir.org/2022/9/e39497", url="http://www.ncbi.nlm.nih.gov/pubmed/36129742" } @Article{info:doi/10.2196/35316, author="Arensman, Remco and Kloek, Corelien and Pisters, Martijn and Koppenaal, Tjarco and Ostelo, Raymond and Veenhof, Cindy", title="Patient Perspectives on Using a Smartphone App to Support Home-Based Exercise During Physical Therapy Treatment: Qualitative Study", journal="JMIR Hum Factors", year="2022", month="Sep", day="13", volume="9", number="3", pages="e35316", keywords="patient perspectives", keywords="mobile health", keywords="mHealth", keywords="home-based exercise", keywords="adherence", keywords="low back pain", keywords="physical therapy", abstract="Background: Home-based exercise is an important part of physical therapy treatment for patients with low back pain. However, treatment effectiveness depends heavily on patient adherence to home-based exercise recommendations. Smartphone apps designed to support home-based exercise have the potential to support adherence to exercise recommendations and possibly improve treatment effects. A better understanding of patient perspectives regarding the use of smartphone apps to support home-based exercise during physical therapy treatment can assist physical therapists with optimal use and implementation of these apps in clinical practice. Objective: The aim of this study was to investigate patient perspectives on the acceptability, satisfaction, and performance of a smartphone app to support home-based exercise following recommendations from a physical therapist. Methods: Using an interpretivist phenomenology approach, 9 patients (4 males and 5 females; aged 20-71 years) with nonspecific low back pain recruited from 2 primary care physical therapy practices were interviewed within 2 weeks after treatment ended. An interview guide was used for the interviews to ensure that different aspects of the patients' perspectives were discussed. The Physitrack smartphone app was used to support home-based exercise as part of treatment for all patients. Data were analyzed using the ``Framework Method'' to assist with interpretation of the data. Results: Data analysis revealed 11 categories distributed among the 3 themes ``acceptability,'' ``satisfaction,'' and ``performance.'' Patients were willing to accept the app as part of treatment when it was easy to use, when it benefited the patient, and when the physical therapist instructed the patient in its use. Satisfaction with the app was determined by users' perceived support from the app when exercising at home and the perceived increase in adherence. The video and text instructions, reminder functions, and self-monitor functions were considered the most important aspects for performance during treatment. The patients did not view the Physitrack app as a replacement for the physical therapist and relied on their therapist for instructions and support when needed. Conclusions: Patients who use an app to support home-based exercise as part of treatment are accepting of the app when it is easy to use, when it benefits the patient, and when the therapist instructs the patient in its use. Physical therapists using an app to support home-based exercise can use the findings from this study to effectively support their patients when exercising at home during treatment. ", doi="10.2196/35316", url="https://humanfactors.jmir.org/2022/3/e35316", url="http://www.ncbi.nlm.nih.gov/pubmed/36098993" } @Article{info:doi/10.2196/39718, author="Saeidnia, Reza Hamid and Kozak, Marcin and Ausloos, Marcel and Herteliu, Claudiu and Mohammadzadeh, Zahra and Ghorbi, Ali and Karajizadeh, Mehrdad and Hassanzadeh, Mohammad", title="Development of a Mobile App for Self-Care Against COVID-19 Using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) Model: Methodological Study", journal="JMIR Form Res", year="2022", month="Sep", day="13", volume="6", number="9", pages="e39718", keywords="self-care", keywords="mobile app", keywords="ADDIE model", keywords="COVID-19", keywords="underdeveloped countries", abstract="Background: Mobile apps have been shown to play an important role in the management, care, and prevention of infectious diseases. Thus, skills for self-care---one of the most effective ways to prevent illness---can be improved through mobile health apps. Objective: This study aimed to design, develop, and evaluate an educational mobile-based self-care app in order to help the self-prevention of COVID-19 in underdeveloped countries. We intended the app to be easy to use, quick, and inexpensive. Methods: In 2020 and 2021, we conducted a methodological study. Using the ADDIE (analysis, design, development, implementation, and evaluation) educational model, we developed a self-care management mobile app. According to the ADDIE model, an effective training and performance support tool is built through the 5 phases that comprise its name. There were 27 participants who conducted 2 evaluations of the mobile app's usability and impact using the mobile health app usability and self-care inventory scales. The study design included pre- and posttesting. Results: An Android app called MyShield was developed. The results of pre- and posttests showed that on a scale from 0 to 5, MyShield scored a performance average of 4.17 in the physical health dimension and an average of 3.88 in the mental well-being dimension, thereby showing positive effects on self-care skills. MyShield scored highly on the ``interface and satisfaction,'' ``ease of use,'' and ``usefulness'' components. Conclusions: MyShield facilitates learning self-care skills at home, even during quarantine, increasing acquisition of information. Given its low development cost and the ADDIE educational design on which it is based, the app can be helpful in underdeveloped countries. Thus, low-income countries---often lacking other tools---can use the app as an effective tool for fighting COVID-19, if it becomes a standard mobile app recommended by the government. ", doi="10.2196/39718", url="https://formative.jmir.org/2022/9/e39718", url="http://www.ncbi.nlm.nih.gov/pubmed/36054441" } @Article{info:doi/10.2196/32795, author="Ma, Tony and Chang, Katie and Alyusuf, Amal and Bajracharya, Elina and Washio, Yukiko and Kelly, J. Patricia and Bellad, M. Roopa and Mahantashetti, S. Niranjana and Charantimath, Umesh and Short, L. Vanessa and Lalakia, Parth and Jaeger, Frances and Goudar, Shivaprasad and Derman, Richard", title="Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study", journal="JMIR Form Res", year="2022", month="Sep", day="8", volume="6", number="9", pages="e32795", keywords="mobile health", keywords="mHealth", keywords="peer counselors", keywords="breastfeeding", keywords="rural", keywords="usability", keywords="low- and middle-income countries", keywords="agile", keywords="task shifting", keywords="user-centered design", keywords="mobile phone", abstract="Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby's design and development, including the app's content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby's usability from the PCs' perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group's EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 ", doi="10.2196/32795", url="https://formative.jmir.org/2022/9/e32795", url="http://www.ncbi.nlm.nih.gov/pubmed/36074546" } @Article{info:doi/10.2196/34303, author="Lawrason, Clewes Sarah Victoria and Brown-Ganzert, Lynda and Campeau, Lysa and MacInnes, Megan and Wilkins, J. C. and Martin Ginis, Anne Kathleen", title="mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes", journal="JMIR Form Res", year="2022", month="Aug", day="19", volume="6", number="8", pages="e34303", keywords="exercise", keywords="stakeholder participation", keywords="spinal cord injuries", keywords="telemedicine", keywords="mobile apps", keywords="mobile phone", abstract="Background: Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population's low levels of physical activity and extensive barriers to quality physical activity experiences. Objective: This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods: Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results: Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants' worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions: Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration: ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617 ", doi="10.2196/34303", url="https://formative.jmir.org/2022/8/e34303", url="http://www.ncbi.nlm.nih.gov/pubmed/35984695" } @Article{info:doi/10.2196/35203, author="Clare, M. Isabelle and Francis, Jacinta and Gamage, Nisali and Nguyen, Rebecca and Gorman, Shelley", title="A Gender Lens on User Quality Ratings From Young Teenagers Assessing the Sun Safe App: Comparing Responses From Co-researchers and Participants of Pilot Intervention Studies", journal="JMIR Dermatol", year="2022", month="Aug", day="18", volume="5", number="3", pages="e35203", keywords="app development", keywords="co-design", keywords="sun exposure", keywords="sun protection", keywords="teenager", keywords="uMARS", keywords="UV index", keywords="vitamin D", keywords="young adolescents", keywords="sunburn", keywords="adolescent", keywords="smartphone", keywords="gender", keywords="sun", keywords="protection", keywords="app", keywords="engagement", keywords="risk", keywords="melanoma", keywords="decision-making", doi="10.2196/35203", url="https://derma.jmir.org/2022/3/e35203" } @Article{info:doi/10.2196/38737, author="Liu, Sam and La, Henry and Willms, Amanda and Rhodes, E. Ryan", title="A ``No-Code'' App Design Platform for Mobile Health Research: Development and Usability Study", journal="JMIR Form Res", year="2022", month="Aug", day="18", volume="6", number="8", pages="e38737", keywords="app development", keywords="behavior change technique", keywords="health promotion", keywords="mobile health", keywords="mobile application", keywords="application development", keywords="design platform", keywords="platform development", keywords="no-code mHealth app", keywords="no-code app", keywords="no-code", keywords="end user", keywords="participatory research", keywords="Pathverse", keywords="agile", keywords="hybrid-agile", keywords="software design", keywords="software development", keywords="software developer", keywords="computer science", keywords="BCT", keywords="behavior change", keywords="research tool", keywords="research instrument", keywords="digital platform", keywords="mHealth", keywords="mobile app", abstract="Background: A challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of ``no-code'' software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps. Objective: We aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform. Methods: The study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process. Results: Our team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat. Conclusions: To our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform. ", doi="10.2196/38737", url="https://formative.jmir.org/2022/8/e38737", url="http://www.ncbi.nlm.nih.gov/pubmed/35980740" } @Article{info:doi/10.2196/34588, author="Johnson, W. Rowan and White, K. Becky and Gucciardi, F. Daniel and Gibson, Noula and Williams, A. Sian", title="Intervention Mapping of a Gamified Therapy Prescription App for Children With Disabilities: User-Centered Design Approach", journal="JMIR Pediatr Parent", year="2022", month="Aug", day="9", volume="5", number="3", pages="e34588", keywords="neurodevelopmental disability", keywords="mobile health", keywords="self-determination theory", keywords="gamification", keywords="physiotherapy", keywords="occupational therapy", keywords="speech pathology", keywords="behavior change", keywords="mobile phone", abstract="Background: Mobile health (mHealth) apps for children are increasing in availability and scope. Therapy (physiotherapy, speech pathology, and occupational therapy) prescription apps to improve home or school program adherence work best when developed to be highly engaging for children and when they incorporate behavior change techniques (BCTs) within their design. Objective: The aim of this study was to describe the development of a user-centered therapy prescription app for children (aged 6-12 years) with neurodevelopmental disabilities (eg, cerebral palsy, autism spectrum disorder, and intellectual disability) incorporating intervention mapping (IM) and gamified design. Methods: We used an iterative, user-centered app development model incorporating the first 3 steps of IM. We conducted a needs analysis with user feedback from our previous mHealth app study, a literature review, and a market audit. Change objectives were then specified in alignment with the psychological needs of autonomy, competence, and relatedness identified in self-determination theory. From these objectives, we then selected BCTs, stipulating parameters for effectiveness and how each BCT would be operationalized. A gamification design was planned and implemented focusing on maximizing engagement in children. In total, 2 rounds of consultations with parents, teachers, and therapists and 1 round of prototype app testing with children were conducted to inform app development, with a final iteration developed for further testing. Results: The IM process resulted in the specification of app elements, self-determination theory--informed BCTs, that were embedded into the app design. The gamification design yielded the selection of a digital pet avatar with a fantasy anime visual theme and multiple layers of incentives earned by completing prescribed therapy activities. Consultation groups with professionals working with children with disabilities (4 therapists and 3 teachers) and parents of children with disabilities (n=3) provided insights into the motivation of children and the pragmatics of implementing app-delivered therapy programs that informed the app development. User testing with children with disabilities (n=4) highlighted their enthusiasm for the app and the need for support in the initial phase of learning the app. App quality testing (Mobile Application Rating Scale-user version) with the children yielded means (out of 5) of 4.5 (SD 0.8) for engagement, 3.3 (SD 1.6) for function, 3.3 (SD 1.7) for aesthetics, and 4.3 (SD 1.1) for subjective quality. Conclusions: mHealth apps designed for children can be greatly enhanced with a systematic yet flexible development process considering the specific contextual needs of the children with user-centered design, addressing the need for behavior change using the IM process, and maximizing engagement with gamification and strong visual design. ", doi="10.2196/34588", url="https://pediatrics.jmir.org/2022/3/e34588", url="http://www.ncbi.nlm.nih.gov/pubmed/35943782" } @Article{info:doi/10.2196/35599, author="Matthews, Stacey and Atkins, Brooke and Walton, Natalie and Mitchell, Julie-Anne and Jennings, Garry and Buttery, K. Amanda", title="Development and Use of a Cardiac Clinical Guideline Mobile App in Australia: Acceptability and Multi-Methods Study", journal="JMIR Form Res", year="2022", month="Aug", day="5", volume="6", number="8", pages="e35599", keywords="mHealth", keywords="mobile heath", keywords="apps", keywords="app", keywords="guideline", keywords="cardiovascular disease", keywords="atrial fibrillation", keywords="heart failure", keywords="heart", keywords="cardiac", keywords="cardiovascular", keywords="acute coronary syndrome", keywords="smartphone", keywords="implementation", keywords="digital health", keywords="develop", keywords="evaluate", keywords="evaluation", keywords="Australia", abstract="Background: Implementation of clinical guidelines into routine practice remains highly variable. Strategies to increase guideline uptake include developing digital tools and mobile apps for use in clinical practice. The National Heart Foundation of Australia in collaboration with the Cardiac Society of Australia and New Zealand published 3 key cardiac clinical guidelines, including the Australian clinical guidelines for the (1) prevention and detection of atrial fibrillation, (2) detection and management of heart failure, and (3) management of acute coronary syndromes. To improve access and uptake for health care providers, we developed the Smart Heart Guideline App. Objective: This study aims to evaluate the acceptability, implementation, and usability of an Australian-specific cardiac guidelines mobile app. Methods: We used an iterative multiple methods development and implementation approach. First, we conducted a cross-sectional web-based survey with end users (n=504 health professionals) in 2017 to determine the acceptability of an Australian-specific cardiac clinical guidelines mobile app. Second, the Smart Heart Guidelines app was created using a design, user testing, and revision process. The app includes interactive algorithms and flowcharts to inform diagnosis and management at the point of care. The freely available app was launched in October 2019 on iOS and Android operating systems and promoted and implemented using multiple methods. Third, data from 2 annual national cross-sectional general practitioner (GP) surveys in 2019 and 2020 were evaluated to understand the awareness and use of the clinical guidelines and the app. Fourth, data from the app stores were analyzed between October 1, 2019, and June 30, 2021, to evaluate usage. Results: Most health professionals surveyed (447/504, 89\%) reported accessing resources electronically, and most (318/504, 63\%) reported that they would use an Australian-specific cardiac guidelines app. GPs surveyed in 2019 were aware of the heart failure (159/312, 51\%) and atrial fibrillation (140/312, 45\%) guidelines, and in 2020, a total of 34 of 189 (18\%) reported that they were aware of the app. The app was downloaded 11,313 times (7483, 66\% from the Apple App Store; 3830, 34\% from Google Play) during the first 20-month period. Most downloads (6300/7483, 84\%) were a result of searching for the app in the stores. Monthly download rates varied. App Store data showed that people used the app twice (on average 2.06 times) during the 20 months. Many (3256/3830, 85\%) Android users deleted the app. Conclusions: Health professionals supported the development of the Smart Heart Guidelines app. Although initial downloads were promising, the frequency of using the app was low and deletion rates were high. Further evaluation of users' experience of the most and least useful components of the app is needed. ", doi="10.2196/35599", url="https://formative.jmir.org/2022/8/e35599", url="http://www.ncbi.nlm.nih.gov/pubmed/35930350" } @Article{info:doi/10.2196/35268, author="Sporrel, Karlijn and Wang, Shihan and Ettema, F. Dick D. and Nibbeling, Nicky and Krose, A. Ben J. and Deutekom, Marije and de Boer, D. R{\'e}mi D. and Simons, Monique", title="Just-in-Time Prompts for Running, Walking, and Performing Strength Exercises in the Built Environment: 4-Week Randomized Feasibility Study", journal="JMIR Form Res", year="2022", month="Aug", day="1", volume="6", number="8", pages="e35268", keywords="just-in-time interventions", keywords="context-based", keywords="prompts", keywords="reminders", keywords="physical activity", keywords="mobile health", keywords="mHealth", keywords="exercise application", keywords="Fogg Behavior Model", keywords="user experience", keywords="engagement", keywords="feasibility study", keywords="mobile phone", abstract="Background: App-based mobile health exercise interventions can motivate individuals to engage in more physical activity (PA). According to the Fogg Behavior Model, it is important that the individual receive prompts at the right time to be successfully persuaded into PA. These are referred to as just-in-time (JIT) interventions. The Playful Active Urban Living (PAUL) app is among the first to include 2 types of JIT prompts: JIT adaptive reminder messages to initiate a run or walk and JIT strength exercise prompts during a walk or run (containing location-based instruction videos). This paper reports on the feasibility of the PAUL app and its JIT prompts. Objective: The main objective of this study was to examine user experience, app engagement, and users' perceptions and opinions regarding the PAUL app and its JIT prompts and to explore changes in the PA behavior, intrinsic motivation, and the perceived capability of the PA behavior of the participants. Methods: In total, 2 versions of the closed-beta version of the PAUL app were evaluated: a basic version (Basic PAUL) and a JIT adaptive version (Smart PAUL). Both apps send JIT exercise prompts, but the versions differ in that the Smart PAUL app sends JIT adaptive reminder messages to initiate running or walking behavior, whereas the Basic PAUL app sends reminder messages at randomized times. A total of 23 participants were randomized into 1 of the 2 intervention arms. PA behavior (accelerometer-measured), intrinsic motivation, and the perceived capability of PA behavior were measured before and after the intervention. After the intervention, participants were also asked to complete a questionnaire on user experience, and they were invited for an exit interview to assess user perceptions and opinions of the app in depth. Results: No differences in PA behavior were observed (Z=?1.433; P=.08), but intrinsic motivation for running and walking and for performing strength exercises significantly increased (Z=?3.342; P<.001 and Z=?1.821; P=.04, respectively). Furthermore, participants increased their perceived capability to perform strength exercises (Z=2.231; P=.01) but not to walk or run (Z=?1.221; P=.12). The interviews indicated that the participants were enthusiastic about the strength exercise prompts. These were perceived as personal, fun, and relevant to their health. The reminders were perceived as important initiators for PA, but participants from both app groups explained that the reminder messages were often not sent at times they could exercise. Although the participants were enthusiastic about the functionalities of the app, technical issues resulted in a low user experience. Conclusions: The preliminary findings suggest that the PAUL apps are promising and innovative interventions for promoting PA. Users perceived the strength exercise prompts as a valuable addition to exercise apps. However, to be a feasible intervention, the app must be more stable. ", doi="10.2196/35268", url="https://formative.jmir.org/2022/8/e35268", url="http://www.ncbi.nlm.nih.gov/pubmed/35916693" } @Article{info:doi/10.2196/37738, author="Johnson, K. Amy and Haider, Sadia and Nikolajuk, Katie and Kuhns, M. Lisa and Ott, Emily and Motley, Darnell and Hill, Brandon and Hirschhorn, Lisa", title="An mHealth Intervention to Improve Pre-Exposure Prophylaxis Knowledge Among Young Black Women in Family Planning Clinics: Development and Usability Study", journal="JMIR Form Res", year="2022", month="Jul", day="28", volume="6", number="7", pages="e37738", keywords="mHealth", keywords="adolescent health", keywords="young Black women", keywords="pre-exposure prophylaxis", keywords="HIV", keywords="mobile health", keywords="PrEP", keywords="mobile app", abstract="Background: Young Black women between the ages of 18 and 24 years are disproportionately impacted by HIV, yet they have a low self-perception of HIV risk and limited exposure to prevention strategies. Pre-exposure prophylaxis (PrEP) is a safe and effective biomedical HIV prevention strategy for those at risk for HIV infection, but uptake has been slow among cisgender women. Family planning clinics are a primary source of health care access for young women, providing an ideal opportunity to integrate PrEP information and care into existing clinic practices. Objective: The aim of this study was to use a multistage, community-engaged process to develop a mobile health app and to evaluate the feasibility and acceptability of the app. Methods: Using user-centered design, the In the Loop app was developed in collaboration with a community advisory board of young Black women. This study employed a multistage design, which included community-engaged app development, user testing, and evaluation of the app's feasibility and acceptability. A pre- and postdesign was used to assess the impact of the app on PrEP knowledge immediately after app use. Descriptive statistics (eg, mean, SD, and percentage values) were used to describe the sample, and Wilcoxon matched-pairs signed-ranks test was used to detect changes in PrEP knowledge before and immediately after using the app. Results: A total of 50 sexually active, young Black women, aged 18-24 (mean 21, SD 1.9) years, were enrolled in this study. Analysis comparing scores before and immediately after use of the app revealed a significant increase in PrEP content knowledge scores on a 7-item true or false scale (z=--6.04, P<.001). Overall, participants considered the In the Loop app feasible and acceptable to use while waiting for a family planning visit. The majority of participants (n=46, 92\%) agreed that they would recommend In the Loop to friends to learn more about PrEP. Participants rated the overall quality of the app 4.3 on a 1-5 scale (1=very poor and 5=very good). Of 50 participants, 40 (80\%) agreed that the app was easy to use, and 48 (96\%) agreed that they found the information in the app easy to understand. Finally, 40 (80\%) agreed that they had enjoyed using the app while waiting for their family planning visit. Conclusions: Our findings suggest that young Black women waiting for family planning visits found the In the Loop app to be feasible and acceptable. This study demonstrates the value of engaging young Black women in the app design process. As family planning clinics are a primary source of health care access for young women, they provide an ideal setting to integrate PrEP information and care into existing clinic practices. Next steps in the development of the In the Loop app include implementing user-suggested improvements and conducting efficacy testing in a randomized controlled trial to determine the app's impact on PrEP uptake. ", doi="10.2196/37738", url="https://formative.jmir.org/2022/7/e37738", url="http://www.ncbi.nlm.nih.gov/pubmed/35900830" } @Article{info:doi/10.2196/34423, author="Ruiz-Burga, Elisa and Bruijning-Verhagen, Patricia and Palmer, Paulette and Sandcroft, Annalisa and Fernandes, Georgina and de Hoog, Marieke and Bryan, Lenroy and Pierre, Russell and Bailey, Heather and Giaquinto, Carlo and Thorne, Claire and Christie, C. Celia D. and ", title="Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study", journal="JMIR Form Res", year="2022", month="Jul", day="27", volume="6", number="7", pages="e34423", keywords="mHealth", keywords="digital health", keywords="arbovirus", keywords="pregnancy", keywords="adherence", keywords="compliance", keywords="low- and middle-income countries", keywords="LMIC", keywords="maternal health", keywords="pregnancy complications", keywords="prenatal care", keywords="pregnancy outcomes", keywords="mobile phone", abstract="Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ?16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users' perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8\%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5\%) used the app for <7 days, and 10 (5.8\%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1\%) to 129 (82.2\%) completed their daily symptom diary; 50 (31.8\%) to 56 (35.7\%) did so on the same day. Overall, 31.8\% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ?80\% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95\% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95\% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6\%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2\%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8\% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3\% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. ", doi="10.2196/34423", url="https://formative.jmir.org/2022/7/e34423", url="http://www.ncbi.nlm.nih.gov/pubmed/35896029" } @Article{info:doi/10.2196/37706, author="Adler, F. Rachel and Morales, Paulina and Sotelo, Jocelyn and Magasi, Susan", title="Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study", journal="JMIR Form Res", year="2022", month="Jul", day="26", volume="6", number="7", pages="e37706", keywords="user-centered design", keywords="co-design", keywords="mobile health", keywords="mHealth", keywords="cancer survivors", keywords="disabilities", abstract="Background: The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective: This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods: We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results: These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions: Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops. ", doi="10.2196/37706", url="https://formative.jmir.org/2022/7/e37706", url="http://www.ncbi.nlm.nih.gov/pubmed/35881439" } @Article{info:doi/10.2196/31529, author="Schwartz-Lasfargues, Christel and Roux-Gendron, Camille and Edomskis, Pim and Marque, Isabelle and Bayon, Yves and Lange, F. Johan and Faucheron, Luc Jean and Trilling, Bertrand", title="Development of a Connected Sensor System in Colorectal Surgery: User-Centered Design Case Study", journal="JMIR Hum Factors", year="2022", month="Jul", day="8", volume="9", number="3", pages="e31529", keywords="user-centered design", keywords="usability", keywords="formative evaluation", keywords="medical device", keywords="innovation", keywords="Internet of Things", keywords="IoT", keywords="colorectal surgery", keywords="colorectal anastomotic leakage", keywords="mobile phone", abstract="Background: A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals' daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development. Objective: The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices. Methods: UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months. Results: Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design. Conclusions: This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case. ", doi="10.2196/31529", url="https://humanfactors.jmir.org/2022/3/e31529", url="http://www.ncbi.nlm.nih.gov/pubmed/35802406" } @Article{info:doi/10.2196/36392, author="Duan, Beibei and Liu, Zhe and Liu, Weiwei and Gou, Baohua", title="Assessing the Views and Needs of People at High Risk of Gestational Diabetes Mellitus for the Development of Mobile Health Apps: Descriptive Qualitative Study", journal="JMIR Form Res", year="2022", month="Jul", day="8", volume="6", number="7", pages="e36392", keywords="gestational diabetes mellitus", keywords="high-risk groups", keywords="mobile health", keywords="mHealth", keywords="applications", keywords="user-centered design", keywords="qualitative research", abstract="Background: Early prevention of gestational diabetes mellitus (GDM) can reduce the incidence of not only GDM, but also adverse perinatal pregnancy outcomes. Moreover, it is of great significance to prevent or reduce the occurrence of type 2 diabetes. Mobile health (mHealth) apps can help pregnant women effectively prevent GDM by providing risk prediction, lifestyle support, peer support, professional support, and other functions. Before designing mHealth apps, developers must understand the views and needs of pregnant women, and closely combine users' needs to develop app functions, in order to better improve user experience and increase the usage rate of these apps in the future. Objective: The objective of this study was to understand the views of the high-risk population of gestational diabetes mellitus on the development of mobile health apps and the demand for app functions, so as to provide a basis for the development of gestational diabetes mellitus prevention apps. Methods: Fifteen pregnant women with at least one risk factor for gestational diabetes were recruited from July to September 2021, and were interviewed via a semistructured interview using the purpose sampling method. The transcribed data were analyzed by the traditional content analysis method, and themes were extracted. Results: Respondents wanted to develop user-friendly and fully functional mobile apps for the prevention of gestational diabetes mellitus. Pregnant women's requirements for app function development include: personalized customization, accurate information support, interactive design, practical tool support, visual presentation, convenient professional support, peer support, reasonable reminder function, appropriate maternal and infant auxiliary function, and differentiated incentive function.These function settings can encourage pregnant women to improve or maintain healthy living habits during their use of the app Conclusions: This study discusses the functional requirements of target users for gestational diabetes mellitus prevention apps, which can provide reference for the development of future applications. ", doi="10.2196/36392", url="https://formative.jmir.org/2022/7/e36392", url="http://www.ncbi.nlm.nih.gov/pubmed/35802414" } @Article{info:doi/10.2196/33541, author="Perkes, Jane Sarah and Huntriss, Belinda and Skinner, Noelene and Leece, Bernise and Dobson, Rosie and Mattes, Joerg and Hall, Kerry and Bonevski, Billie", title="Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach", journal="JMIR Form Res", year="2022", month="Jul", day="8", volume="6", number="7", pages="e33541", keywords="mHealth", keywords="co-design", keywords="Aboriginal and Torres Strait Islander", keywords="mother", keywords="baby", keywords="young children", keywords="mobile phone", abstract="Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women's health: Smoke-free families, Safe drinking, Feeling good, Women's business, Eating, and Exercising. The content also includes 6 modules for children's health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. ", doi="10.2196/33541", url="https://formative.jmir.org/2022/7/e33541", url="http://www.ncbi.nlm.nih.gov/pubmed/35802404" } @Article{info:doi/10.2196/37933, author="Shan, Yi and Ji, Meng and Xie, Wenxiu and Li, Rongying and Qian, Xiaobo and Zhang, Xiaomin and Hao, Tianyong", title="Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study", journal="JMIR Form Res", year="2022", month="Jul", day="6", volume="6", number="7", pages="e37933", keywords="mHealth app", keywords="usability", keywords="Chinese version of MAUQ", keywords="improved translation", keywords="validity", keywords="stability", keywords="reliability", keywords="cross-cultural adaptability", keywords="mobile phone", abstract="Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular ``reaching out to patients'' interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential ``reaching out to patients'' mHealth apps without chatbot function in China. After asking for the researchers' approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference--induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach $\alpha$=.988), and validity (Kaiser--Meyer--Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80\% of informants' positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users' age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. ", doi="10.2196/37933", url="https://formative.jmir.org/2022/7/e37933", url="http://www.ncbi.nlm.nih.gov/pubmed/35793132" } @Article{info:doi/10.2196/37291, author="Lukkanalikitkul, Eakalak and Kongpetch, Sawinee and Chotmongkol, Wijittra and Morley, G. Michael and Anutrakulchai, Sirirat and Srichan, Chavis and Thinkhamrop, Bandit and Chunghom, Theenatchar and Wiangnon, Pongsai and Thinkhamrop, Wilaiphorn and Morley, E. Katharine", title="Optimization of the Chronic Kidney Disease--Peritoneal Dialysis App to Improve Care for Patients on Peritoneal Dialysis in Northeast Thailand: User-Centered Design Study", journal="JMIR Form Res", year="2022", month="Jul", day="6", volume="6", number="7", pages="e37291", keywords="peritoneal", keywords="dialysis", keywords="peritoneum", keywords="mobile health", keywords="mHealth", keywords="rapid cycle process improvement methodology", keywords="home monitoring", keywords="near-field communication", keywords="monitor", keywords="kidney", keywords="rapid cycle improvement", keywords="quality improvement", keywords="process improvement", keywords="methodology", keywords="nephrology", keywords="nephrologist", keywords="internal medicine", keywords="computer program", keywords="Unified Theory of Acceptance and Use of Technology", keywords="UTAUT", keywords="usability", keywords="interface", keywords="metric capture", keywords="barrier", keywords="renal", keywords="mobile phone", abstract="Background: The prevalence of peritoneal dialysis (PD) in Thailand is increasing rapidly in part because of Thailand's Peritoneal Dialysis First policy. PD is a home-based renal replacement therapy in which patients with chronic kidney disease perform up to 4 exchanges of dialysate fluid per day in the peritoneal cavity. Overhydration is one of the most common complications in patients on PD and is associated with increased morbidity and mortality. To monitor hydration status, patients collect hydration metrics, including body weight, blood pressure, urine output, and ultrafiltration volume, from each dialysis cycle and enter this information into a PD logbook. This information is reviewed bimonthly at PD clinic appointments. The chronic kidney disease-PD (CKD-PD) app with near-field communication (NFC) and optical character recognition (OCR) was developed to automate hydration metric collection. The information was displayed in the app for self-monitoring and uploaded to a database for real-time monitoring by the PD clinic staff. Early detection and treatment of overhydration could potentially reduce the morbidity and mortality related to overhydration. Objective: This study aims to identify usability issues and technology adoption barriers for the CKD-PD app with NFC and OCR and a monitoring system and to use this information to make rapid cycle improvements. Methods: A multidisciplinary team of nephrologists, PD clinic nurses, computer programmers, and engineers trained and observed 2 groups of 5 participants in the use of the CKD-PD app with NFC and OCR and a monitoring system. The participants were observed using technology in their homes in 3 phases. The data collected included the Unified Theory of Acceptance and Use of Technology questionnaire, think-aloud observation, user ratings, completion of hydration metrics, and upload of hydration metrics to the central database. These results were used by the team between phases to improve the functionality and usefulness of the app. Results: The CKD-PD app with NFC and OCR and a monitoring system underwent 3 rapid improvement cycles. Issues were identified regarding the usability of the NFC and OCR data collection, app stability, user interface, hydration metric calculation, and display. NFC and OCR improved hydration metric capture; however, issues remained with their usability. App stability and user interface issues were corrected, and hydration metrics were successfully uploaded by the end of phase 3. Participants' scores on technology adoption decreased but were still high, and there was enthusiasm for the self-monitoring and clinical communication features. Conclusions: Our rapid cycle process improvement methodology identified and resolved key barriers and usability issues for the CKD-PD app with NFC and OCR and a monitoring system. We believe that this methodology can be accomplished with limited training in data collection, statistical analysis, and funding. ", doi="10.2196/37291", url="https://formative.jmir.org/2022/7/e37291", url="http://www.ncbi.nlm.nih.gov/pubmed/35793137" } @Article{info:doi/10.2196/36091, author="Jiang, Nan and Rogers, S. Erin and Cupertino, Paula and Zhao, Xiaoquan and Cartujano-Barrera, Francisco and Lyu, Chen Joanne and Hu, Lu and Sherman, E. Scott", title="Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study", journal="JMIR Form Res", year="2022", month="Jun", day="30", volume="6", number="6", pages="e36091", keywords="smoking cessation", keywords="text messaging", keywords="mobile health", keywords="Chinese American", abstract="Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers' access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Dec{\'i}detexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers' barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants' smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. ", doi="10.2196/36091", url="https://formative.jmir.org/2022/6/e36091", url="http://www.ncbi.nlm.nih.gov/pubmed/35771603" } @Article{info:doi/10.2196/35997, author="Sybil, Deborah and Krishna, Meenakshi and Shrivastava, Kumar Priyanshu and Singh, Shradha and Khan, Imran", title="Innovative App (ExoDont) and Other Conventional Methods to Improve Patient Compliance After Minor Oral Surgical Procedures: Pilot, Nonrandomized, and Prospective Comparative Study", journal="JMIR Perioper Med", year="2022", month="Jun", day="28", volume="5", number="1", pages="e35997", keywords="ExoDont", keywords="mHealth", keywords="mobile health", keywords="Android app", keywords="dental extraction", keywords="postoperative", keywords="oral surgery", keywords="dentistry", keywords="teledentistry", keywords="mobile app", abstract="Background: Postoperative care is influenced by various factors such as compliance, comprehension, retention of instructions, and other unaccounted elements. It is imperative that patients adhere to the instructions and prescribed regimen for smooth and placid healing. ExoDont, an Android-based mobile health app, was designed to ensure a smooth postoperative period for patients after a dental extraction. Besides providing postoperative instructions at defined intervals, the app also sends drug reminders as an added advantage over other available, conventional methods. Objective: The aim of this study was to compare the compliance rate of individuals with respect to the prescribed regimen and postoperative instructions. Additionally, we aimed to assess any changes in the postoperative complication rate of patients assigned to 3 categories: the verbal, verbal plus written, and ExoDont app-based delivery groups. Methods: We conducted a pilot, nonrandomized, and prospective comparative study in which patients after tooth extraction were assigned to 3 groups---verbal (Group A), verbal plus written (Group B), and ExoDont app-based delivery (Group C)---based on the eligibility criteria, and a 1-week follow-up was planned to obtain the responses regarding compliance and postoperative complications from the participants. Results: In total, 90 patients were recruited and equally divided into 3 groups. Compliance to prescribed drug was found to be the highest in Group C, where of the 30 participants, 25 (83\%) and 28 (93\%) followed the entire course of antibiotics and analgesics, respectively. For postoperative instructions, higher compliance was observed in Group C in relation to compliance to diet restrictions (P=.001), not rinsing for 24 hours (P<.001), and warm saline rinses after 24 hours (P=.001). However, the difference was not significant for smoking restrictions (P=.07) and avoiding alcohol (P=.16). Moreover, the difference in postoperative complication rate was not statistically significant among the 3 groups (P=.31). Conclusions: As evident from the results, it is anticipated that the ExoDont app will be helpful in circumventing the unaccounted possibilities of missing the prescribed dosage and postoperative instructions and ensuring the smooth recovery of patients after dental extraction. However, future studies are required to establish this app-based method of delivery of postoperative instructions as a viable option in routine clinical practice. ", doi="10.2196/35997", url="https://periop.jmir.org/2022/1/e35997", url="http://www.ncbi.nlm.nih.gov/pubmed/35763332" } @Article{info:doi/10.2196/33849, author="Al-Mondhiry, Jafar and D'Ambruoso, Sarah and Pietras, Christopher and Strouse, Thomas and Benzeevi, Dikla and Arevian, C. Armen and Wells, B. Kenneth", title="Co-created Mobile Apps for Palliative Care Using Community-Partnered Participatory Research: Development and Usability Study", journal="JMIR Form Res", year="2022", month="Jun", day="23", volume="6", number="6", pages="e33849", keywords="mobile phone", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="digital health", keywords="palliative care", keywords="quality of life", keywords="survivorship", keywords="patient advocacy", keywords="oncology", keywords="patient-reported outcomes", keywords="PRO", keywords="community-partnered participatory research", keywords="CPPR", abstract="Background: Open design formats for mobile apps help clinicians and stakeholders bring their needs to direct, co-creative solutions. Palliative care for patients with advanced cancers requires intensive monitoring and support and remains an area in high need for innovation. Objective: This study aims to use community-partnered participatory research to co-design and pretest a mobile app that focuses on palliative care priorities of clinicians and patients with advanced cancer. Methods: In-person and teleconference workshops were held with patient and family stakeholders, researchers, and clinicians in palliative care and oncology. Question prompts, written feedback, semistructured interviews, and facilitated group discussions identified the core palliative care needs. Using Chorus, a no-code app-building platform, a mobile app was co-designed with the stakeholders. A pretest with 11 patients was conducted, with semistructured interviews of clinician and patient users for feedback. Results: Key themes identified from the focus groups included needs for patient advocacy and encouragement, access to vetted information, patient-clinician communication support, and symptom management. The initial prototype, My Wellness App, contained a weekly wellness journal to track patient-reported symptoms, goals, and medication use; information on self-management of symptoms; community resources; and patient and caregiver testimonial videos. Initial pretesting identified value in app-based communication for clinicians, patients, and caregivers, with suggestions for improving user interface, feedback and presentation of symptom reports, and gamification and staff coordinators to support patient app engagement. Conclusions: The development of a mobile app using community-partnered participatory research is a low-technology and feasible intervention for palliative care. Iterative redesign and user interface expertise may improve implementation. ", doi="10.2196/33849", url="https://formative.jmir.org/2022/6/e33849", url="http://www.ncbi.nlm.nih.gov/pubmed/35737441" } @Article{info:doi/10.2196/31011, author="Kasetsuwan, Ngamjit and Suwan-Apichon, Olan and Lekhanont, Kaevalin and Chuckpaiwong, Varintorn and Reinprayoon, Usanee and Chantra, Somporn and Puangsricharern, Vilavun and Pariyakanok, Lalida and Prabhasawat, Pinnita and Tesavibul, Nattaporn and Chaidaroon, Winai and Tananuvat, Napaporn and Hirunpat, Chakree and Prakairungthong, Nauljira and Sansanayudh, Wiwan and Chirapapaisan, Chareenun and Phrueksaudomchai, Pakornkit", title="Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="22", volume="10", number="6", pages="e31011", keywords="blink rate", keywords="dry eye", keywords="smartphone application", keywords="maximum blink interval", keywords="prevalence", keywords="mHealth", keywords="epidemiology", keywords="screening", keywords="risk factors", keywords="symptoms", keywords="ophthalmology", keywords="vision", abstract="Background: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The ``Dry eye or not?'' app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. Objective: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. Methods: This cross-sectional study sourced data from the ``Dry eye or not?'' smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ?13. Results: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8\% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95\% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95\% CI 1.15-2.19; P=.004), and lower than bachelor's degree (adjusted OR 1.30; 95\% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95\% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). Conclusions: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8\%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand. ", doi="10.2196/31011", url="https://mhealth.jmir.org/2022/6/e31011", url="http://www.ncbi.nlm.nih.gov/pubmed/35731569" } @Article{info:doi/10.2196/29856, author="Lambert, Yann and Galindo, Muriel and Sua?rez-Mutis, Martha and Mutricy, Louise and Sanna, Alice and Garancher, Laure and Cairo, Hedley and Hiwat, Helene and Bordalo Miller, Jane and Gomes, Hermenegildo Jose? and Marchesini, Paola and Adenis, Antoine and Nacher, Mathieu and Vreden, Stephen and Douine, Maylis", title="Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study", journal="JMIR Form Res", year="2022", month="Jun", day="16", volume="6", number="6", pages="e29856", keywords="malaria", keywords="Guiana Shield", keywords="information system", keywords="mobile data collection", keywords="Open Data Kit", keywords="ODK", abstract="Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators' feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03\% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators' experience. Trial Registration: ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770 ", doi="10.2196/29856", url="https://formative.jmir.org/2022/6/e29856", url="http://www.ncbi.nlm.nih.gov/pubmed/35708763" } @Article{info:doi/10.2196/38283, author="Saha, Sanjoy and Lozano, Panizza Chloe and Broyles, Stephanie and Martin, K. Corby and Apolzan, W. John", title="Assessing the Initial Validity of the PortionSize App to Estimate Dietary Intake Among Adults: Pilot and Feasibility App Validation Study", journal="JMIR Form Res", year="2022", month="Jun", day="15", volume="6", number="6", pages="e38283", keywords="dietary assessment", keywords="eating", keywords="food intake", keywords="energy intake", keywords="portion size", keywords="mHealth", keywords="digital health", keywords="eHealth", keywords="nutrition", keywords="food groups", abstract="Background: Accurately assessing dietary intake can promote improved nutrition. The PortionSize app (Pennington Biomedical Research Center) was designed to quantify and provide real-time feedback on the intake of energy, food groups, saturated fat, and added sugar. Objective: This study aimed to assess the preliminary feasibility and validity of estimating food intake via the PortionSize app among adults. Methods: A total of 15 adults (aged 18-65 years) were recruited and trained to quantify the food intake from a simulated meal by using PortionSize. Trained personnel prepared 15 simulated meals and covertly weighed (weigh back) the amount of food provided to participants as well as food waste. Equivalence tests ({\textpm}25\% bounds) were performed to compare PortionSize to the weigh back method. Results: Participants were aged a mean of 28 (SD 12) years, and 11 were female. The mean energy intake estimated with PortionSize was 742.9 (SD 328.2) kcal, and that estimated via weigh back was 659.3 (SD 190.7) kcal (energy intake difference: mean 83.5, SD 287.5 kcal). The methods were not equivalent in estimating energy intake (P=.18), and PortionSize overestimated energy intake by 83.5 kcal (12.7\%) at the meal level. Estimates of portion sizes (gram weight; P=.01), total sugar (P=.049), fruit servings (P=.01), and dairy servings (P=.047) from PortionSize were equivalent to those estimated via weigh back. PortionSize was not equivalent to weigh back with regard to estimates for carbohydrate (P=.10), fat (P=.32), vegetable (P=.37), grain (P=.31), and protein servings (P=.87). Conclusions: Due to power limitations, the equivalence tests had large equivalence bounds. Though preliminary, the results of this small pilot study warrant the further adaptation, development, and validation of PortionSize as a means to estimate energy intake and provide users with real-time and actionable dietary feedback. ", doi="10.2196/38283", url="https://formative.jmir.org/2022/6/e38283", url="http://www.ncbi.nlm.nih.gov/pubmed/35704355" } @Article{info:doi/10.2196/39198, author="Carney, E. Colleen and Carmona, E. Nicole", title="Authors' Response to: Additional Measurement Approaches for Sleep Disturbances. Comment on ``Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study''", journal="JMIR Form Res", year="2022", month="Jun", day="13", volume="6", number="6", pages="e39198", keywords="youth", keywords="sleep", keywords="technology", keywords="mHealth", keywords="self-management", keywords="adolescents", keywords="young adults", keywords="mobile phone", keywords="smartphone", keywords="polysomnography", doi="10.2196/39198", url="https://formative.jmir.org/2022/6/e39198", url="http://www.ncbi.nlm.nih.gov/pubmed/35699990" } @Article{info:doi/10.2196/38075, author="Jones, Jeb and Edwards, Winslow O. and Merrill, Leland and Sullivan, S. Patrick and Stephenson, Rob", title="Interest in HIV Prevention Mobile Phone Apps: Focus Group Study With Sexual and Gender Minority Persons Living in the Rural Southern United States", journal="JMIR Form Res", year="2022", month="Jun", day="13", volume="6", number="6", pages="e38075", keywords="men who have sex with men", keywords="transgender persons", keywords="nonbinary persons", keywords="mHealth", keywords="mobile app", keywords="HIV", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="sexually transmitted infection testing", keywords="STI testing", keywords="HIV testing", keywords="mobile phone", abstract="Background: Mobile health (mHealth) interventions, including smartphone apps, have been found to be an effective means of increasing the uptake of HIV prevention tools, including HIV and sexually transmitted infection (STI) tests and pre-exposure prophylaxis. However, most HIV prevention mHealth apps tested in the United States have been tested among populations living in areas surrounding urban centers. Owing to reduced access to broadband internet and reliable cellular data services, it remains unclear how accessible and effective these interventions will be in rural areas. In addition, gay and bisexual men who have sex with men and gender minority populations in rural areas experience enhanced stigma when compared with their more urban counterparts, and these experiences might affect their willingness and interest in mHealth apps. Objective: This study aimed to conduct online focus groups with men who have sex with men and transgender and gender diverse populations in the rural southern United States to assess their interest in mHealth HIV prevention apps and the features that they would be the most interested in using. Methods: Focus group participants were recruited from a larger pool of sexual and gender minority respondents to a web-based research survey. The participants indicated that they would be willing to participate in an online focus group discussion. Focus groups were conducted via secure Zoom (Zoom Video Communications Inc) videoconferencing. During the focus group discussions, participants were asked to discuss their experiences with HIV and STI prevention and how these experiences were affected by living in a rural area. They were then shown screenshots of a new app to promote HIV and STI prevention among rural populations and asked to provide their opinions on the app's features. The transcripts of the discussions were reviewed and coded using a constant comparative approach. Results: A total of 6 focus groups were conducted with 26 participants. Most participants were cisgender gay and bisexual men who have sex with men (19/26, 73\%); the remaining participants were transgender men (2/26, 8\%), were nonbinary people (2/26, 8\%), or had multiple gender identities (3/26, 12\%). Participants reported numerous barriers to accessing HIV and STI prevention services and accurate information about HIV and STI prevention options. Overall, the participants reported a high degree of interest in mHealth interventions for HIV and STI prevention and suggested several recommendations for the features of an app-based intervention that would be the most useful for rural residents. Conclusions: These focus group discussions indicate that rural residence is not a major barrier to mHealth HIV and STI prevention intervention implementation and that there is a high degree of interest in these approaches to HIV and STI prevention. ", doi="10.2196/38075", url="https://formative.jmir.org/2022/6/e38075", url="http://www.ncbi.nlm.nih.gov/pubmed/35699980" } @Article{info:doi/10.2196/35959, author="Tsai, Wan-Tong and Liu, Tzung-Liang", title="Additional Measurement Approaches for Sleep Disturbances. Comment on ``A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study''", journal="JMIR Form Res", year="2022", month="Jun", day="13", volume="6", number="6", pages="e35959", keywords="youth", keywords="sleep", keywords="technology", keywords="mHealth", keywords="self-management", keywords="adolescents", keywords="young adults", keywords="mobile phone", keywords="smartphone", keywords="polysomnography", doi="10.2196/35959", url="https://formative.jmir.org/2022/6/e35959", url="http://www.ncbi.nlm.nih.gov/pubmed/35700003" } @Article{info:doi/10.2196/34191, author="Coughlin, W. Janelle and Martin, M. Lindsay and Zhao, Di and Goheer, Attia and Woolf, B. Thomas and Holzhauer, Katherine and Lehmann, P. Harold and Lent, R. Michelle and McTigue, M. Kathleen and Clark, M. Jeanne and Bennett, L. Wendy", title="Electronic Health Record--Based Recruitment and Retention and Mobile Health App Usage: Multisite Cohort Study", journal="J Med Internet Res", year="2022", month="Jun", day="10", volume="24", number="6", pages="e34191", keywords="mHealth", keywords="mobile apps", keywords="recruitment", keywords="engagement", keywords="retention", keywords="timing of eating", keywords="timing of sleep", keywords="obesity", keywords="EHR", abstract="Background: To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. Objective: The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. Methods: Using an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. Results: Of 70,661 patients who were sent research invitations, 1021 (1.44\%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79\% (n=547) of the participants were app users and, of those, 75.3\% (n=412), 50.1\% (n=274), and 25.4\% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31\%) of the participants completed the 4-month online surveys. A total of 33.5\% (183/547), 29.3\% (157/536), and 27.1\% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. Conclusions: EHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use. ", doi="10.2196/34191", url="https://www.jmir.org/2022/6/e34191", url="http://www.ncbi.nlm.nih.gov/pubmed/35687400" } @Article{info:doi/10.2196/31069, author="Merid, Beza and Robles, Cielito Maria and Nallamothu, K. Brahmajee and Newman, W. Mark and Skolarus, E. Lesli", title="Viewing Mobile Health Technology Design Through the Lens of Amplification Theory", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="10", volume="10", number="6", pages="e31069", keywords="mHealth", keywords="digital health", keywords="cardiovascular disease", keywords="high blood pressure", keywords="structural barriers to health", keywords="racial health disparities", keywords="Amplification Theory of Technology", doi="10.2196/31069", url="https://mhealth.jmir.org/2022/6/e31069", url="http://www.ncbi.nlm.nih.gov/pubmed/35687411" } @Article{info:doi/10.2196/36052, author="Plantinga, C. Laura and Hoge, Courtney and Vandenberg, E. Ann and James, Kyle and Masud, Tahsin and Khakharia, Anjali and Gray, Carol and Jaar, G. Bernard and Lea, P. Janice and O'Donnell, M. Christopher and Mutell, Richard", title="A Web-Based, Provider-Driven Mobile App to Enhance Patient Care Coordination Between Dialysis Facilities and Hospitals: Development and Pilot Implementation Study", journal="JMIR Form Res", year="2022", month="Jun", day="10", volume="6", number="6", pages="e36052", keywords="dialysis", keywords="hospitals", keywords="physicians", keywords="advanced practice providers", keywords="nurses", keywords="care coordination", keywords="mobile app", abstract="Background: We piloted a web-based, provider-driven mobile app (DialysisConnect) to fill the communication and care coordination gap between hospitals and dialysis facilities. Objective: This study aimed to describe the development and pilot implementation of DialysisConnect. Methods: DialysisConnect was developed iteratively with focus group and user testing feedback and was made available to 120 potential users at 1 hospital (hospitalists, advanced practice providers [APPs], and care coordinators) and 4 affiliated dialysis facilities (nephrologists, APPs, nurses and nurse managers, social workers, and administrative personnel) before the start of the pilot (November 1, 2020, to May 31, 2021). Midpilot and end-of-pilot web-based surveys of potential users were also conducted. Descriptive statistics were used to describe system use patterns, ratings of multiple satisfaction items (1=not at all; 3=to a great extent), and provider-selected motivators of and barriers to using DialysisConnect. Results: The pilot version of DialysisConnect included clinical information that was automatically uploaded from dialysis facilities, forms for entering critical admission and discharge information, and a direct communication channel. Although physicians comprised most of the potential users of DialysisConnect, APPs and dialysis nurses were the most active users. Activities were unevenly distributed; for example, 1 hospital-based APP recorded most of the admissions (280/309, 90.6\%) among patients treated at the pilot dialysis facilities. End-of-pilot ratings of DialysisConnect were generally higher for users versus nonusers (eg, ``I can see the potential value of DialysisConnect for my work with dialysis patients'': mean 2.8, SD 0.4, vs mean 2.3, SD 0.6; P=.02). Providers most commonly selected reduced time and energy spent gathering information as a motivator (11/26, 42\%) and a lack of time to use the system as a barrier (8/26, 31\%) at the end of the pilot. Conclusions: This pilot study found that APPs and nurses were most likely to engage with the system. Survey participants generally viewed the system favorably while identifying substantial barriers to its use. These results inform how best to motivate providers to use this system and similar systems and inform future pragmatic research in care coordination among this and other populations. ", doi="10.2196/36052", url="https://formative.jmir.org/2022/6/e36052", url="http://www.ncbi.nlm.nih.gov/pubmed/35687405" } @Article{info:doi/10.2196/35118, author="Domin, Alex and Uslu, Arif and Schulz, Andr{\'e} and Ouzzahra, Yacine and V{\"o}gele, Claus", title="A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study", journal="JMIR Form Res", year="2022", month="Jun", day="10", volume="6", number="6", pages="e35118", keywords="mobile health", keywords="physical activity", keywords="app", keywords="adolescents", keywords="within-subject", keywords="mHealth", keywords="sedentary behavior", keywords="behavior change techniques", keywords="BCTs", keywords="Fitbit", keywords="mobile phone", abstract="Background: Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content. Objective: This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed. Methods: A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery. Results: The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t17=?1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task--based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate--based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t16=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants' overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t17=1.35; P=.09; bootstrapped P=.05). Conclusions: The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants' sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents. ", doi="10.2196/35118", url="https://formative.jmir.org/2022/6/e35118", url="http://www.ncbi.nlm.nih.gov/pubmed/35687409" } @Article{info:doi/10.2196/34566, author="Truong, Tam Minh and Nwosu, Bertrand Obioma and Gaytan Torres, Elena Maria and Segura Vargas, Paula Maria and Seifer, Ann-Kristin and Nitschke, Marlies and Ibrahim, A. Alzhraa and Knitza, Johannes and Krusche, Martin and Eskofier, M. Bjoern and Schett, Georg and Morf, Harriet", title="A Yoga Exercise App Designed for Patients With Axial Spondylarthritis: Development and User Experience Study", journal="JMIR Form Res", year="2022", month="Jun", day="3", volume="6", number="6", pages="e34566", keywords="spondylarthritis", keywords="digital health application", keywords="yoga", keywords="usability", keywords="patient empowerment", keywords="mobile health", keywords="mHealth", keywords="health applications", keywords="smartphone", keywords="physical exercise", keywords="wellness", keywords="mobile phone", abstract="Background: Besides anti-inflammatory medication, physical exercise represents a cornerstone of modern treatment for patients with axial spondyloarthritis (AS). Digital health apps (DHAs) such as the yoga app YogiTherapy could remotely empower patients to autonomously and correctly perform exercises. Objective: This study aimed to design and develop a smartphone-based app, YogiTherapy, for patients with AS. To gain additional insights into the usability of the graphical user interface (GUI) for further development of the app, this study focused exclusively on evaluating users' interaction with the GUI. Methods: The development of the app and the user experience study took place between October 2020 and March 2021. The DHA was designed by engineering students, rheumatologists, and patients with AS. After the initial development process, a pilot version of the app was evaluated by 5 patients and 5 rheumatologists. The participants had to interact with the app's GUI and complete 5 navigation tasks within the app. Subsequently, the completion rate and experience questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) were completed by the patients. Results: The results of the posttest questionnaires showed that most patients were already familiar with digital apps (4/5, 80\%). The task completion rates of the usability test were 100\% (5/5) for the tasks T1 and T2, which included selecting and starting a yoga lesson and navigating to an information page. Rheumatologists indicated that they were even more experienced with digital devices (2/5, 40\% experts; 3/5, 60\% intermediates). In this case, they scored task completion rates of 100\% (5/5) for all 5 usability tasks T1 to T5. The mean results from the User Experience Questionnaire range from ?3 (most negative) to +3 (most positive). According to rheumatologists' evaluations, attractiveness (mean 2.267, SD 0.401) and stimulation (mean 2.250, SD 0.354) achieved the best mean results compared with dependability (mean 2.000, SD 0.395). Patients rated attractiveness at a mean of 2.167 (SD 0.565) and stimulation at a mean of 1.950 (SD 0.873). The lowest mean score was reported for perspicuity (mean 1.250, SD 1.425). Conclusions: The newly developed and tested DHA YogiTherapy demonstrated moderate usability among rheumatologists and patients with rheumatic diseases. The app can be used by patients with AS as a complementary treatment. The initial evaluation of the GUI identified significant usability problems that need to be addressed before the start of a clinical evaluation. Prospective trials are also needed in the second step to prove the clinical benefits of the app. ", doi="10.2196/34566", url="https://formative.jmir.org/2022/6/e34566", url="http://www.ncbi.nlm.nih.gov/pubmed/35657655" } @Article{info:doi/10.2196/36068, author="Birrell, Louise and Furneaux-Bate, Ainsley and Debenham, Jennifer and Spallek, Sophia and Newton, Nicola and Chapman, Catherine", title="Development of a Peer Support Mobile App and Web-Based Lesson for Adolescent Mental Health (Mind Your Mate): User-Centered Design Approach", journal="JMIR Form Res", year="2022", month="May", day="27", volume="6", number="5", pages="e36068", keywords="mobile health", keywords="depression", keywords="anxiety", keywords="psychosocial support system", keywords="alcohol drinking", keywords="adolescent", keywords="digital technology", keywords="mobile intervention", keywords="intervention", keywords="social", keywords="economic", keywords="development", keywords="mind your mate", keywords="app", keywords="application", keywords="mHealth", keywords="mobile phone", abstract="Background: Digital technologies and mobile interventions are possible tools for prevention initiatives to target the substantial social and economic impacts that anxiety, mood, and substance use disorders have on young people. Objective: This paper described the design and development of the Mind your Mate program, a smartphone app and introductory classroom lesson enhancing peer support around the topics of anxiety, depression, and substance use for adolescents. Methods: The development of Mind your Mate was an iterative process conducted in collaboration with adolescents (n=23), experts, school staff, and software developers. The development process consisted of 3 stages: scoping; end-user consultations, including a web-based survey and 2 focus groups with 23 adolescents (mean age 15.9, SD 0.6 years); and app development and beta-testing. Results: This process resulted in a smartphone peer support app and introductory classroom lesson aimed at empowering adolescents to access evidence-based information and tools to better support peers regarding mental health and substance use--related issues. The program contains links to external support services and encourages adolescents to reach out for help if they are concerned about themselves or a friend. Conclusions: The Mind your Mate program was developed in collaboration with a number of key stakeholders in youth mental health, including adolescents. The resulting program has the potential to be taken to scale to aid prevention efforts for youth mental health and substance use. The next step is to conduct a randomized controlled trial testing the feasibility, acceptability, and efficacy of the program. ", doi="10.2196/36068", url="https://formative.jmir.org/2022/5/e36068", url="http://www.ncbi.nlm.nih.gov/pubmed/35622401" } @Article{info:doi/10.2196/36824, author="Berlet, Maximilian and Vogel, Thomas and Gharba, Mohamed and Eichinger, Joseph and Schulz, Egon and Friess, Helmut and Wilhelm, Dirk and Ostler, Daniel and Kranzfelder, Michael", title="Emergency Telemedicine Mobile Ultrasounds Using a 5G-Enabled Application: Development and Usability Study", journal="JMIR Form Res", year="2022", month="May", day="26", volume="6", number="5", pages="e36824", keywords="5G", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="digital health", keywords="digital medicine", keywords="mobile ultrasound", keywords="ultrasound", keywords="imaging", keywords="digitalized medicine", keywords="emergency care", keywords="emergency", keywords="ambulance", keywords="slicing", keywords="diagnostic", keywords="diagnosis", keywords="image quality", keywords="field test", abstract="Background: Digitalization affects almost every aspect of modern daily life, including a growing number of health care services along with telemedicine applications. Fifth-generation (5G) mobile communication technology has the potential to meet the requirements for this digitalized future with high bandwidths (10 GB/s), low latency (<1 ms), and high quality of service, enabling wireless real-time data transmission in telemedical emergency health care applications. Objective: The aim of this study is the development and clinical evaluation of a 5G usability test framework enabling preclinical diagnostics with mobile ultrasound using 5G network technology. Methods: A bidirectional audio-video data transmission between the ambulance car and hospital was established, combining both 5G-radio and -core network parts. Besides technical performance evaluations, a medical assessment of transferred ultrasound image quality and transmission latency was examined. Results: Telemedical and clinical application properties of the ultrasound probe were rated 1 (very good) to 2 (good; on a 6 -point Likert scale rated by 20 survey participants). The 5G field test revealed an average end-to-end round trip latency of 10 milliseconds. The measured average throughput for the ultrasound image traffic was 4 Mbps and for the video stream 12 Mbps. Traffic saturation revealed a lower video quality and a slower video stream. Without core slicing, the throughput for the video application was reduced to 8 Mbps. The deployment of core network slicing facilitated quality and latency recovery. Conclusions: Bidirectional data transmission between ambulance car and remote hospital site was successfully established through the 5G network, facilitating sending/receiving data and measurements from both applications (ultrasound unit and video streaming). Core slicing was implemented for a better user experience. Clinical evaluation of the telemedical transmission and applicability of the ultrasound probe was consistently positive. ", doi="10.2196/36824", url="https://formative.jmir.org/2022/5/e36824", url="http://www.ncbi.nlm.nih.gov/pubmed/35617009" } @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/10.2196/37521, author="Miguel Cruz, Antonio and Lopez Portillo, Perez Hector and Daum, Christine and Rutledge, Emily and King, Sharla and Liu, Lili", title="Technology Acceptance and Usability of a Mobile App to Support the Workflow of Health Care Aides Who Provide Services to Older Adults: Pilot Mixed Methods Study", journal="JMIR Aging", year="2022", month="May", day="18", volume="5", number="2", pages="e37521", keywords="usability", keywords="technology acceptance", keywords="Unified Theory of Acceptance and Use of Technology", keywords="UTAUT", keywords="older adults", keywords="caregivers", keywords="health care aides", keywords="mobile phone", abstract="Background: Health care aides are unlicensed support personnel who provide direct care, personal assistance, and support to people with health conditions. The shortage of health care aides has been attributed to recruitment challenges, high turnover, an aging population, the COVID-19 pandemic, and low retention rates. Mobile apps are among the many information communication technologies that are paving the way for eHealth solutions to help address this workforce shortage by enhancing the workflow of health care aides. In collaboration with Clinisys EMR Inc, we developed a mobile app (Mobile Smart Care System [mSCS]) to support the workflow of health care aides who provide services to older adult residents of a long-term care facility. Objective: The purpose of this study was to investigate the technology acceptance and usability of a mobile app in a real-world environment, while it is used by health care aides who provide services to older adults. Methods: This pilot study used a mixed methods design: sequential mixed methods (QUANTITATIVE, qualitative). Our study included a pre-- and post--paper-based questionnaire with no control group (QUAN). Toward the end of the study, 2 focus groups were conducted with a subsample of health care aides (qual, qualitative description design). Technology acceptance and usability questionnaires used a 5-point Likert scale ranging from disagree (1) to agree (5). The items included in the questionnaires were validated in earlier research as having high levels of internal consistency for the Unified Theory of Acceptance and Use of Technology constructs. A total of 60 health care aides who provided services to older adults as part of their routine caseloads used the mobile app for 1 month. Comparisons of the Unified Theory of Acceptance and Use of Technology constructs' summative scores at pretest and posttest were calculated using a paired t test (2-tailed). We used the partial least squares structural regression model to determine the factors influencing mobile app acceptance and usability for health care aides. The $\alpha$ level of significance for all tests was set at P?.05 (2-tailed). Results: We found that acceptance of the mSCS was high among health care aides, performance expectancy construct was the strongest predictor of intention to use the mSCS, intention to use the mSCS predicted usage behavior. The qualitative data support the quantitative findings and showed health care aides' strong belief that the mSCS was useful, portable, and reliable, although there were still opportunities for improvement, especially with regard to the mSCS user interface. Conclusions: Overall, these results support the assertion that mSCS technology acceptance and usability are high among health care aides. In other words, health care aides perceived that the mSCS assisted them in addressing their workflow issues. ", doi="10.2196/37521", url="https://aging.jmir.org/2022/2/e37521", url="http://www.ncbi.nlm.nih.gov/pubmed/35583930" } @Article{info:doi/10.2196/38181, author="Denis, Fabrice and Maurier, Laura and Carillo, Kevin and Ologeanu-Taddei, Roxana and Septans, Anne-Lise and Gepner, Agnes and Le Goff, Florian and Desbois, Madhu and Demurger, Baptiste and Silber, Denise and Zeitoun, Jean-David and Assuied, Peretz Guedalia and Bonnot, Olivier", title="Early Detection of Neurodevelopmental Disorders of Toddlers and Postnatal Depression by Mobile Health App: Observational Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="16", volume="10", number="5", pages="e38181", keywords="early detection", keywords="NDD", keywords="neurodevelopmental disorder", keywords="ASD", keywords="autism spectrum disorder", keywords="PND", keywords="postnatal depression", keywords="mHealth", keywords="mobile health", keywords="real-world study", keywords="autism", keywords="parenting", keywords="pediatric", keywords="children", keywords="mobile phone", keywords="smartphone", keywords="mobile health app", keywords="digital health intervention", keywords="digital product", keywords="algorithm", abstract="Background: Delays in the diagnosis of neurodevelopmental disorders (NDDs) in toddlers and postnatal depression (PND) in mothers are major public health issues. In both cases, early intervention is crucial. Objective: We aimed to assess if a mobile app named Malo can reduce delay in the recognition of NDD and PND. Methods: We performed an observational, cross-sectional, data-based study in a population of young parents with a minimum of 1 child under 3 years of age at the time of inclusion and using Malo on a regular basis. We included the first 4000 users matching the criteria and agreeing to participate between November 11, 2021, and January 14, 2022. Parents received monthly questionnaires via the app, assessing skills on sociability, hearing, vision, motricity, language of their infants, and possible autism spectrum disorder. Mothers were also requested to answer regular questionnaires regarding PND, from 4-28 weeks after childbirth. When any patient-reported outcomes matched predefined criteria, an in-app notification was sent to the user, recommending the booking of an appointment with their family physician or pediatrician.The main outcomes were the median age of the infant at the time of notification for possible NDD and the median time of PND notifications after childbirth. One secondary outcome was the relevance of the NDD notification for a consultation as assessed by the physicians. Results: Among 4242 children assessed by 5309 questionnaires, 613 (14.5\%) had at least 1 disorder requiring a consultation. The median age of notification for possible autism spectrum, vision, audition, socialization, language, or motor disorders was 11, 9, 17, 12, 22, and 4 months, respectively. The sensitivity of the alert notifications of suspected NDDs as assessed by the physicians was 100\%, and the specificity was 73.5\%. Among 907 mothers who completed a PND questionnaire, highly probable PND was detected in 151 (16.6\%) mothers, and the median time of detection was 8-12 weeks. Conclusions: The algorithm-based alert suggesting NDD was highly sensitive with good specificity as assessed by real-life practitioners. The app was also efficient in the early detection of PND. Our results suggest that the regular use of this multidomain familial smartphone app would permit the early detection of NDD and PND. Trial Registration: ClinicalTrials.gov NCT04958174; https://clinicaltrials.gov/ct2/show/NCT04958174 ", doi="10.2196/38181", url="https://mhealth.jmir.org/2022/5/e38181", url="http://www.ncbi.nlm.nih.gov/pubmed/35576565" } @Article{info:doi/10.2196/35065, author="Buss, Helen Vera and Varnfield, Marlien and Harris, Mark and Barr, Margo", title="A Mobile App for Prevention of Cardiovascular Disease and Type 2 Diabetes Mellitus: Development and Usability Study", journal="JMIR Hum Factors", year="2022", month="May", day="10", volume="9", number="2", pages="e35065", keywords="mobile health", keywords="behavior change intervention", keywords="primary prevention", keywords="health promotion", keywords="cardiovascular disease", keywords="diabetes mellitus, type 2", keywords="mobile phone", abstract="Background: Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are posing a huge burden on health care systems worldwide. Mobile apps can deliver behavior change interventions for chronic disease prevention on a large scale, but current evidence for their effectiveness is limited. Objective: This paper reported on the development and user testing of a mobile app that aims at increasing risk awareness and engaging users in behavior change. It would form part of an intervention for primary prevention of CVD and T2DM. Methods: The theoretical framework of the app design was based on the Behaviour Change Wheel, combined with the capability, opportunity, and motivation for behavior change system and the behavior change techniques from the Behavior Change Technique Taxonomy (version 1). In addition, evidence from scientific literature has guided the development process. The prototype was tested for user-friendliness via an iterative approach. We conducted semistructured interviews with individuals in the target populations, which included the System Usability Scale. We transcribed and analyzed the interviews using descriptive statistics for the System Usability Scale and thematic analysis to identify app features that improved utility and usability. Results: The target population was Australians aged ?45 years. The app included 4 core modules (risk score, goal setting, health measures, and education). In these modules, users learned about their risk for CVD and T2DM; set goals for smoking, alcohol consumption, diet, and physical activity; and tracked them. In total, we included 12 behavior change techniques. We conducted 2 rounds of usability testing, each involving 5 participants. The average age of the participants was 58 (SD 8) years. Totally, 60\% (6/10) of the participants owned iPhone Operating System phones, and 40\% (4/10) of them owned Android phones. In the first round, we identified a technical issue that prevented 30\% (3/10) of the participants from completing the registration process. Among the 70\% (7/10) of participants who were able to complete the registration process, 71\% (5/7) rated the app above average, based on the System Usability Scale. During the interviews, we identified some issues related to functionality, content, and language and clarity. We used the participants' feedback to improve these aspects. Conclusions: We developed the app using behavior change theory and scientific evidence. The user testing allowed us to identify and remove technical errors and integrate additional functions into the app, which the participants had requested. Next, we will evaluate the feasibility of the revised version of the app developed through this design process and usability testing. ", doi="10.2196/35065", url="https://humanfactors.jmir.org/2022/2/e35065", url="http://www.ncbi.nlm.nih.gov/pubmed/35536603" } @Article{info:doi/10.2196/36284, author="Jacob, Christine and Sezgin, Emre and Sanchez-Vazquez, Antonio and Ivory, Chris", title="Sociotechnical Factors Affecting Patients' Adoption of Mobile Health Tools: Systematic Literature Review and Narrative Synthesis", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="5", volume="10", number="5", pages="e36284", keywords="telemedicine", keywords="smartphone", keywords="mobile phone", keywords="electronic health record", keywords="public health practice", keywords="technology", keywords="perception", keywords="health education", keywords="mHealth", keywords="mobile health", keywords="telehealth", keywords="eHealth", keywords="patients", abstract="Background: Mobile health (mHealth) tools have emerged as a promising health care technology that may contribute to cost savings, better access to care, and enhanced clinical outcomes; however, it is important to ensure their acceptance and adoption to harness this potential. Patient adoption has been recognized as a key challenge that requires further exploration. Objective: The aim of this review was to systematically investigate the literature to understand the factors affecting patients' adoption of mHealth tools by considering sociotechnical factors (from technical, social, and health perspectives). Methods: A structured search was completed following the participants, intervention, comparators, and outcomes framework. We searched the MEDLINE, PubMed, Cochrane Library, and SAGE databases for studies published between January 2011 and July 2021 in the English language, yielding 5873 results, of which 147 studies met the inclusion criteria. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the Cochrane Handbook were followed to ensure a systematic process. Extracted data were analyzed using NVivo (QSR International), with thematic analysis and narrative synthesis of emergent themes. Results: The technical factors affecting patients' adoption of mHealth tools were categorized into six key themes, which in turn were divided into 20 subthemes: usefulness, ease of use, data-related, monetary factors, technical issues, and user experience. Health-related factors were categorized into six key themes: the disease or health condition, the care team's role, health consciousness and literacy, health behavior, relation to other therapies, integration into patient journey, and the patients' insurance status. Social and personal factors were divided into three key clusters: demographic factors, personal characteristics, and social and cultural aspects; these were divided into 19 subthemes, highlighting the importance of considering these factors when addressing potential barriers to mHealth adoption and how to overcome them. Conclusions: This review builds on the growing body of research that investigates patients' adoption of mHealth services and highlights the complexity of the factors affecting adoption, including personal, social, technical, organizational, and health care aspects. We recommend a more patient-centered approach by ensuring the tools' fit into the overall patient journey and treatment plan, emphasizing inclusive design, and warranting comprehensive patient education and support. Moreover, empowering and mobilizing clinicians and care teams, addressing ethical data management issues, and focusing on health care policies may facilitate adoption. ", doi="10.2196/36284", url="https://mhealth.jmir.org/2022/5/e36284", url="http://www.ncbi.nlm.nih.gov/pubmed/35318189" } @Article{info:doi/10.2196/35094, author="Pit, Sabrina and Ramsden, Robyn and Tan, JH Aaron and Payne, Kristy and Barr, James and Eames, Benjamin and Edwards, Mike and Colbran, Richard", title="Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help?", journal="JMIR Hum Factors", year="2022", month="May", day="2", volume="9", number="2", pages="e35094", keywords="health", keywords="wellness", keywords="mobile apps", keywords="persuasive strategies", keywords="behavior change", keywords="review", keywords="health workforce", keywords="capability", keywords="career", keywords="employment", keywords="rural", keywords="workforce planning", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="health professional", keywords="user experience", keywords="health application", keywords="task support", keywords="social support", keywords="dialog support", abstract="Background: Health professionals' perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals' perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini's Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific--based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals' perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. ", doi="10.2196/35094", url="https://humanfactors.jmir.org/2022/2/e35094", url="http://www.ncbi.nlm.nih.gov/pubmed/35499866" } @Article{info:doi/10.2196/31815, author="Robertson, C. Michael and Cox-Martin, Emily and Shegog, Ross and Markham, M. Christine and Fujimoto, Kayo and Durand, P. Casey and Brewster, Abenaa and Lyons, J. Elizabeth and Liao, Yue and Flores, A. Sara and Basen-Engquist, M. Karen", title="The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design", journal="JMIR Cancer", year="2022", month="Apr", day="29", volume="8", number="2", pages="e31815", keywords="cancer survivors", keywords="exercise", keywords="mindfulness", keywords="Acceptance and Commitment Therapy", keywords="behavioral sciences", abstract="Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (?70\%), adherence rates (?75\% of the participants completing ?50\% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (?5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening--physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76\%), adherence rate (60/80, 75\%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening--physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. ", doi="10.2196/31815", url="https://cancer.jmir.org/2022/2/e31815", url="http://www.ncbi.nlm.nih.gov/pubmed/35486425" } @Article{info:doi/10.2196/29292, author="Kudel, Ian and Perry, Toni", title="Communicating Treatment-Related Symptoms Using Passively Collected Data and Satisfaction/Loyalty Ratings: Exploratory Study", journal="JMIR Cancer", year="2022", month="Apr", day="29", volume="8", number="2", pages="e29292", keywords="electronic patient-reported outcomes", keywords="ePRO", keywords="cancer", keywords="symptoms", keywords="health-related quality of life", abstract="Background: Electronic patient-reported outcomes' real time communication of treatment-related symptoms is increasingly associated with better outcomes including longer survival and less health care resource use, but the primary method of collecting this information, static questionnaires, has not evolved. Objective: The aim of this paper is to describe the use of Noona's three methods of communicating treatment-related symptoms, which are as follows: (1) Noona symptom questionnaires (NSQ), which incorporate branching logic; (2) a diary; and (3) secure messaging, the last two of which have NSQ reporting functionality. It also aims to explore, using multivariable analyses, whether patients find value using these features. Methods: Noona users (N=1081) who have an active account for more than 30 days, who responded to the satisfaction/loyalty item, and who were undergoing active cancer treatment (systemic or radiotherapy) in the United States were included in this study. All study data were collected via software embedded within Noona code. This includes metadata, patient activities (measured in clicks), and responses to a satisfaction/loyalty question (``How likely are you to recommend Noona to another patient'') displayed on the Noona home page. Results: Noona users expressed a high degree of satisfaction/loyalty when asked to rate how likely they would recommend Noona to another patient. Multivariable analyses indicate small but significant effects for some of the analyses. Use of NSQs were significantly related to satisfaction/loyalty, users of NSQs had significantly higher satisfaction/loyalty than those who did not use any, and secure communication use was significantly higher for those who rated the app highly compared to those who did not. These relationships will likely be further explicated with the use of satisfaction/loyalty questions that focus specifically on feature use. Conclusions: Noona is well liked by respondents, and exploratory multivariable analyses demonstrate the potential for using passively and minimally invasive data to demonstrate value. ", doi="10.2196/29292", url="https://cancer.jmir.org/2022/2/e29292", url="http://www.ncbi.nlm.nih.gov/pubmed/35175206" } @Article{info:doi/10.2196/32990, author="Teramoto, Kei and Kuwata, Shigeki", title="Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: Retrospective Observational Study", journal="JMIR Form Res", year="2022", month="Apr", day="21", volume="6", number="4", pages="e32990", keywords="mHealth", keywords="outpatient clinics", keywords="electronic medical records", keywords="COVID-19", keywords="EHR", abstract="Background: The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced. Objective: This study aimed to report the system design and postintroductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. Methods: The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following functions: (1) GPS-based examination check-in processing and (2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatients, implemented a user questionnaire, and polled the average time required for patients to respond to call notifications about their turn. Results: The 3-month average of TR2 users 9 months after the TR 2 system introduction was 17.9\% (14,536/81,066). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7\% (144/166) said that the system helped reduce the burden of waiting time. Conclusions: The app allowed 17.9\% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as that of coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times. ", doi="10.2196/32990", url="https://formative.jmir.org/2022/4/e32990", url="http://www.ncbi.nlm.nih.gov/pubmed/34818208" } @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/10.2196/33725, author="Yamamoto, Kazumichi and Ito, Masami and Sakata, Masatsugu and Koizumi, Shiho and Hashisako, Mizuho and Sato, Masaaki and Stoyanov, R. Stoyan and Furukawa, A. Toshi", title="Japanese Version of the Mobile App Rating Scale (MARS): Development and Validation", journal="JMIR Mhealth Uhealth", year="2022", month="Apr", day="14", volume="10", number="4", pages="e33725", keywords="mobile health apps", keywords="MHAs", keywords="mHealth", keywords="mobile application", keywords="mobile application rating scale", keywords="MARS", keywords="scale development", keywords="mental health", keywords="mobile health applications", abstract="Background: The number of mobile health (mHealth) apps continues to rise each year. Widespread use of the Mobile App Rating Scale (MARS) has allowed objective and multidimensional evaluation of the quality of these apps. However, no Japanese version of MARS has been made available to date. Objective: The purposes of this study were (1) to develop a Japanese version of MARS and (2) to assess the translated version's reliability and validity in evaluating mHealth apps. Methods: To develop the Japanese version of MARS, cross-cultural adaptation was used using a universalist approach. A total of 50 mental health apps were evaluated by 2 independent raters. Internal consistency and interrater reliability were then calculated. Convergent and divergent validity were assessed using multitrait scaling analysis and concurrent validity. Results: After cross-cultural adaptation, all 23 items from the original MARS were included in the Japanese version. Following translation, back-translation, and review by the author of the original MARS, a Japanese version of MARS was finalized. Internal consistency was acceptable by all subscales of objective and subjective quality (Cronbach $\alpha$=.78-.89). Interrater reliability was deemed acceptable, with the intraclass correlation coefficient (ICC) ranging from 0.61 to 0.79 for all subscales, except for ``functionality,'' which had an ICC of 0.40. Convergent/divergent validity and concurrent validity were also considered acceptable. The rate of missing responses was high in several items in the ``information'' subscale. Conclusions: A Japanese version of MARS was developed and shown to be reliable and valid to a degree that was comparable to the original MARS. This Japanese version of MARS can be used as a standard to evaluate the quality and credibility of mHealth apps. ", doi="10.2196/33725", url="https://mhealth.jmir.org/2022/4/e33725", url="http://www.ncbi.nlm.nih.gov/pubmed/35197241" } @Article{info:doi/10.2196/32628, author="Hendriks, Ylva and Peek, Sebastiaan and Kaptein, Maurits and Bongers, Inge", title="Process and Information Needs When Searching for and Selecting Apps for Smoking Cessation: Qualitative Study Using Contextual Inquiry", journal="JMIR Hum Factors", year="2022", month="Apr", day="14", volume="9", number="2", pages="e32628", keywords="mHealth and eHealth", keywords="contextual inquiry", keywords="decision-making", keywords="mobile app search and selection", keywords="apps for smoking cessation", keywords="mobile apps", keywords="mobile phone", abstract="Background: Hundreds of apps are available to support people in their quest to quit smoking. It has been hypothesized that selecting an app from a sizable volume without any aid can be overwhelming and difficult. However, little is known about how people choose apps for smoking cessation and what exactly people want to know about an app before choosing to install it. Understanding the decision-making process may ultimately be helpful in creating tools to help people meaningfully select apps. Objective: The aim of this study is to obtain insights into the process of searching and selecting mobile apps for smoking cessation and map the range of actions and the accompanying reasons during the search, focusing on the information needs and experiences of those who aim to find an app. Methods: Contextual inquiries were conducted with 10 Dutch adults wanting to quit smoking by using an app. During the inquiries, we observed people as they chose an app. In addition, 2 weeks later, there was a short semistructured follow-up interview over the phone. Through convenience and purposive sampling, we included participants differing in gender, age, and educational level. We used thematic analysis to analyze the transcribed interviews and leveraged a combination of video and audio recordings to understand what is involved in searching and selecting apps for smoking cessation. Results: The process of finding smoking cessation apps is comprehensive: participants explored, evaluated, and searched for information; imagined using functions; compared apps; assessed the trustworthiness of apps and information; and made several decisions while navigating the internet and app stores. During the search, the participants gained knowledge of apps and developed clearer ideas about their wishes and requirements. Confidence and trust in these apps to help quitting remained quite low or even decreased. Although the process was predominantly a positive experience, the whole process took time and energy and caused negative emotions such as frustration and disappointment for some participants. In addition, without the participants realizing it, errors in information processing occurred, which affected the choices they made. All participants chose an app with the explicit intention of using it. After 2 weeks, of the 10 participants, 6 had used the app, of whom only 1 extensively. Conclusions: Finding an app in the current app stores that contains functions and features expected to help in quitting smoking takes considerable time and energy, can be a negative experience, and is prone to errors in information processing that affect decision-making. Therefore, we advise the further development of decision aids, such as advanced filters, recommender systems and curated health app portals, and make a number of concrete recommendations for the design of such systems. ", doi="10.2196/32628", url="https://humanfactors.jmir.org/2022/2/e32628", url="http://www.ncbi.nlm.nih.gov/pubmed/35436217" } @Article{info:doi/10.2196/29846, author="Hill, Claire and Reardon, Tessa and Taylor, Lucy and Creswell, Cathy", title="Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing", journal="JMIR Form Res", year="2022", month="Apr", day="13", volume="6", number="4", pages="e29846", keywords="user-centered design", keywords="co-design", keywords="usability testing", keywords="internet-based treatment", keywords="app", keywords="CBT", keywords="anxiety", keywords="children", keywords="mobile phone", abstract="Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. Objective: The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Methods: Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. Results: In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Conclusions: Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use. ", doi="10.2196/29846", url="https://formative.jmir.org/2022/4/e29846", url="http://www.ncbi.nlm.nih.gov/pubmed/35416781" } @Article{info:doi/10.2196/29492, author="Aronoff-Spencer, Eliah and McComsey, Melanie and Chih, Ming-Yuan and Hubenko, Alexandra and Baker, Corey and Kim, John and Ahern, K. David and Gibbons, Christopher Michael and Cafazzo, A. Joseph and Nyakairu, Pia and Vanderpool, C. Robin and Mullett, W. Timothy and Hesse, W. Bradford", title="Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study", journal="J Med Internet Res", year="2022", month="Apr", day="12", volume="24", number="4", pages="e29492", keywords="cancer care", keywords="distress screening", keywords="human-centered design", keywords="participatory design", keywords="Appalachia", keywords="mobile phone", abstract="Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=--0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. ", doi="10.2196/29492", url="https://www.jmir.org/2022/4/e29492", url="http://www.ncbi.nlm.nih.gov/pubmed/35412457" } @Article{info:doi/10.2196/35069, author="Hendawi, Rasha and Alian, Shadi and Li, Juan", title="A Smart Mobile App to Simplify Medical Documents and Improve Health Literacy: System Design and Feasibility Validation", journal="JMIR Form Res", year="2022", month="Apr", day="1", volume="6", number="4", pages="e35069", keywords="health literacy", keywords="knowledge graph", keywords="natural language processing", keywords="machine learning", keywords="medical entity recognition", abstract="Background: People with low health literacy experience more challenges in understanding instructions given by their health providers, following prescriptions, and understanding their health care system sufficiently to obtain the maximum benefits. People with insufficient health literacy have high risk of making medical mistakes, more chances of experiencing adverse drug effects, and inferior control of chronic diseases. Objective: This study aims to design, develop, and evaluate a mobile health app, MediReader, to help individuals better understand complex medical materials and improve their health literacy. Methods: MediReader is designed and implemented through several steps, which are as follows: measure and understand an individual's health literacy level; identify medical terminologies that the individual may not understand based on their health literacy; annotate and interpret the identified medical terminologies tailored to the individual's reading skill levels, with meanings defined in the appropriate external knowledge sources; evaluate MediReader using task-based user study and satisfaction surveys. Results: On the basis of the comparison with a control group, user study results demonstrate that MediReader can improve users' understanding of medical documents. This improvement is particularly significant for users with low health literacy levels. The satisfaction survey showed that users are satisfied with the tool in general. Conclusions: MediReader provides an easy-to-use interface for users to read and understand medical documents. It can effectively identify medical terms that a user may not understand, and then, annotate and interpret them with appropriate meanings using languages that the user can understand. Experimental results demonstrate the feasibility of using this tool to improve an individual's understanding of medical materials. ", doi="10.2196/35069", url="https://formative.jmir.org/2022/4/e35069", url="http://www.ncbi.nlm.nih.gov/pubmed/35363142" } @Article{info:doi/10.2196/33581, author="Win, Hninyee and Russell, Samantha and Wertheim, C. Betsy and Maizes, Victoria and Crocker, Robert and Brooks, J. Audrey and Mesa, Ruben and Huberty, Jennifer and Geyer, Holly and Eckert, Ryan and Larsen, Ashley and Gowin, Krisstina", title="Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study", journal="JMIR Form Res", year="2022", month="Mar", day="31", volume="6", number="3", pages="e33581", keywords="myeloproliferative neoplasm", keywords="mobile application", keywords="symptom burden", keywords="wellness", keywords="self-management", keywords="mobile phone", abstract="Background: Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective: This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine's global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods: Of the 30 patients enrolled in a 12-week intervention, 16 (53\%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results: Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75\%), although similar to mobile device app use in other studies (53\%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions: Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted. ", doi="10.2196/33581", url="https://formative.jmir.org/2022/3/e33581", url="http://www.ncbi.nlm.nih.gov/pubmed/35357315" } @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/10.2196/32340, author="Cotte, Fabienne and Mueller, Tobias and Gilbert, Stephen and Bl{\"u}mke, Bibiana and Multmeier, Jan and Hirsch, Christian Martin and Wicks, Paul and Wolanski, Joseph and Tutschkow, Darja and Schade Brittinger, Carmen and Timmermann, Lars and Jerrentrup, Andreas", title="Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="28", volume="10", number="3", pages="e32340", keywords="symptom checker", keywords="emergency medicine", keywords="app", keywords="triage", keywords="safety", keywords="innovative", keywords="eHealth", keywords="artificial intelligence", abstract="Background: Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective: The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods: The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app's urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results: Of 378 participants, 344 (91\%) were triaged the same or more conservatively and 34 (8.9\%) were undertriaged by the app. Of the 378 patients, 14 (3.7\%) had received safe advice determined by the expert panel and 20 (5.3\%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7\% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4\% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions: The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration: German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks\_web/navigate.do? navigationId=trial.HTML\&TRIAL\_ID=DRKS00024909 ", doi="10.2196/32340", url="https://mhealth.jmir.org/2022/3/e32340", url="http://www.ncbi.nlm.nih.gov/pubmed/35343909" } @Article{info:doi/10.2196/28157, author="Resnick, Daniel and Kearney, D. Matthew and Smith, M. Jazmine and Bautista, Allison and Jones, Liz and Schapira, M. Marilyn and Aysola, Jaya", title="Designing a Cancer Prevention Collaborative Goal-Setting Mobile App for Non-Hispanic Black Primary Care Patients: An Iterative, Qualitative Patient-Led Process", journal="JMIR Form Res", year="2022", month="Mar", day="24", volume="6", number="3", pages="e28157", keywords="mHealth", keywords="cancer prevention", keywords="goal setting", keywords="social networks", keywords="health disparities", keywords="primary care", keywords="accessibility", keywords="development", keywords="feasibility", keywords="mobile phone", abstract="Background: There remains a need to engage at-risk primary care populations in cancer prevention behaviors, yet primary care physicians often lack the time or resources to discuss these behaviors with their patients. Objective: The objective of this study is to evaluate the content, usability, and acceptability of a mobile app that leverages insights from goal-setting and social network literature to facilitate cancer prevention goal setting, tracking, and sharing between non-Hispanic Black primary care patients and their social ties. Methods: We recruited eligible non-Hispanic Black primary care patients (aged ?18 years) from 2 practice sites in West Philadelphia, using nonprobabilistic purposive sampling. We conducted semistructured interviews with 5 to 7 participants over 3 weeks to solicit feedback on paper mock-ups of the app, iteratively adapting these mock-ups after each set of interviews. Thereafter, and informed by initial feedback, we created an electronic beta version of the app and sought acceptability and usability feedback from a different set of participants. Then, we conducted content analysis of all user responses to search for unifying themes on acceptability and usability of both the initial mock-ups and beta version of the app. We further assessed app usability using questions derived from the System Usability Scale. Results: A total of 33 non-Hispanic Black primary care patients participated in this study. The mean age was 49 (SD 13) years, and 26 (79\%) out of 33 participants identified as female. Semistructured interviews revealed three primary generalizable insights from our target population: the framing of each goal and its relevance to cancer impacted the likelihood that the goal would be chosen, participants thought that sharing health goals with others facilitates health behaviors, and most participants found it motivating to see other users' goal progress, while still collaborating with these users on their health goals. An overarching insight that permeated across each theme was the participants' desire to customize and personalize the app. Usability testing revealed that 100\% (33/33) of participants found the app easy to use, and 76\% (25/33) of participants reported that they would like to use this app frequently. Conclusions: Cancer prevention in the modern era must include options that are accessible to all, but this does not mean that all options must be universal. This study's iterative process led to the development of a cancer prevention mobile app that non-Hispanic Black primary care patients deemed usable and acceptable and yielded noteworthy insights about what intended end users value in setting and accomplishing health goals. ", doi="10.2196/28157", url="https://formative.jmir.org/2022/3/e28157", url="http://www.ncbi.nlm.nih.gov/pubmed/35323124" } @Article{info:doi/10.2196/32212, author="Pischke, R. Claudia and Voelcker-Rehage, Claudia and Ratz, Tiara and Peters, Manuela and Buck, Christoph and Meyer, Jochen and von Holdt, Kai and Lippke, Sonia", title="Web-Based Versus Print-Based Physical Activity Intervention for Community-Dwelling Older Adults: Crossover Randomized Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="23", volume="10", number="3", pages="e32212", keywords="physical activity", keywords="older adults", keywords="eHealth", keywords="print-based intervention", keywords="web-based intervention", keywords="physical activity promotion", keywords="healthy aging", keywords="preferences", keywords="randomized trial", keywords="mobile phone", abstract="Background: Fewer than half of older German adults engage in the recommended levels of endurance training. Objective: The study aim is to compare the acceptance and effectiveness of two interventions for physical activity (PA) promotion among initially inactive community-dwelling older adults ?60 years in a 9-month, crossover randomized trial. Methods: Participants were recruited in person and randomized to one of the following interventions for self-monitoring PA: a print-based intervention (PRINT: 113/242, 46.7\%) or a web-based intervention (WEB: 129/242, 53.3\%). Furthermore, 29.5\% (38/129) of those in the web-based intervention group received a PA tracker in addition to WEB (WEB+). After randomization, the participants and researchers were not blinded. The participants' baseline intervention preferences were retrospectively assessed. All the intervention groups were offered 10 weekly face-to-face group sessions. Afterward, participants could choose to stay in their group or cross over to one of the other groups, and group sessions were continued monthly for another 6 months. 3D accelerometers to assess PA and sedentary behavior (SB) at baseline (T0), 3-month follow-up (T1), and 9-month follow-up (T2) were used. Adherence to PA recommendations, attendance of group sessions, and intervention acceptance were assessed using self-administered paper-based questionnaires. Linear mixed models were used to calculate differences in moderate to vigorous PA (MVPA) and SB between time points and intervention groups. Results: Of the 242 initially recruited participants, 91 (37.6\%) were randomized to the WEB group; 38 (15.7\%) to the WEB+ group; and 113 (46.7\%) to the PRINT group. Overall, 80.6\% (195/242) of the participants completed T1. Only 0.4\% (1/242) of the participants changed from the WEB group to the PRINT group and 6.2\% (15/242) moved from the PRINT group to the WEB group (WEB-WEB: 103/249, (41.4\%); PRINT-PRINT: 76/249, 30.5\%) when offered to cross over at T1. Furthermore, 66.1\% (160/242) of participants completed T2. MVPA in minutes per day increased between baseline and T1, but these within-group changes disappeared after adjusting for covariates. MVPA decreased by 9 minutes per day between baseline and T2 ($\beta$time=?9.37, 95\% CI ?18.58 to ?0.16), regardless of the intervention group (WEB vs PRINT: $\beta$group*time=?3.76, 95\% CI ?13.33 to 5.82, WEB+ vs PRINT: $\beta$group*time=1.40, 95\% CI ?11.04 to 13.83). Of the participants, 18.6\% (38/204) met the PA recommendations at T0, 16.4\% (26/159) at T1, and 20.3\% (28/138) at T2. For SB, there were no significant group differences or group-by-time interactions at T1 or T2. Intervention acceptance was generally high. The use of intervention material was high to moderate at T1 and decreased by T2. Conclusions: There was little movement between intervention groups at T1 when given the choice, and participation was not associated with increases in PA or decreases in SB over time. Trial Registration: German Clinical Trials Register DRKS00016073; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00016073 ", doi="10.2196/32212", url="https://mhealth.jmir.org/2022/3/e32212", url="http://www.ncbi.nlm.nih.gov/pubmed/35319484" } @Article{info:doi/10.2196/30606, author="Militello, Lisa and Sobolev, Michael and Okeke, Fabian and Adler, A. Daniel and Nahum-Shani, Inbal", title="Digital Prompts to Increase Engagement With the Headspace App and for Stress Regulation Among Parents: Feasibility Study", journal="JMIR Form Res", year="2022", month="Mar", day="21", volume="6", number="3", pages="e30606", keywords="Headspace", keywords="engagement", keywords="mHealth", keywords="mindfulness", keywords="mental health", keywords="mobile phone", abstract="Background: Given the interrelated health of children and parents, strategies to promote stress regulation are critically important in the family context. However, the uptake of preventive mental health is limited among parents owing to competing family demands. Objective: In this study, we aim to determine whether it is feasible and acceptable to randomize digital prompts designed to engage parents in real-time brief mindfulness activities guided by a commercially available app. Methods: We conducted a 30-day pilot microrandomized trial among a sample of parents who used Android smartphones. Each day during a parent-specified time frame, participants had a 50\% probability of receiving a prompt with a message encouraging them to engage in a mindfulness activity using a commercial app, Headspace. In the 24 hours following randomization, ecological momentary assessments and passively collected smartphone data were used to assess proximal engagement (yes or no) with the app and any mindfulness activity (with or without the app). These data were combined with baseline and exit surveys to determine feasibility and acceptability. Results: Over 4 months, 83 interested parents were screened, 48 were eligible, 16 were enrolled, and 10 were successfully onboarded. Reasons for nonparticipation included technology barriers, privacy concerns, time constraints, or change of mind. In total, 80\% (8/10) of parents who onboarded successfully completed all aspects of the intervention. While it is feasible to randomize prompt delivery, only 60\% (6/10) of parents reported that the timing of prompts was helpful despite having control over the delivery window. Across the study period, we observed higher self-reported engagement with Headspace on days with prompts (31/62, 50\% of days), as opposed to days without prompts (33/103, 32\% of days). This pattern was consistent for most participants in this study (7/8, 87\%). The time spent using the app on days with prompts (mean 566, SD 378 seconds) was descriptively higher than on days without prompts (mean 225, SD 276 seconds). App usage was highest during the first week and declined over each of the remaining 3 weeks. However, self-reported engagement in mindfulness activities without the app increased over time. Self-reported engagement with any mindfulness activity was similar on days with (40/62, 65\% of days) and without (65/103, 63\% of days) prompts. Participants found the Headspace app helpful (10/10, 100\%) and would recommend the program to others (9/10, 90\%). Conclusions: Preliminary findings suggest that parents are receptive to using mindfulness apps to support stress management, and prompts are likely to increase engagement with the app. However, we identified several implementation challenges in the current trial, specifically a need to optimize prompt timing and frequency as a strategy to engage users in preventive digital mental health. ", doi="10.2196/30606", url="https://formative.jmir.org/2022/3/e30606", url="http://www.ncbi.nlm.nih.gov/pubmed/35311675" } @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/10.2196/35799, author="Voorheis, Paula and Zhao, Albert and Kuluski, Kerry and Pham, Quynh and Scott, Ted and Sztur, Peter and Khanna, Nityan and Ibrahim, Mohamed and Petch, Jeremy", title="Integrating Behavioral Science and Design Thinking to Develop Mobile Health Interventions: Systematic Scoping Review", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="16", volume="10", number="3", pages="e35799", keywords="behavior change", keywords="design thinking", keywords="digital health", keywords="health behavior", keywords="mobile application", keywords="mobile health", keywords="mobile phone", keywords="product design", keywords="scoping review", keywords="systems design", keywords="telemedicine", keywords="user-centered design", abstract="Background: Mobile health (mHealth) interventions are increasingly being designed to facilitate health-related behavior change. Integrating insights from behavioral science and design science can help support the development of more effective mHealth interventions. Behavioral Design (BD) and Design Thinking (DT) have emerged as best practice approaches in their respective fields. Until now, little work has been done to examine how BD and DT can be integrated throughout the mHealth design process. Objective: The aim of this scoping review was to map the evidence on how insights from BD and DT can be integrated to guide the design of mHealth interventions. The following questions were addressed: (1) what are the main characteristics of studies that integrate BD and DT during the mHealth design process? (2) what theories, models, and frameworks do design teams use during the mHealth design process? (3) what methods do design teams use to integrate BD and DT during the mHealth design process? and (4) what are key design challenges, implementation considerations, and future directions for integrating BD and DT during mHealth design? Methods: This review followed the Joanna Briggs Institute reviewer manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Studies were identified from MEDLINE, PsycINFO, Embase, CINAHL, and JMIR by using search terms related to mHealth, BD, and DT. Included studies had to clearly describe their mHealth design process and how behavior change theories, models, frameworks, or techniques were incorporated. Two independent reviewers screened the studies for inclusion and completed the data extraction. A descriptive analysis was conducted. Results: A total of 75 papers met the inclusion criteria. All studies were published between 2012 and 2021. Studies integrated BD and DT in notable ways, which can be referred to as ``Behavioral Design Thinking.'' Five steps were followed in Behavioral Design Thinking: (1) empathize with users and their behavior change needs, (2) define user and behavior change requirements, (3) ideate user-centered features and behavior change content, (4) prototype a user-centered solution that supports behavior change, and (5) test the solution against users' needs and for its behavior change potential. The key challenges experienced during mHealth design included meaningfully engaging patient and public partners in the design process, translating evidence-based behavior change techniques into actual mHealth features, and planning for how to integrate the mHealth intervention into existing clinical systems. Conclusions: Best practices from BD and DT can be integrated throughout the mHealth design process to ensure that mHealth interventions are purposefully developed to effectively engage users. Although this scoping review clarified how insights from BD and DT can be integrated during mHealth design, future research is needed to identify the most effective design approaches. ", doi="10.2196/35799", url="https://mhealth.jmir.org/2022/3/e35799", url="http://www.ncbi.nlm.nih.gov/pubmed/35293871" } @Article{info:doi/10.2196/33152, author="Mueller, L. Emily and Cochrane, R. Anneli and Campbell, E. Madison and Nikkhah, Sarah and Miller, D. Andrew", title="An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study", journal="JMIR Cancer", year="2022", month="Mar", day="16", volume="8", number="1", pages="e33152", keywords="child", keywords="adolescent", keywords="oncology", keywords="supportive care", keywords="mHealth", keywords="mobile health", keywords="cancer", keywords="pediatrics", keywords="children", keywords="digital health", keywords="health applications", keywords="parent", keywords="caregiver", abstract="Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50\%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95\% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. ", doi="10.2196/33152", url="https://cancer.jmir.org/2022/1/e33152", url="http://www.ncbi.nlm.nih.gov/pubmed/35293867" } @Article{info:doi/10.2196/32499, author="Fradkin, Nick and Zbikowski, M. Susan and Christensen, Trevor", title="Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study", journal="JMIR Public Health Surveill", year="2022", month="Mar", day="9", volume="8", number="3", pages="e32499", keywords="mobile applications", keywords="mHealth", keywords="eHealth", keywords="smartphone app", keywords="tobacco", keywords="smoking cessation", keywords="public health", keywords="smoking", keywords="application", abstract="Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco ``quitline'' services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3\%), identified as female (780/1236, 63.1\%), were between ages 25-54 years (903/1186, 76.1\%), had at least some college education (836/1222, 68.4\%), and reported a household income under US \$50,000 (742/1055, 70.3\%). Fewer respondents were from rural counties (359/1220, 29.4\%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5\%); were uninsured (147/1206, 12.2\%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7\%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. ", doi="10.2196/32499", url="https://publichealth.jmir.org/2022/3/e32499", url="http://www.ncbi.nlm.nih.gov/pubmed/35262491" } @Article{info:doi/10.2196/30872, author="Idris, Yassin Muhammed and Korin, Maya and Araya, Faven and Chowdhury, Sayeeda and Medina, Patty and Cruz, Larissa and Hawkins, Trey-Rashad and Brown, Humberto and Claudio, Luz", title="Including the Public in Public eHealth: The Need for Community Participation in the Development of State-Sponsored COVID-19--Related Mobile Apps", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="9", volume="10", number="3", pages="e30872", keywords="mobile apps", keywords="COVID-19", keywords="CBPR", keywords="digital health", keywords="eHealth", keywords="community health", keywords="health disparities", doi="10.2196/30872", url="https://mhealth.jmir.org/2022/3/e30872", url="http://www.ncbi.nlm.nih.gov/pubmed/35113793" } @Article{info:doi/10.2196/26764, author="Jackson, N. Devlon and Sehgal, Neil and Baur, Cynthia", title="Benefits of mHealth Co-design for African American and Hispanic Adults: Multi-Method Participatory Research for a Health Information App", journal="JMIR Form Res", year="2022", month="Mar", day="9", volume="6", number="3", pages="e26764", keywords="mHealth app design", keywords="health literacy", keywords="health disparities", keywords="health equity", keywords="African Americans", keywords="Hispanics", keywords="mobile phone", abstract="Background: Participatory research methodologies can provide insight into the use of mobile health (mHealth) apps, cultural preferences and needs, and health literacy issues for racial and ethnic groups, such as African Americans and Hispanics who experience health disparities. Objective: This methodological paper aims to describe a 1-year multi-method participatory research process that directly engaged English-speaking African American and bilingual or Spanish-speaking Hispanic adults in designing a prevention-focused, personalized mHealth, information-seeking smartphone app. We report design team participants' experiences with the methods to show why our approach is valuable in producing apps that are more aligned with their needs. Methods: Three design sessions were conducted to inform the iteration of a prevention-focused, personalized mHealth, information-seeking app. The research team led sessions with 2 community member design teams. Design team participants described their goals, motives, and interests regarding prevention information using different approaches, such as collage and card sorting (design session 1), interaction with the app prototype (design session 2), and rating of cultural appropriateness strategies (design session 3). Results: Each design team had 5 to 6 participants: 2 to 3 male participants and 3 female participants aged between 30 and 76 years. Design team participants shared their likes and dislikes about the sessions and the overall experience of the design sessions. Both African American and Hispanic teams reported positive participation experience. The primary reasons included the opportunity for their views to be heard, collectively working together in the design process, having their apprehension about mHealth reduced, and an opportunity to increase their knowledge of how they could manage their health through mHealth. The feedback from each session informed the following design sessions and a community-engaged process. In addition, the specific findings for each design session informed the design of the app for both communities. Conclusions: This multi-method participatory research process revealed 4 key lessons learned and recommendations for future research in mHealth app design for African Americans and Hispanics. Lesson 1---community partnerships are key because they provide the chain of trust that helps African American and Hispanic participants feel comfortable participating in app research. Lesson 2---community-based participatory research principles continue to yield promising results to engage these populations in mHealth research. Lesson 3---interactive design sessions uncover participants' needs and development opportunities for mHealth tools. Lesson 4---multiple design sessions with different methods provide an in-depth understanding of participants' mHealth preferences and needs. Future developers should consider these methods and lessons to ensure health apps in the marketplace contribute to eliminating health disparities and achieving health equity. ", doi="10.2196/26764", url="https://formative.jmir.org/2022/3/e26764", url="http://www.ncbi.nlm.nih.gov/pubmed/35262496" } @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/10.2196/32669, author="Berry, Alice and McClellan, Carey and Wanless, Ben and Walsh, Nicola", title="A Tailored App for the Self-management of Musculoskeletal Conditions: Evidencing a Logic Model of Behavior Change", journal="JMIR Form Res", year="2022", month="Mar", day="8", volume="6", number="3", pages="e32669", keywords="musculoskeletal", keywords="supported self-management", keywords="behavior change", keywords="digital health intervention", keywords="behavior change wheel", abstract="Background: Musculoskeletal conditions such as joint pain are a growing problem, affecting 18.8 million people in the United Kingdom. Digital health interventions (DHIs) are a potentially effective way of delivering information and supporting self-management. It is vital that the development of such interventions is transparent and can illustrate how individual components work, how they link back to the theoretical constructs they are attempting to change, and how this might influence outcomes. getUBetter is a DHI developed to address the lack of personalized, supported self-management tools available to patients with musculoskeletal conditions by providing knowledge, skills, and confidence to navigate through a self-management journey. Objective: The aim of this study was to map a logic model of behavior change for getUBetter to illustrate how the content and functionality of the DHI are aligned with recognized behavioral theory, effective behavior change techniques, and clinical guidelines. Methods: A range of behavior change models and frameworks were used, including the behavior change wheel and persuasive systems design framework, to map the logic model of behavior change underpinning getUBetter. The three main stages included understanding the behavior the intervention is attempting to change, identifying which elements of the intervention might bring about the desired change in behavior, and describing intervention content and how this can be optimally implemented. Results: The content was mapped to 25 behavior change techniques, including information about health consequences, instruction on how to perform a behavior, reducing negative emotions, and verbal persuasion about capability. Mapping to the persuasive system design framework illustrated the use of a number of persuasive design principles, including tailoring, personalization, simulation, and reminders. Conclusions: This process enabled the proposed mechanisms of action and theoretical foundations of getUBetter to be comprehensively described, highlighting the key techniques used to support patients to self-manage their condition. These findings provide guidance for the ongoing evaluation of the effectiveness (including quality of engagement) of the intervention and highlight areas that might be strengthened in future iterations. ", doi="10.2196/32669", url="https://formative.jmir.org/2022/3/e32669", url="http://www.ncbi.nlm.nih.gov/pubmed/35258462" } @Article{info:doi/10.2196/29832, author="Dietvorst, Evelien and Aukes, A. Michelle and Legerstee, S. Jeroen and Vreeker, Annabel and Hrehovcsik, M. Micah and Keijsers, Loes and Hillegers, J. Manon H.", title="A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study", journal="JMIR Form Res", year="2022", month="Mar", day="3", volume="6", number="3", pages="e29832", keywords="ecological momentary assessment", keywords="EMA", keywords="serious game", keywords="CBT", keywords="depression", keywords="internalizing problems", keywords="adolescents", keywords="high risk", keywords="digital health", keywords="mobile health", keywords="mHealth", keywords="game design", keywords="app development", keywords="mobile phone", abstract="Background: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. Objective: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy--based challenges to promote adaptive coping. Methods: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. Results: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2\% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64\% boys) completed 31.5\% (13.2/42) to 49.5\% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7\% to 32.5/105, 30.9\%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6\% (278/383) to 75.6\% (487/644) would recommend the app to friends. Conclusions: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy--based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles. ", doi="10.2196/29832", url="https://formative.jmir.org/2022/3/e29832", url="http://www.ncbi.nlm.nih.gov/pubmed/35238795" } @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/10.2196/34477, author="Ben-Yehuda, Ofri and Dreazen, Efrat and Koren, Danny and Peleg, Mor", title="Participatory Design of a Mobile App to Safeguard Mental Resilience in the Context of Drug Use in Young Adults: Multi-Method Study", journal="JMIR Form Res", year="2022", month="Feb", day="25", volume="6", number="2", pages="e34477", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="telehealth", keywords="mental health", keywords="mental resilience", keywords="participatory design", keywords="mobile phone", abstract="Background: Existing mental health apps are largely not aimed at generally healthy young people who may be experimenting with addictive substances and mind-altering experiences. Objective: The aim of this study is to examine the interest and expectations of young people regarding a proposed smartphone app designed to help protect and promote mental health and resilience in the face of risks associated with substance use. Methods: The study was based on agile system development and had 3 empirical substudies. Our feasibility study (study 1) included an anonymous questionnaire that examined the potential interest of young people in this type of app. It was answered by 339 Israelis aged 18-30 years. The second part of the feasibility study was a pilot study with 1.2\% (4/339) of the people who answered the questionnaire and expressed interest in participating in a focus group. They tested and refined the elements planned for the focus groups. Study 2 was a participatory design study involving 7 focus groups of 5 to 7 participants each (young people aged 18-35 years, n=38). Persona development, open discussion, and a Technology Acceptance Model questionnaire were used to elicit user expectations and requirements for the app and to understand the perceived usefulness and usability of the proposed features. Study 3 comprised in-depth interviews with experts in the field of youth mental health and drug use to enlist their professional opinion regarding the value of such an app and recommendations about the features it should include. Results: The mock-up for the proposed app had five key features: personalized assessment of risk for a drug-associated mental crisis, support for self-monitoring, useful information (eg, warning signs and first-aid guidelines), resilience-building exercises, and a support center. Participants rated highly the usefulness of all 5 main features and 96\% (24/25) of the specific features we proposed within those main categories. The participants also suggested additional features as well as a new user persona we had not considered: the parents or family members of the young person. The focus groups rated highly the perceived usability of the app. Most of the experts saw value in all the main features and suggested specific knowledge sources for the app's content. Finally, participants of both the feasibility study and the participatory design study expressed moderate to high interest in using the app for self-help and high interest in using the app to help friends. Conclusions: The findings provide preliminary encouraging support for the 5 main features suggested by the research team and reinforce recommendations for mobile health apps found in the literature. The findings emphasize the insight that this kind of app should be designed primarily for use by individuals seeking to help others. ", doi="10.2196/34477", url="https://formative.jmir.org/2022/2/e34477", url="http://www.ncbi.nlm.nih.gov/pubmed/35212631" } @Article{info:doi/10.2196/23794, author="Chowdhary, Kuntal and Yu, Xie Daihua and Pramana, Gede and Mesoros, Matthew and Fairman, Andrea and Dicianno, Edward Brad and Parmanto, Bambang", title="User-Centered Design to Enhance mHealth Systems for Individuals With Dexterity Impairments: Accessibility and Usability Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="24", volume="9", number="1", pages="e23794", keywords="cellular phone", keywords="mobile apps", keywords="telemedicine", keywords="adaptive mHealth", keywords="rehabilitation", keywords="self-care", keywords="spinal cord injury", keywords="spina bifida", keywords="chronic disease", keywords="persons with disability", keywords="accessibility", keywords="dexterity impairments", keywords="mobile phone", abstract="Background: Mobile health systems have been shown to be useful in supporting self-management by promoting adherence to schedules and longitudinal health interventions, especially in people with disabilities. The Interactive Mobile Health and Rehabilitation (iMHere) system was developed to empower people with disabilities and those with chronic conditions with supports needed for self-management and independent living. Since the first iteration of the iMHere 1.0 app, several studies have evaluated the accessibility and usability of the system. Potential opportunities to improve and simplify the user interface were identified, and the iMHere modules were redesigned accordingly. Objective: In this study, we aim to evaluate the usability of the redesigned modules within the iMHere 1.0 app. Methods: We evaluated the original and redesigned iMHere modules---MyMeds and SkinCare. The Purdue Pegboard Test was administered to assess the participants' dexterity levels. Participants were then asked to perform a set of tasks using both the original and redesigned MyMeds and SkinCare modules to assess their efficiency and effectiveness. Usability was measured using the Telehealth Usability Questionnaire to evaluate 10 new accessibility features that were added to the redesigned app. Participants were also asked which version they preferred. Results: In total, 24 participants with disabilities and varying degrees of dexterity impairments completed the entire study protocol. Participants displayed improved efficiency and effectiveness when using the redesigned modules compared with the original modules. The participants also reported improved usability and preferred the redesigned modules. Conclusions: This study demonstrated that the iMHere system became more efficient, effective, and usable for individuals with dexterity impairments after redesigning it according to user-centered principles. ", doi="10.2196/23794", url="https://humanfactors.jmir.org/2022/1/e23794", url="http://www.ncbi.nlm.nih.gov/pubmed/35200144" } @Article{info:doi/10.2196/27501, author="Stocks, Jacob and Choi, Yujung and Ibrahim, Saduma and Huchko, Megan", title="Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study", journal="JMIR Form Res", year="2022", month="Feb", day="24", volume="6", number="2", pages="e27501", keywords="mHealth", keywords="cervical cancer screening", keywords="Kenya", keywords="HPV testing", keywords="user-testing", keywords="community health volunteers", keywords="mobile phone", abstract="Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)--based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada's impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs. ", doi="10.2196/27501", url="https://formative.jmir.org/2022/2/e27501", url="http://www.ncbi.nlm.nih.gov/pubmed/35200151" } @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/10.2196/29922, author="Sharma, Shreya and Gergen Barnett, Katherine and Maypole, (Jack) John and Grochow Mishuris, Rebecca", title="Evaluation of mHealth Apps for Diverse, Low-Income Patient Populations: Framework Development and Application Study", journal="JMIR Form Res", year="2022", month="Feb", day="11", volume="6", number="2", pages="e29922", keywords="mobile health application", keywords="apps", keywords="mobile health", keywords="diverse", keywords="low-income", keywords="mHealth", keywords="framework", keywords="chronic disease", keywords="condition", keywords="smoking cessation", keywords="diabetes", keywords="medication adherence", keywords="safety net hospital", keywords="personal", keywords="self-management", keywords="usability test", abstract="Background: The use of mobile technology or smartphones has grown exponentially in the United States, allowing more individuals than ever internet access. This access has been especially critical to households earning less than US \$30,000, the majority of whom indicate that smartphones are their main source of internet access. The increasing ubiquity of smartphones and virtual care promises to offset some of the health disparities that cut through the United States. However, disparities cannot be addressed if the medical information offered though smartphones is not accessible or reliable. Objective: This study seeks to create a framework to review the strengths and weaknesses of mobile Health (mHealth) apps for diverse, low-income populations. Methods: Focusing on smoking cessation, diabetes management, and medication adherence as models of disease management, we describe the process for selecting, evaluating, and obtaining patient feedback on mHealth apps. Results: The top 2 scoring apps in each category were QuitNow! and Smoke Free-Quit Smoking Now for smoking cessation, Glucosio and MyNetDiary for diabetes management, and Medisafe and MyMeds for medication adherence. Conclusions: We believe that this framework will prove useful for future mHealth app development, and clinicians and patient advisory groups in connecting culturally, educationally, and socioeconomically appropriate mHealth apps with low-income, diverse communities and thus work to bridge health disparities. ", doi="10.2196/29922", url="https://formative.jmir.org/2022/2/e29922", url="http://www.ncbi.nlm.nih.gov/pubmed/35147502" } @Article{info:doi/10.2196/33413, author="Pit, Winona Sabrina and Tan, H. Aaron J. and Ramsden, Robyn and Payne, Kristy and Freihaut, Winona and Hayes, Oliver and Eames, Benjamin and Edwards, Mike and Colbran, Richard", title="Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="7", volume="10", number="2", pages="e33413", keywords="health", keywords="wellness", keywords="mobile apps", keywords="persuasive strategies", keywords="behavior change", keywords="review", keywords="health workforce", keywords="capability", keywords="career", keywords="employment", keywords="rural", keywords="workforce planning", abstract="Background: There is a need to further investigate how persuasive design principles can change rural health professionals' behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini's principles of persuasion. These have not been analyzed yet in the field of health workforce capability. Objective: This study aims to determine the persuasive design techniques used in capability building--related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. Methods: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. Results: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6\%) and liking (n=48), followed by trustworthiness (n=43, 81.1\%), reminders (n=38, 71.7\%), and suggestion (n=30, 56.6\%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. Conclusions: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce. ", doi="10.2196/33413", url="https://mhealth.jmir.org/2022/2/e33413", url="http://www.ncbi.nlm.nih.gov/pubmed/35129447" } @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/10.2196/30989, author="Jaffar, Aida and Mohd-Sidik, Sherina and Foo, Nien Chai and Admodisastro, Novia and Abdul Salam, Nur Sobihatun and Ismail, Diana Noor", title="Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="3", volume="9", number="1", pages="e30989", keywords="User-centered design", keywords="mHealth app", keywords="Digital intervention", keywords="mHealth Development and Evaluation Framework", keywords="Usability", keywords="Acceptability", keywords="Pelvic Floor Muscle Training", keywords="Urinary incontinence", keywords="Pregnancy", abstract="Background: Mobile health apps, for example, the T{\"a}t, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9\% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design--11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. ", doi="10.2196/30989", url="https://humanfactors.jmir.org/2022/1/e30989", url="http://www.ncbi.nlm.nih.gov/pubmed/35113025" } @Article{info:doi/10.2196/26891, author="Ongadi, Beatrice and Lihana, Raphael and Kiiru, John and Ngayo, Musa and Obiero, George", title="An Android-Based Mobile App (ARVPredictor) for the Detection of HIV Drug-Resistance Mutations and Treatment at the Point of Care: Development Study", journal="JMIR Form Res", year="2022", month="Feb", day="2", volume="6", number="2", pages="e26891", keywords="database", keywords="mobile Android app", keywords="HIV/AIDS", keywords="mutation", keywords="pol gene", keywords="protease", keywords="reverse transcriptase", keywords="integrase", keywords="ARVPredictor", keywords="mobile app", keywords="mHealth", keywords="HIV", keywords="Android", keywords="digital health", abstract="Background: HIV/AIDS remains one of the major global human health challenges, especially in resource-limited environments. By 2017, over 77.3 million people were infected with the disease, and approximately 35.4 million individuals had already died from AIDS-related illnesses. Approximately 21.7 million people were accessing ART with significant clinical outcomes. However, numerous challenges are experienced in the delivery and accurate interpretation of data on patients with HIV data by various health care providers at different care levels. Mobile health (mHealth) technology is progressively making inroads into the health sector as well as medical research. Different mobile devices have become common in health care settings, leading to rapid growth in the development of downloadable software specifically designed to fulfill particular health-related purposes. Objective: We developed a mobile-based app called ARVPredictor and demonstrated that it can accurately define HIV-1 drug-resistance mutations in the HIV pol gene for use at the point of care. Methods: ARVPredictor was designed using Android Studio with Java as the programming language and is compatible with both Android and iOS. The app system is hosted on Nginx Server, and network calls are built on PHP's Laravel framework handled by the Retrofit Library. The DigitalOcean offers a high-performance and stable cloud computing platform for ARVPredictor. This mobile app is enlisted in the Google Play Store as an ``ARVPredictor'' and the source code is available under MIT permissive license at a GitHub repository. To test for agreement between the ARVPredictor and Stanford HIV Database in detecting HIV subtype and NNRT and NRTI mutations, a total of 100 known HIV sequences were evaluated. Results: The mobile-based app (ARVPredictor) takes in a set of sequences or known mutations (protease, reverse transcriptase and integrase). It then returns inferred levels of resistance to selected nucleoside, nonnucleoside protease, and integrase inhibitors for accurate HIV/AIDS management at the point of care. The ARVPredictor identified similar HIV subtypes in 98/100 sequences compared with the Stanford HIV Database ($\kappa$=0.98, indicating near perfect agreement). There were 89/100 major NNRTI and NRTI mutations identified by ARVPredictor, similar to the Stanford HIV Database ($\kappa$=0.89, indicating near perfect agreement). Eight mutations classified as major by the Stanford HIV Database were classified as others by ARVPredictor. Conclusions: The ARVPredictor largely agrees with the Stanford HIV Database in identifying both major and minor proteases, reverse transcriptase, and integrase mutations. The app can be conveniently used robustly at the point of care by HIV/AIDS care providers to improve the management of HIV infection. ", doi="10.2196/26891", url="https://formative.jmir.org/2022/2/e26891", url="http://www.ncbi.nlm.nih.gov/pubmed/35107425" } @Article{info:doi/10.2196/26033, author="Lalla-Edward, Tresha Samanta and Mashabane, Nonkululeko and Stewart-Isherwood, Lynsey and Scott, Lesley and Fyvie, Kyle and Duncan, Dana and Haile, Betiel and Chugh, Kamal and Zhou, Yiyong and Reimers, Jacob and Pan, Matteus and Venkatraman, Maya and Stevens, Wendy", title="Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study", journal="JMIR Form Res", year="2022", month="Feb", day="2", volume="6", number="2", pages="e26033", keywords="HIV", keywords="virological suppression", keywords="mHealth", keywords="digital health", keywords="South Africa", keywords="patient-centric", keywords="disease management", keywords="mobile phone", abstract="Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1\%) failed eligibility screening. 21.5\% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2\% (461/500) of participants' phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1\% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4\% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60\%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4\% (262/500) of participants completed an exit survey; 23.2\% (58/250) reported challenges in viewing their VL results. Moreover, 58\% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3\% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. ", doi="10.2196/26033", url="https://formative.jmir.org/2022/2/e26033", url="http://www.ncbi.nlm.nih.gov/pubmed/35107427" } @Article{info:doi/10.2196/30360, author="Trang, Kathy and Le, X. Lam and Brown, A. Carolyn and To, Q. Margaret and Sullivan, S. Patrick and Jovanovic, Tanja and Worthman, M. Carol and Giang, Minh Le", title="Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study", journal="JMIR Form Res", year="2022", month="Jan", day="27", volume="6", number="1", pages="e30360", keywords="men who have sex with men", keywords="HIV", keywords="mental disorder", keywords="ecological momentary assessment", keywords="mobile phone", keywords="mHealth", keywords="sexual minorities", keywords="pilot projects", abstract="Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people's behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants' perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8\% (SD 26.6\%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. ", doi="10.2196/30360", url="https://formative.jmir.org/2022/1/e30360", url="http://www.ncbi.nlm.nih.gov/pubmed/35084340" } @Article{info:doi/10.2196/34309, author="Ismail, Tasnim and Al Thani, Dena", title="Design and Evaluation of a Just-in-Time Adaptive Intervention (JITAI) to Reduce Sedentary Behavior at Work: Experimental Study", journal="JMIR Form Res", year="2022", month="Jan", day="26", volume="6", number="1", pages="e34309", keywords="sedentary behavior", keywords="persuasive technology", keywords="behavior change", keywords="physical activity", keywords="adaptive intervention", abstract="Background: Employees in sedentary occupations tend to spend prolonged hours physically inactive. Physical inactivity is a main factor in the increase in the risks of a wide range of chronic diseases, including obesity, diabetes, hypertension, and heart disease. This has drawn researchers' attention to investigate methods of increasing the level of activity of employees during working hours and in their daily lifestyle. Objective: The objective of this paper is to investigate the effectiveness of using personalized messages that include user information, user goals, daily routine, and the surrounding environment to increase the level of activity among employees. In this study, we hypothesize that sending context-aware motivational messages to workers in sedentary occupations after sitting for 40 minutes can break sedentary behavior and increase daily active time compared to static reminder messages. Methods: A 66-day between-group study using a mixed methods design approach was conducted with employees who are located in Qatar and spend most of their working day sedentary. The 58 participants used 2 different interventions: The control group (n=29, 50\%) used a mobile app that only sends a static message after prolonged sitting (MotiFit Lite), and the intervention group (n=29, 50\%) used a mobile app that sends context-aware personalized messages to promote physical activity (PA; MotiFit). Both apps log the received messages, the step count before and after the messages are sent, and the user response to the messages to obtain an idea of the impact of the messages. The study received approval from the Qatar Biomedical Research Institute's institutional review board (IRB application \#2019-10-037). Results: The questionnaires showed satisfaction of the designed apps' subjective quality and perceived impact. The quantitative analysis showed a high level of engagement in the intervention group compared to the control group (P<.001). The results support the original hypothesis that using context-aware motivational messages can increase PA at work compared to static messages (P<.001). However, the analysis showed no significant impact of the message type on the overall activity level during the day (P=.06). Conclusions: Context-aware motivational messages motivate employees to increase their PA in the workplace. However, future research will further develop the analysis to investigate the impact on increasing the overall activity level during the day. ", doi="10.2196/34309", url="https://formative.jmir.org/2022/1/e34309", url="http://www.ncbi.nlm.nih.gov/pubmed/35080498" } @Article{info:doi/10.2196/33449, author="Zucchelli, Fabio and Donnelly, Olivia and Rush, Emma and White, Paul and Gwyther, Holly and Williamson, Heidi and ", title="An Acceptance and Commitment Therapy Prototype Mobile Program for Individuals With a Visible Difference: Mixed Methods Feasibility Study", journal="JMIR Form Res", year="2022", month="Jan", day="21", volume="6", number="1", pages="e33449", keywords="mobile health", keywords="acceptance and commitment therapy", keywords="appearance", keywords="mixed methods", keywords="mobile phone", abstract="Background: Mobile apps may offer a valuable platform for delivering evidence-based psychological interventions for individuals with atypical appearances, or visible differences, who experience psychosocial appearance concerns such as appearance-based social anxiety and body dissatisfaction. Before this study, researchers and stakeholders collaboratively designed an app prototype based on acceptance and commitment therapy (ACT), an evidence-based form of cognitive behavioral therapy that uses strategies such as mindfulness, clarification of personal values, and value-based goal setting. The intervention also included social skills training, an established approach for increasing individuals' confidence in managing social interactions, which evoke appearance-based anxiety for many. Objective: In this study, the authors aim to evaluate the feasibility of an ACT-based app prototype via the primary objectives of user engagement and acceptability and the secondary feasibility objective of clinical safety and preliminary effectiveness. Methods: To address the feasibility objectives, the authors used a single-group intervention design with mixed methods in a group of 36 participants who have a range of visible differences. The authors collected quantitative data via measures of program use, satisfaction ratings, and changes over 3 time points spanning 12 weeks in outcomes, including selected ACT process measures (experiential avoidance, cognitive defusion, and valued action), scales of appearance concerns (appearance-based life disengagement, appearance-fixing behaviors, appearance self-evaluation, and fear of negative appearance evaluation), and clinical well-being (depression and anxiety). Semistructured exit interviews with a subsample of 12 participants provided qualitative data to give a more in-depth understanding of participants' views and experiences of the program. Results: In terms of user engagement, adherence rates over 6 sessions aligned with the upper boundary of those reported across mobile mental health apps, with over one-third of participants completing all sessions over 12 weeks, during which a steady decline in adherence was observed. Time spent on sessions matched design intentions, and engagement frequencies highlighted semiregular mindfulness practice, mixed use of value-based goal setting, and high engagement with social skills training. The findings indicate a good overall level of program acceptability via satisfaction ratings, and qualitative interview findings offer positive feedback as well as valuable directions for revisions. Overall, testing for clinical safety and potential effectiveness showed encouraging changes over time, including favorable changes in appearance-related life disengagement, appearance-fixing behaviors, and selected ACT measures. No iatrogenic effects were indicated for depression or anxiety. Conclusions: An ACT-based mobile program for individuals struggling with visible differences shows promising proof of concept in addressing appearance concerns, although further revisions and development are required before further development and more rigorous evaluation. ", doi="10.2196/33449", url="https://formative.jmir.org/2022/1/e33449", url="http://www.ncbi.nlm.nih.gov/pubmed/35060908" } @Article{info:doi/10.2196/32104, author="Sengupta, Arijit and Subramanian, Hemang", title="User Control of Personal mHealth Data Using a Mobile Blockchain App: Design Science Perspective", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="20", volume="10", number="1", pages="e32104", keywords="blockchain", keywords="mobile apps", keywords="mining", keywords="HIPAA", keywords="personal health data", keywords="data privacy preservation", keywords="security", keywords="accuracy", keywords="transaction safety", abstract="Background: Integrating pervasive computing with blockchain's ability to store privacy-protected mobile health (mHealth) data while providing Health Insurance Portability and Accountability Act (HIPAA) compliance is a challenge. Patients use a multitude of devices, apps, and services to collect and store mHealth data. We present the design of an internet of things (IoT)--based configurable blockchain with different mHealth apps on iOS and Android, which collect the same user's data. We discuss the advantages of using such a blockchain architecture and demonstrate 2 things: the ease with which users can retain full control of their pervasive mHealth data and the ease with which HIPAA compliance can be accomplished by providers who choose to access user data. Objective: The purpose of this paper is to design, evaluate, and test IoT-based mHealth data using wearable devices and an efficient, configurable blockchain, which has been designed and implemented from the first principles to store such data. The purpose of this paper is also to demonstrate the privacy-preserving and HIPAA-compliant nature of pervasive computing-based personalized health care systems that provide users with total control of their own data. Methods: This paper followed the methodical design science approach adapted in information systems, wherein we evaluated prior designs, proposed enhancements with a blockchain design pattern published by the same authors, and used the design to support IoT transactions. We prototyped both the blockchain and IoT-based mHealth apps in different devices and tested all use cases that formed the design goals for such a system. Specifically, we validated the design goals for our system using the HIPAA checklist for businesses and proved the compliance of our architecture for mHealth data on pervasive computing devices. Results: Blockchain-based personalized health care systems provide several advantages over traditional systems. They provide and support extreme privacy protection, provide the ability to share personalized data and delete data upon request, and support the ability to analyze such data. Conclusions: We conclude that blockchains, specifically the consensus, hasher, storer, miner architecture presented in this paper, with configurable modules and software as a service model, provide many advantages for patients using pervasive devices that store mHealth data on the blockchain. Among them is the ability to store, retrieve, and modify ones generated health care data with a single private key across devices. These data are transparent, stored perennially, and provide patients with privacy and pseudoanonymity, in addition to very strong encryption for data access. Firms and device manufacturers would benefit from such an approach wherein they relinquish user data control while giving users the ability to select and offer their own mHealth data on data marketplaces. We show that such an architecture complies with the stringent requirements of HIPAA for patient data access. ", doi="10.2196/32104", url="https://mhealth.jmir.org/2022/1/e32104", url="http://www.ncbi.nlm.nih.gov/pubmed/35049504" } @Article{info:doi/10.2196/33716, author="Hogan, P. Timothy and Etingen, Bella and McMahon, Nicholas and Bixler, R. Felicia and Am, Linda and Wacks, E. Rachel and Shimada, L. Stephanie and Reilly, D. Erin and Frisbee, L. Kathleen and Smith, M. Bridget", title="Understanding Adoption and Preliminary Effectiveness of a Mobile App for Chronic Pain Management Among US Military Veterans: Pre-Post Mixed Methods Evaluation", journal="JMIR Form Res", year="2022", month="Jan", day="20", volume="6", number="1", pages="e33716", keywords="mobile health applications", keywords="pain", keywords="veterans", keywords="usability", abstract="Background: The Veterans Health Administration Pain Coach mobile health app was developed to support veterans with chronic pain. Objective: Our objective was to evaluate early user experiences with the Pain Coach app and preliminary impacts of app use on pain-related outcomes. Methods: Following a sequential, explanatory, mixed methods design, we mailed surveys to veterans at 2 time points with an outreach program in between and conducted semistructured interviews with a subsample of survey respondents. We analyzed survey data using descriptive statistics among veterans who completed both surveys and examined differences in key outcomes using paired samples t tests. We analyzed semistructured interview data using thematic analysis. Results: Of 1507 veterans invited and eligible to complete the baseline survey, we received responses from 393 (26.1\%). These veterans received our outreach program; 236 (236/393, 60.1\%) completed follow-up surveys. We conducted interviews with 10 app users and 10 nonusers. Among survey respondents, 10.2\% (24/236) used Pain Coach, and 58\% (14/24) reported it was easy to use, though interviews identified various app usability issues. Veterans who used Pain Coach reported greater pain self-efficacy (mean 23.1 vs mean 16.6; P=.01) and lower pain interference (mean 34.6 vs mean 31.8; P=.03) after (vs before) use. The most frequent reason veterans reported for not using the app was that their health care team had not discussed it with them (96/212, 45.3\%). Conclusions: Our findings suggest that future efforts to increase adoption of Pain Coach and other mobile apps among veterans should include health care team endorsement. Our findings regarding the impact of Pain Coach use on outcomes warrant further study. ", doi="10.2196/33716", url="https://formative.jmir.org/2022/1/e33716", url="http://www.ncbi.nlm.nih.gov/pubmed/35049515" } @Article{info:doi/10.2196/28300, author="Moltrecht, Bettina and Patalay, Praveetha and Bear, Alice Holly and Deighton, Jessica and Edbrooke-Childs, Julian", title="A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned", journal="JMIR Form Res", year="2022", month="Jan", day="19", volume="6", number="1", pages="e28300", keywords="mHealth", keywords="participatory design", keywords="emotion regulation", keywords="interdisciplinary development", keywords="child mental health", abstract="Background: Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. Objective: This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. Methods: The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). Results: For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient--clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. Conclusions: Although mobile apps could be highly suitable to support children's mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people. ", doi="10.2196/28300", url="https://formative.jmir.org/2022/1/e28300", url="http://www.ncbi.nlm.nih.gov/pubmed/35044312" } @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/10.2196/24483, 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/10.2196/32458, 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/10.2196/32610, author="Sanchez Antelo, Victoria and Szwarc, Lucila and Paolino, Melisa and Saimovici, Diana and Massaccesi, Silvia and Viswanath, Kasisomayajula and Arrossi, Silvina", title="A Counseling Mobile App to Reduce the Psychosocial Impact of Human Papillomavirus Testing: Formative Research Using a User-Centered Design Approach in a Low-Middle-Income Setting in Argentina", journal="JMIR Form Res", year="2022", month="Jan", day="13", volume="6", number="1", pages="e32610", keywords="mHealth", keywords="mobile application", keywords="counseling", keywords="HPV test", keywords="cervical cancer", keywords="health belief model", keywords="integrated behavioral model", keywords="patient education", keywords="Argentina", abstract="Background: Human papillomavirus (HPV) testing detects sexually transmitted infections with oncogenic types of HPV. For many HPV-positive women, this result has negative connotations. It produces anxiety, fear of cancer or death, and disease denial. Face-to-face counseling could present many difficulties in its implementation, but a counseling mobile app could be practical and may help HPV-positive women reduce the psychosocial impact of the result, improve their knowledge of HPV and cervical cancer, and increase adherence to follow-up. Objective: This study aims to understand HPV-tested women's perceptions about an app as a tool to receive information and support to reduce the emotional impact of HPV-positive results. We investigated their preferences regarding app design, content, and framing. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV-positive women aged 30 years and over and 4 focus groups (FGs) with women through a virtual platform (n=19). We shared a draft of the app's potential screens with a provisional label of the possible content, options menus, draft illustrations, and wording. This allowed us to give women understandable triggers to debate the concepts involved on each screen. The draft content and labels were developed drawing from the health belief model (HBM) and integrative behavioral model (IBM) variables and findings of mobile health literature. We used an FG guide to generate data for the information architecture (ie, how to organize contents into features). We carried out thematic analysis using constructs from the HBM and IBM to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: We found that participants required more information regarding the procedures they had received, what HPV-positive means, what the causes of HPV are, and its consequences on their sexuality. The women mentioned fear of the disease and stated they had concerns and misconceptions, such as believing that an HPV-positive result is a synonym for cancer. They accepted the app as a tool to obtain information and to reduce fears related to HPV-positive results. They would use a mobile app under doctor or health authority recommendation. The women did not agree with the draft organization of screens and contents. They believed the app should first offer information about HPV and then provide customized content according to the users' needs. The app should provide information via videos with experts and testimonies of other HPV-positive women, and they suggested a medical appointment reminder feature. The app should also offer information through illustrations, or infographics, but not pictures or solely text. Conclusions: Providing information that meets women's needs and counseling could be a method to reduce fears. A mobile app seems to be an acceptable and suitable tool to help HPV-positive women. ", doi="10.2196/32610", url="https://formative.jmir.org/2022/1/e32610", url="http://www.ncbi.nlm.nih.gov/pubmed/35023843" } @Article{info:doi/10.2196/32273, author="Feldman, G. Amy and Moore, Susan and Bull, Sheana and Morris, A. Megan and Wilson, Kumanan and Bell, Cameron and Collins, M. Margaret and Denize, M. Kathryn and Kempe, Allison", title="A Smartphone App to Increase Immunizations in the Pediatric Solid Organ Transplant Population: Development and Initial Usability Study", journal="JMIR Form Res", year="2022", month="Jan", day="13", volume="6", number="1", pages="e32273", keywords="vaccinations", keywords="transplantation", keywords="mobile app", keywords="agile development", keywords="immunization", keywords="mHealth", keywords="mobile health", keywords="children", keywords="transplant recipients", keywords="pediatric transplant recipients", keywords="pediatrics", abstract="Background: Vaccine-preventable infections result in significant morbidity, mortality, and costs in pediatric transplant recipients. However, at the time of transplant, less than 20\% of children are up-to-date for age-appropriate immunizations that could prevent these diseases. Smartphone apps have the potential to increase immunization rates through their ability to provide vaccine education, send vaccine reminders, and facilitate communication between parents and a multidisciplinary medical group. Objective: The aim of this study was to describe the development of a smartphone app, Immunize PediatricTransplant, to promote pretransplant immunization and to report on app functionality and usability when applied to the target population. Methods: We used a mixed methods study design guided by the Mobile Health Agile Development and Evaluation Lifecycle. We first completed a formative research including semistructured interviews with transplant stakeholders (12 primary care physicians, 40 parents or guardians of transplant recipients, 11 transplant nurse coordinators, and 19 transplant subspecialists) to explore the acceptability of an immunization app to be used in the pretransplant period. Based on these findings, CANImmunize Inc developed the Immunize PediatricTransplant app. We next held 2 focus group discussions with 5-6 transplant stakeholders/group (n=11; 5 parents of transplant recipients, 2 primary care physicians, 2 transplant nurse coordinators, and 2 transplant subspecialists) to receive feedback on the app. After the app modifications were made, alpha testing was conducted on the functional prototype. We then implemented beta testing with 12 stakeholders (6 parents of transplant recipients, 2 primary care doctors, 2 transplant nurse coordinators, and 2 transplant subspecialists) to refine the app through an iterative process. Finally, the stakeholders completed the user version of the Mobile Application Rating Scale (uMARS) to assess the functionality and quality of the app. Results: A new Android- and Apple-compatible app, Immunize PediatricTransplant, was developed to improve immunization delivery in the pretransplant period. The app contains information about vaccine use in the pretransplant period, houses a complete immunization record for each child, includes a communication tool for parents and care providers, and sends automated reminders to parents and care providers when immunizations are due. During usability testing, the stakeholders were able to enter a mock vaccine record containing 16 vaccines in an average of 8.1 minutes (SD 1.8) with 87\% accuracy. The stakeholders rated engagement, functionality, aesthetics, and information quality of the app as 4.2/5, 4.5/5, 4.6/5, and 4.8/5, respectively. All participants reported that they would recommend this app to families and care teams with a child awaiting solid organ transplant. Conclusions: Through a systematic, user-centered, agile, iterative approach, the Immunize PediatricTransplant app was developed to improve immunization delivery in the pretransplant period. The app tested well with end users. Further testing and agile development among patients awaiting transplant are needed to understand real-world acceptability and effectiveness in improving immunization rates in children awaiting transplant. ", doi="10.2196/32273", url="https://formative.jmir.org/2022/1/e32273", url="http://www.ncbi.nlm.nih.gov/pubmed/35023840" } @Article{info:doi/10.2196/30640, author="Chaudhry, Moalla Beenish and Islam, Ashraful and Matthieu, Monica", title="Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study", journal="JMIR Form Res", year="2022", month="Jan", day="13", volume="6", number="1", pages="e30640", keywords="mental health", keywords="stress", keywords="mHealth", keywords="frontline health worker", keywords="design requirements", keywords="pandemic", keywords="COVID-19", keywords="design", keywords="intervention", keywords="burnout", keywords="perspective", keywords="need", keywords="user design", abstract="Background: In recent years, mobile apps have been developed to prevent burnout, promote anxiety management, and provide health education to workers in various workplace settings. However, there remains a paucity of such apps for frontline health workers (FHWs), even though FHWs are the most susceptible to stress due to the nature of their jobs. Objective: The goal of this study was to provide suggestions for designing stress management apps to address workplace stressors of FHWs based on the understanding of their needs from FHWs' own perspectives and theories of stress. Methods: A mixed methods qualitative study was conducted. Using a variety of search strings, we first collected 41 relevant web-based news articles published between December 2019 and May 2020 through the Google search engine. We then conducted a cross-sectional survey with 20 FHWs. Two researchers independently conducted qualitative analysis of all the collected data using a deductive followed by an inductive approach. Results: Prevailing uncertainty and fear of contracting the infection was causing stress among FHWs. Moral injury associated with seeing patients die from lack of care and lack of experience in handling various circumstances were other sources of stress. FHWs mentioned 4 coping strategies. Quick coping strategies such as walking away from stressful situations, entertainment, and exercise were the most common ways to mitigate the impact of stress at work. Peer support and counseling services were other popular methods. Building resilience and driving oneself forward using internal motivation were also meaningful ways of overcoming stressful situations. Time constraints and limited management support prevented FHWs from engaging in stress management activities. Conclusions: Our study identified stressors, coping strategies, and challenges with applying coping strategies that can guide the design of stress management apps for FHWs. Given that the pandemic is ongoing and health care crises continue, FHWs remain a vulnerable population in need of attention. ", doi="10.2196/30640", url="https://formative.jmir.org/2022/1/e30640", url="http://www.ncbi.nlm.nih.gov/pubmed/34806985" } @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/10.2196/32785, 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/10.2196/22582, author="Choo, C. Carol and Tan, Zhuang Yi and Zhang, B. Melvyn W.", title="A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study", journal="JMIR Form Res", year="2022", month="Jan", day="3", volume="6", number="1", pages="e22582", keywords="attentional bias retraining", keywords="smartphone app", keywords="mixed methods", keywords="smoking", keywords="mobile phone", abstract="Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study's hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. ", doi="10.2196/22582", url="https://formative.jmir.org/2022/1/e22582", url="http://www.ncbi.nlm.nih.gov/pubmed/34982037" } @Article{info:doi/10.2196/31852, author="Krishna, Meenakshi and Sybil, Deborah and Shrivastava, Kumar Priyanshu and Premchandani, Shubhangi and Kumar, Himanshu and Kumar, Pintu", title="An Innovative App (ExoDont) for Postoperative Care of Patients After Tooth Extraction: Prototype Development and Testing Study", journal="JMIR Perioper Med", year="2021", month="Dec", day="31", volume="4", number="2", pages="e31852", keywords="ExoDont", keywords="Android app", keywords="teledentistry", keywords="mHealth", keywords="tooth extraction", keywords="postoperative", keywords="dentistry", keywords="dentist", keywords="teeth", keywords="dental surgery", keywords="oral surgery", abstract="Background: The postoperative period is crucial for the initiation of healing and prevention of complications after any surgical procedure. Due to factors such as poor compliance, comprehension, and retention of instructions, and other unaccounted factors, the objectives of postoperative care are not always achieved. Therefore, an Android-based mobile health app (ExoDont) was developed to ensure a smooth postoperative period for patients after a dental extraction. The ExoDont app delivers reminders for postoperative instructions and drug intake at defined intervals, thus fostering self-reliance among patients in taking their prescribed dose of medication. Objective: The aim of this study is to design, develop, and validate ExoDont, an innovative app for improved adherence to postoperative instructions after tooth extraction. Methods: A postoperative treatment protocol was developed by a team of oral and maxillofacial surgeons and general dentists, following which the clinical and technological requirements of the app were determined along with the software engineers, graphic designers, and applications architect in the team. ExoDont was developed to provide timely reminders for medication and postoperative care. The app was field tested and validated using the User Version of the Mobile Application Rating Scale. Results: The ExoDont software design was divided into a 3-level architecture comprising a user interface application, logical layer, and database layer. The software architecture consists of an Android-based ExoDont app for patients and a web version of the admin panel. The testing and validation of the ExoDont app revealed that Perceived Impact received the highest mean score of all rated components (mean 4.6, SD 0.5), while Engagement received the lowest mean score (mean 3.5, SD 0.8). Conclusions: The testing and validation of the app support its usability and functionality, as well as its impact on users. The ExoDont app has been designed, keeping the welfare of patients in view, in a user-friendly manner that will help patients adhere to the prescribed drug regimen and ensure easy and efficient dissemination of postoperative instructions. It could play an instrumental role in fostering compliance among patients and significantly decrease the complication rate following dental extractions. ", doi="10.2196/31852", url="https://periop.jmir.org/2021/2/e31852", url="http://www.ncbi.nlm.nih.gov/pubmed/34982720" } @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/10.2196/24792, author="Koziol-McLain, Jane and Wilson, Denise and Vandal, C. Alain and Eruera, Moana and Nada-Raja, Shyamala and Dobbs, Terry and Roguski, Michael and Barbarich-Unasa, Wai Te", title="Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="30", volume="10", number="12", pages="e24792", keywords="indigenous", keywords="M?ori", keywords="young people", keywords="relationships", keywords="school", keywords="mHealth", keywords="smartphone app", keywords="mobile phone", abstract="Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or wh?nau (indigenous M?ori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and M?ori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the M?ori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous M?ori--centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 ", doi="10.2196/24792", url="https://www.researchprotocols.org/2021/12/e24792", url="http://www.ncbi.nlm.nih.gov/pubmed/34967750" } @Article{info:doi/10.2196/27033, author="Shorey, Shefaly and Tan, Chye Thiam and and Mathews, Jancy and Yu, Yan Chun and Lim, Hoon Siew and Shi, Luming and Ng, Debby Esperanza and Chan, Huak Yiong and Law, Evelyn and Chee, Cornelia and Chong, Seng Yap", title="Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study", journal="J Med Internet Res", year="2021", month="Dec", day="24", volume="23", number="12", pages="e27033", keywords="depression", keywords="development", keywords="education", keywords="parent", keywords="perinatal", keywords="support", keywords="telehealth", keywords="mobile phone", abstract="Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child's development. Given the rise in technology and parents' preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles---the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. ", doi="10.2196/27033", url="https://www.jmir.org/2021/12/e27033", url="http://www.ncbi.nlm.nih.gov/pubmed/36260376" } @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/10.2196/30268, author="Adams, Zachary and Grant, Miyah and Hupp, Samantha and Scott, Taylor and Feagans, Amanda and Phillips, Lois Meredith and Bixler, Kristina and Nallam, Teja Phani and La Putt, Dorothy", title="Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design", journal="JMIR Form Res", year="2021", month="Dec", day="24", volume="5", number="12", pages="e30268", keywords="mobile health", keywords="user-centered design", keywords="adolescents", keywords="substance use disorders", keywords="mental health", keywords="mHealth", keywords="cognitive behavioral therapy", keywords="homework", keywords="technology acceptance model", keywords="trauma", keywords="mobile phone", abstract="Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. ", doi="10.2196/30268", url="https://formative.jmir.org/2021/12/e30268", url="http://www.ncbi.nlm.nih.gov/pubmed/34951593" } @Article{info:doi/10.2196/32794, author="Stecher, Chad and Sullivan, Mariah and Huberty, Jennifer", title="Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="22", volume="9", number="12", pages="e32794", keywords="mindfulness", keywords="meditation", keywords="mobile meditation app", keywords="behavioral persistence", keywords="habit formation", keywords="randomized controlled trial", keywords="mental health", keywords="physical health", keywords="app engagement", keywords="routine", abstract="Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2\%), female (77/101, 76.2\%), and college educated (ie, bachelor's or graduate degree; 82/101, 81.2\%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95\% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95\% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95\% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95\% CI 1.02-1.35; P=.007). Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial Registration: ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530 ", doi="10.2196/32794", url="https://mhealth.jmir.org/2021/12/e32794", url="http://www.ncbi.nlm.nih.gov/pubmed/34941558" } @Article{info:doi/10.2196/24114, author="O'Campo, Patricia and Velonis, Alisa and Buhariwala, Pearl and Kamalanathan, Janisha and Hassan, Awaiz Maha and Metheny, Nicholas", title="Design and Development of a Suite of Intimate Partner Violence Screening and Safety Planning Web Apps: User-Centered Approach", journal="J Med Internet Res", year="2021", month="Dec", day="21", volume="23", number="12", pages="e24114", keywords="intimate partner violence", keywords="web-based applications", keywords="women", keywords="user-centered design", abstract="Background: The popularity of mobile health (mHealth) technology has resulted in the development of numerous apps for almost every condition and disease management. mHealth and eHealth solutions for increasing awareness about, and safety around, intimate partner violence are no exception. These apps allow women to control access to these resources and provide unlimited, and with the right design features, safe access when these resources are needed. Few apps, however, have been designed in close collaboration with intended users to ensure relevance and effectiveness. Objective: The objective of this paper is to discuss the design of a suite of evidence-based mHealth and eHealth apps to facilitate early identification of unsafe relationship behaviors and tailored safety planning to reduce harm from violence including the methods by which we collaborated with and sought input from a population of intended users. Methods: A user-centered approach with aspects of human-centered design was followed to design a suite of 3 app-based safety planning interventions. Results: This review of the design suite of app-based interventions revealed challenges faced and lessons learned that may inform future efforts to design evidence-based mHealth and eHealth interventions. Conclusions: Following a user-centered approach can be helpful in designing mHealth and eHealth interventions for marginalized and vulnerable populations, and led to novel insights that improved the design of our interventions. ", doi="10.2196/24114", url="https://www.jmir.org/2021/12/e24114", url="http://www.ncbi.nlm.nih.gov/pubmed/34931998" } @Article{info:doi/10.2196/27991, author="Majid, Shazmin and Reeves, Stuart and Figueredo, Grazziela and Brown, Susan and Lang, Alexandra and Moore, Matthew and Morriss, Richard", title="The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review", journal="JMIR Ment Health", year="2021", month="Dec", day="20", volume="8", number="12", pages="e27991", keywords="user-centered design", keywords="participatory design", keywords="human-computer interaction", keywords="patient and public involvement", keywords="self-monitoring technology", keywords="bipolar disorder", keywords="mobile phone", abstract="Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36\%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9\%) self-monitoring app was classified as having low user involvement, 4 (36\%) self-monitoring apps were classified as having medium user involvement, and 2 (18\%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care--based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. ", doi="10.2196/27991", url="https://mental.jmir.org/2021/12/e27991", url="http://www.ncbi.nlm.nih.gov/pubmed/34931992" } @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/10.2196/29197, 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/10.2196/26439, 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/10.2196/32450, author="Ryan, A. Kelly and Smith, N. Shawna and Yocum, K. Anastasia and Carley, Isabel and Liebrecht, Celeste and Navis, Bethany and Vest, Erica and Bertram, Holli and McInnis, G. Melvin and Kilbourne, M. Amy", title="The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e32450", keywords="self-management", keywords="app", keywords="bipolar disorder", keywords="symptom management", keywords="mental health", keywords="feasibility", keywords="usability", keywords="acceptability", keywords="intervention", keywords="bipolar", keywords="coping", keywords="survey", keywords="engagement", abstract="Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35\% and 22\% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60\%) and easy to use (18/25, 72\%), and they reported that the screen displayed the material adequately (22/25, 88\%). However, less than half of the participants found the app helpful in managing their health (10/25, 40\%) or in making progress on their wellness goals (9/25, 36\%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. ", doi="10.2196/32450", url="https://formative.jmir.org/2021/12/e32450", url="http://www.ncbi.nlm.nih.gov/pubmed/34898452" } @Article{info:doi/10.2196/31353, author="Manning, Victoria and Piercy, Hugh and Garfield, Bernard Joshua Benjamin and Clark, Gregory Stuart and Andrabi, Noor Mah and Lubman, Ian Dan", title="A Personalized Approach Bias Modification Smartphone App (``SWiPE'') to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="10", volume="9", number="12", pages="e31353", keywords="alcohol", keywords="hazardous alcohol use", keywords="alcohol use disorder", keywords="approach bias modification", keywords="cognitive bias modification", keywords="smartphone app", keywords="ehealth", keywords="mobile phone app", keywords="mhealth", keywords="digital health", abstract="Background: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to ``avoid'' alcohol-related images and ``approach'' nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective: We examined the feasibility, acceptability, and preliminary effectiveness of ``SWiPE,'' a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ?8) who wanted to reduce their alcohol use. Methods: In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results: We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9\% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2\% (409/1309) completed ?8 sessions; and 34.8\% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4\% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions: The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE's efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): RR2-10.2196/21278 ", doi="10.2196/31353", url="https://mhealth.jmir.org/2021/12/e31353", url="http://www.ncbi.nlm.nih.gov/pubmed/34890355" } @Article{info:doi/10.2196/31092, author="Fang, Su-Ying and Lin, Pin-Jun and Kuo, Yao-Lung", title="Long-Term Effectiveness of a Decision Support App (Pink Journey) for Women Considering Breast Reconstruction Surgery: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="10", volume="9", number="12", pages="e31092", keywords="breast cancer", keywords="breast reconstruction surgery", keywords="decision aid", keywords="decision support", keywords="mHealth", keywords="app", keywords="women", abstract="Background: Various kinds of breast reconstruction (BR) options, including implants and autologous, and surgery techniques, including traditional and endoscope assisted, can be used to perform surgery. All options have their own advantages and disadvantages. Women decide on an option depending on the values and preferences they emphasize. Lacking knowledge about BR or having decision difficulties during the treatment decision process makes women experience more decision regret, psychological distress, and poor body image. Delivering decision support with a values clarification exercise using eHealth approaches would be beneficial for patient outcomes. Objective: This study aims to examine the effects of a decision support app on decision-making quality and psychological morbidity for women considering BR surgery. Methods: This randomized controlled trial included women who were over 20 years of age and were newly diagnosed with breast cancer and candidates for mastectomy. Women having an option for breast conservation were excluded. After being referred from the outpatient physician, the women provided consent and completed the baseline assessment. Women allocated to the control group (CG) received usual care and were provided with a pamphlet with information about types of surgery and the advantages and disadvantages of different surgery types. Women allocated to the intervention group (IG) were given the same pamphlet and guided to use the Pink Journey app to support their decision. Then they were also prompted to discuss the opinions with their significant others. Finally, the decision-making process of using the app was printed out for women that they could take home. Decision conflict, anxiety, and depression were measured at baseline. At 1 week after the intervention (T1) and at 1 month (T2), 8 months (T3), and 12 months (T4) after surgery, the women completed decision conflict, decision regret, anxiety, depression, and body image scales. An intention-to-treat analysis was performed. Results: From February 2018 to July 2019, 96 women were randomly assigned to the CG (n=48) or the IG (n=48). Results revealed that body image distress declined significantly for the IG but increased for the CG. The interaction of time and group also reached significance, indicating a significant decrease in body image distress from baseline in the IG compared with the CG after the 12th month (T4) follow-up ($\beta$=--2.25, standard error=1.01, P=.027). However, there was no significant difference in decision conflict (P=.21-.87), decision regret (P=.44-.55), anxiety (P=.26-.33), and depression (P=.20-.75), indicating that the decrease in these outcomes in the IG was not greater than those in the CG. Conclusions: Although we found no effect on decision conflict, decision regret, anxiety, and depression, a decision aid that combines surgery information and values clarification can help women reduce their body image distress. Trial Registration: ClinicalTrials.gov NCT04190992; https://clinicaltrials.gov/ct2/show/NCT04190992 ", doi="10.2196/31092", url="https://mhealth.jmir.org/2021/12/e31092", url="http://www.ncbi.nlm.nih.gov/pubmed/34890354" } @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/10.2196/33123, author="Hijab, Fadi Mohamad Hassan and Al-Thani, Dena and Banire, Bilikis", title="A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study", journal="JMIR Form Res", year="2021", month="Dec", day="7", volume="5", number="12", pages="e33123", keywords="autism", keywords="assistive technology", keywords="mobile app", keywords="social and communication skills", abstract="Background: Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD. Objective: This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD. Methods: Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants' interactions with the app were collected. Additionally, 6 participants' parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app's usability. Following the study, interviews were conducted with participants to discuss their experiences with the app. Results: The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=?2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=?0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations. Conclusions: This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD. ", doi="10.2196/33123", url="https://formative.jmir.org/2021/12/e33123", url="http://www.ncbi.nlm.nih.gov/pubmed/34878998" } @Article{info:doi/10.2196/28102, author="G{\"o}ttgens, Irene and Oertelt-Prigione, Sabine", title="The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="6", volume="9", number="12", pages="e28102", keywords="human-centered design", keywords="design thinking", keywords="user-centered design", keywords="design-based research", keywords="methodology", keywords="review", keywords="mobile phone", abstract="Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user's needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups. ", doi="10.2196/28102", url="https://mhealth.jmir.org/2021/12/e28102", url="http://www.ncbi.nlm.nih.gov/pubmed/34874893" } @Article{info:doi/10.2196/25305, author="Marques, M. Marta and Matos, Marcela and Mattila, Elina and Encantado, Jorge and Duarte, Cristiana and Teixeira, J. Pedro and Stubbs, James R. and Sniehotta, F. Falko and Ermes, Miikka and Harjumaa, Marja and Lepp{\"a}nen, Juha and V{\"a}lkkynen, Pasi and Silva, N. Marlene and Ferreira, Cl{\'a}udia and Carvalho, S{\'e}rgio and Palmeira, Lara and Horgan, Graham and Heitmann, Lilienthal Berit and Evans, H. Elizabeth and Palmeira, L. Ant{\'o}nio", title="A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study", journal="J Med Internet Res", year="2021", month="Dec", day="3", volume="23", number="12", pages="e25305", keywords="mHealth", keywords="behavior change techniques", keywords="weight management", keywords="motivation", keywords="self-regulation", keywords="emotion regulation", keywords="self-monitoring", keywords="user testing", keywords="logic models", abstract="Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight management. The toolkit was tested in an 18-month, large-scale, international, 2{\texttimes}2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ?5\% of their body weight in the preceding 12 months before enrollment into the intervention. Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the user evaluation and refinement of the toolkit. Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood, and sleep. Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2{\texttimes}2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. ", doi="10.2196/25305", url="https://www.jmir.org/2021/12/e25305", url="http://www.ncbi.nlm.nih.gov/pubmed/34870602" } @Article{info:doi/10.2196/31559, author="Herrmann-Werner, Anne and Loda, Teresa and Zipfel, Stephan and Holderried, Martin and Holderried, Friederike and Erschens, Rebecca", title="Evaluation of a Language Translation App in an Undergraduate Medical Communication Course: Proof-of-Concept and Usability Study", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="2", volume="9", number="12", pages="e31559", keywords="undergraduate medical students", keywords="translation app", keywords="simulation", keywords="physician-patient communication", keywords="mHealth", keywords="mobile applications", keywords="digital health", keywords="app development", keywords="language translation", keywords="translation apps", abstract="Background: Language barriers in medical encounters pose risks for interactions with patients, their care, and their outcomes. Because human translators, the gold standard for mitigating language barriers, can be cost- and time-intensive, mechanical alternatives such as language translation apps (LTA) have gained in popularity. However, adequate training for physicians in using LTAs remains elusive. Objective: A proof-of-concept pilot study was designed to evaluate the use of a speech-to-speech LTA in a specific simulated physician-patient situation, particularly its perceived usability, helpfulness, and meaningfulness, and to assess the teaching unit overall. Methods: Students engaged in a 90-min simulation with a standardized patient (SP) and the LTA iTranslate Converse. Thereafter, they rated the LTA with six items---helpful, intuitive, informative, accurate, recommendable, and applicable---on a 7-point Likert scale ranging from 1 (don't agree at all) to 7 (completely agree) and could provide free-text responses for four items: general impression of the LTA, the LTA's benefits, the LTA's risks, and suggestions for improvement. Students also assessed the teaching unit on a 6-point scale from 1 (excellent) to 6 (insufficient). Data were evaluated quantitatively with mean (SD) values and qualitatively in thematic content analysis. Results: Of 111 students in the course, 76 (68.5\%) participated (59.2\% women, age 20.7 years, SD 3.3 years). Values for the LTA's being helpful (mean 3.45, SD 1.79), recommendable (mean 3.33, SD 1.65) and applicable (mean 3.57, SD 1.85) were centered around the average of 3.5. The items intuitive (mean 4.57, SD 1.74) and informative (mean 4.53, SD 1.95) were above average. The only below-average item concerned its accuracy (mean 2.38, SD 1.36). Students rated the teaching unit as being excellent (mean 1.2, SD 0.54) but wanted practical training with an SP plus a simulated human translator first. Free-text responses revealed several concerns about translation errors that could jeopardize diagnostic decisions. Students feared that patient-physician communication mediated by the LTA could decrease empathy and raised concerns regarding data protection and technical reliability. Nevertheless, they appreciated the LTA's cost-effectiveness and usefulness as the best option when the gold standard is unavailable. They also reported wanting more medical-specific vocabulary and images to convey all information necessary for medical communication. Conclusions: This study revealed the feasibility of using a speech-to-speech LTA in an undergraduate medical course. Although human translators remain the gold standard, LTAs could be valuable alternatives. Students appreciated the simulated teaching and recognized the LTA's potential benefits and risks for use in real-world clinical settings. To optimize patients' and health care professionals' experiences with LTAs, future investigations should examine specific design options for training interventions and consider the legal aspects of human-machine interaction in health care settings. ", doi="10.2196/31559", url="https://mhealth.jmir.org/2021/12/e31559", url="http://www.ncbi.nlm.nih.gov/pubmed/34860678" } @Article{info:doi/10.2196/26370, author="Counson, Isabelle and Bartholomew, Alexandra and Crawford, Joanna and Petrie, Katherine and Basarkod, Geetanjali and Moynihan, Victoria and Pires, Josie and Cohen, Rachel and Glozier, Nicholas and Harvey, Samuel and Sanatkar, Samineh", title="Development of the Shift Smartphone App to Support the Emotional Well-Being of Junior Physicians: Design of a Prototype and Results of Usability and Acceptability Testing", journal="JMIR Form Res", year="2021", month="Dec", day="2", volume="5", number="12", pages="e26370", keywords="digital mental health", keywords="mHealth apps", keywords="help-seeking", keywords="junior physicians", keywords="co-design", keywords="user-centered design", keywords="mobile phone", abstract="Background: Junior physicians report higher levels of psychological distress than senior doctors and report several barriers to seeking professional mental health support, including concerns about confidentiality and career progression. Mobile health (mHealth) apps may be utilized to help overcome these barriers to assist the emotional well-being of this population and encourage help-seeking. Objective: This study describes the development and pilot trial of the Shift mHealth app to provide an unobtrusive avenue for junior physicians to seek information about, and help for, well-being and mental health concerns, which is sensitive to workplace settings. Methods: A 4-phase iterative development process was undertaken to create the content and features of Shift involving junior physicians using the principles of user-centered design. These 4 phases were---needs assessment, on the basis of interviews with 12 junior physicians; prototype development with user experience feedback from 2 junior physicians; evaluation, consisting of a pilot trial with 22 junior physicians to assess the usability and acceptability of the initial prototype; and redesign, including user experience workshops with 51 junior physicians. Results: Qualitative results informed the content and design of Shift to ensure that the app was tailored to junior physicians' needs. The Shift app prototype contained cognitive behavioral, mindfulness, value-based actions, and psychoeducational modules, as well as a tracking function that visualized patterns of daily variations in mood and health behaviors. Pilot-testing revealed possible issues with the organization of the app content, which were addressed through a thorough restructuring and redesign of Shift with the help of junior physicians across 3 user experience workshops. Conclusions: This study demonstrates the importance of ongoing end user involvement in the creation of a specialized mHealth app for a unique working population experiencing profession-specific stressors and barriers to help-seeking. The development and pilot trial of this novel Shift mHealth app are the first steps in addressing the mental health and support-seeking needs of junior physicians, although further research is required to validate its effectiveness and appropriateness on a larger scale. ", doi="10.2196/26370", url="https://formative.jmir.org/2021/12/e26370", url="http://www.ncbi.nlm.nih.gov/pubmed/34860662" } @Article{info:doi/10.2196/27208, author="Bisson, N. Alycia and Sorrentino, Victoria and Lachman, E. Margie", title="Walking and Daily Affect Among Sedentary Older Adults Measured Using the StepMATE App: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Dec", day="1", volume="9", number="12", pages="e27208", keywords="physical activity", keywords="fitness technology", keywords="intervention", keywords="behavioral science", keywords="aging", keywords="mobile phone", abstract="Background: Although fitness technology can track and encourage increases in physical activity, few smartphone apps are based on behavior change theories. Apps that do include behavioral components tend to be costly and often do not include strategies to help those who are unsure of how to increase their physical activity. Objective: The aim of this pilot study is to test the efficacy of a new app, StepMATE, for increasing daily walking in a sample of inactive adults and to examine daily relationships between walking and self-reported mood and energy. Methods: The participants were middle-aged and older adults aged ?50 years (mean 61.64, SD 7.67 years). They were randomly assigned to receive either a basic, pedometer-like version of the app or a version with supports to help them determine where, when, and with whom to walk. Of the 96 participants randomized to 1 of 2 conditions, 87 (91\%) completed pretest assessments and 81 (84\%) successfully downloaded the app. Upon downloading the app, step data from the week prior were automatically recorded. The participants in both groups were asked to set a daily walking goal, which they could change at any point during the intervention. They were asked to use the app as much as possible over the next 4 weeks. Twice per day, pop-up notifications assessed mood and energy levels. Results: Although one group had access to additional app features, both groups used the app in a similar way, mainly using just the walk-tracking feature. Multilevel models revealed that both groups took significantly more steps during the 4-week study than during the week before downloading the app ($\gamma$=0.24; P<.001). During the study, the participants in both groups averaged 5248 steps per day compared with an average of 3753 steps per day during the baseline week. Contrary to predictions, there were no differences in step increases between the two conditions. Cognition significantly improved from pre- to posttest ($\gamma$=0.17; P=.02). Across conditions, on days in which the participants took more steps than average, they reported better mood and higher energy levels on the same day and better mood on the subsequent day. Daily associations among walking, mood, and energy were significant for women but not for men and were stronger for older participants (those aged ?62 years) than for the younger participants. Conclusions: Both groups increased their steps to a similar extent, suggesting that setting and monitoring daily walking goals was sufficient for an initial increase and maintenance of steps. Across conditions, walking had benefits for positive mood and energy levels, particularly for women and older participants. Further investigations should identify other motivating factors that could lead to greater and more sustained increases in physical activity. Trial Registration: ClinicalTrials.gov NCT03124537; https://clinicaltrials.gov/ct2/show/NCT03124537 ", doi="10.2196/27208", url="https://mhealth.jmir.org/2021/12/e27208", url="http://www.ncbi.nlm.nih.gov/pubmed/34855609" } @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/10.2196/30053, author="Danieli, Morena and Ciulli, Tommaso and Mousavi, Mahed Seyed and Riccardi, Giuseppe", title="A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design", journal="JMIR Form Res", year="2021", month="Dec", day="1", volume="5", number="12", pages="e30053", keywords="mental health care", keywords="conversational AI", keywords="mHealth", keywords="personal health care agents", keywords="participatory design", keywords="psychotherapy", abstract="Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists' acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants' levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. ", doi="10.2196/30053", url="https://formative.jmir.org/2021/12/e30053", url="http://www.ncbi.nlm.nih.gov/pubmed/34855607" } @Article{info:doi/10.2196/26597, author="Chudyk, M. Anna and Ragheb, Sandra and Kent, David and Duhamel, A. Todd and Hyra, Carole and Dave, G. Mudra and Arora, C. Rakesh and Schultz, SH Annette", title="Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study", journal="JMIR Perioper Med", year="2021", month="Nov", day="30", volume="4", number="2", pages="e26597", keywords="cardiac surgery", keywords="perioperative care", keywords="enhanced recovery protocols", keywords="mobile app", keywords="smartphone app", keywords="mHealth", keywords="development", keywords="patient and public involvement", keywords="patient engagement in research", abstract="Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. ", doi="10.2196/26597", url="https://periop.jmir.org/2021/2/e26597", url="http://www.ncbi.nlm.nih.gov/pubmed/34851299" } @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/10.2196/28652, author="Goodridge, Donna and Reis, Nathan and Neiser, Jenna and Haubrich, Tim and Westberg, Bev and Erickson-Lumb, Laura and Storozinski, Jo and Gonzales, Cesar and Michael, Joanne and Cammer, Allison and Osgood, Nathaniel", title="An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People With Dementia: Participatory Feasibility Study", journal="JMIR Aging", year="2021", month="Nov", day="26", volume="4", number="4", pages="e28652", keywords="virtual support programs", keywords="caregivers", keywords="dementia", keywords="mindfulness", keywords="self-compassion", keywords="mobile health", keywords="mobile applications", keywords="elderly", keywords="older adults", keywords="usability", keywords="feasibility", keywords="smartphone app", keywords="mobile phone", abstract="Background: The number of persons with dementia is steadily growing, as is the number of individuals supporting persons with dementia. Primary caregivers of persons with dementia are most often family members or spouses of the persons with dementia, and they are more likely to experience increased stress and other negative effects than individuals who are not primary caregivers. Although in-person support groups have been shown to help buffer the negative impacts of caregiving, some caregivers live in isolated or rural communities and are unable to make the burdensome commitment of traveling to cities. Using an interdisciplinary approach, we developed a mobile smartphone support app designed for primary caregivers of persons with dementia, with the goal of reducing caregiver burden and easing stress. The app features a 12-week intervention, largely rooted in mindfulness-based self-compassion (MBSC), because MBSC has been linked to minimizing stress, depression, and anxiety. Objective: The primary objectives of our program are twofold: to explore the feasibility of a 12-week mobile support program and to conduct an initial efficacy evaluation of changes in perceived caregiver burden, coping styles, and emotional well-being of caregivers before and after the program. Methods: Our feasibility study used a 2-phase participatory pretest and posttest design, focusing on acceptability, demand, practicality, implementation, and efficacy. At phase I, we recruited 57 primary caregivers of persons with dementia (mean age 76.3, SD 12.9 years), comprising spouses (21/57, 37\%), children (21/57, 37\%), and friends or relatives (15/57, 26\%) of persons with dementia, of whom 29 (51\%) completed all measures at both pre- and postprogram. The content of the program featured a series of MBSC podcasts. Our primary outcome measure was caregiver burden, with secondary outcome measures including coping styles and emotional well-being. Daily ecological momentary assessments enabled us to ask participants, ``How are you feeling today?'' Phase II of our study involved semistructured follow-up interviews with most participants (n=21) who completed phase I. Results: Our findings suggest that our app or program meets the feasibility criteria examined. Notably, participants generally accepted the program and believed it could be a useful resource. Emotional well-being increased significantly (P=.04), and emotion-based coping significantly decreased (P=.01). Participants generally considered the app or program to be a helpful resource. Conclusions: Although there were no significant changes in caregiver burden, we were encouraged by the increased emotional well-being of our participants following the completion of our program. We also conclude that our app or program demonstrated feasibility (ie, acceptability, practicality, implementation, and efficacy) and can provide a much-needed resource for primary caregivers of persons with dementia. In the subsequent version of the program, we will respond to participant feedback by incorporating web-based weekly sessions and incorporating an outcome measure of self-compassion. ", doi="10.2196/28652", url="https://aging.jmir.org/2021/4/e28652", url="http://www.ncbi.nlm.nih.gov/pubmed/34842530" } @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/10.2196/29214, author="Atukunda, Cathyln Esther and Matthews, T. Lynn and Musiimenta, Angella and Mugyenyi, Rwambuka Godfrey and Mugisha, Samuel and Ware, C. Norma and Obua, Celestino and Siedner, J. Mark", title="mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study", journal="JMIR Form Res", year="2021", month="Nov", day="25", volume="5", number="11", pages="e29214", keywords="mHealth app", keywords="app development", keywords="messaging", keywords="health education", keywords="health promotion", keywords="mobile phone", abstract="Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52\%) had at least a primary education and 75 (100\%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner's involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women's significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women's preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. ", doi="10.2196/29214", url="https://formative.jmir.org/2021/11/e29214", url="http://www.ncbi.nlm.nih.gov/pubmed/34842541" } @Article{info:doi/10.2196/26397, author="Keller, Jan and Roitzheim, Christina and Radtke, Theda and Schenkel, Konstantin and Schwarzer, Ralf", title="A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="23", volume="9", number="11", pages="e26397", keywords="problematic smartphone use", keywords="smartphone unlocks", keywords="smartphone time", keywords="behavior change", keywords="self-efficacy", keywords="action planning", keywords="digital detox", keywords="time-out", keywords="randomized controlled trial", abstract="Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app ``Not Less But Better'' that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4\%; 55 participants in each condition) provided data at postintervention and 88 (37.9\%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=--0.09; 95\% bias-corrected bootstrap CI --0.26 to --0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=--0.029, 95\% bias-corrected bootstrap CI --0.078 to --0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users' needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy ", doi="10.2196/26397", url="https://mhealth.jmir.org/2021/11/e26397", url="http://www.ncbi.nlm.nih.gov/pubmed/34817388" } @Article{info:doi/10.2196/32351, author="Montgomery, M. Robert and Boucher, M. Eliane and Honomichl, D. Ryan and Powell, A. Tyler and Guyton, L. Sharelle and Bernecker, L. Samantha and Stoeckl, Elizabeth Sarah and Parks, C. Acacia", title="The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data", journal="JMIR Cardio", year="2021", month="Nov", day="19", volume="5", number="2", pages="e32351", keywords="digital mental health", keywords="digital health", keywords="mobile apps", keywords="mobile health", keywords="internet-based intervention", keywords="happiness", keywords="subjective well-being", keywords="anxiety", keywords="cardiovascular health", keywords="high blood pressure", keywords="high cholesterol", keywords="diabetes", keywords="cardiovascular disease risk", keywords="real-world data", abstract="Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. ", doi="10.2196/32351", url="https://cardio.jmir.org/2021/2/e32351", url="http://www.ncbi.nlm.nih.gov/pubmed/34806986" } @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/10.2196/28956, author="Oyibo, Kiemute and Morita, Pelegrini Plinio", title="Designing Better Exposure Notification Apps: The Role of Persuasive Design", journal="JMIR Public Health Surveill", year="2021", month="Nov", day="16", volume="7", number="11", pages="e28956", keywords="contact tracing app", keywords="exposure notification app", keywords="COVID Alert", keywords="COVID-19", keywords="persuasive technology", keywords="behavior change", abstract="Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada's official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface's effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. ", doi="10.2196/28956", url="https://publichealth.jmir.org/2021/11/e28956", url="http://www.ncbi.nlm.nih.gov/pubmed/34783673" } @Article{info:doi/10.2196/25192, author="Amin, Shiraz and Gupta, Vedant and Du, Gaixin and McMullen, Colleen and Sirrine, Matthew and Williams, V. Mark and Smyth, S. Susan and Chadha, Romil and Stearley, Seth and Li, Jing", title="Developing and Demonstrating the Viability and Availability of the Multilevel Implementation Strategy for Syncope Optimal Care Through Engagement (MISSION) Syncope App: Evidence-Based Clinical Decision Support Tool", journal="J Med Internet Res", year="2021", month="Nov", day="16", volume="23", number="11", pages="e25192", keywords="cardiology", keywords="medical diagnosis", keywords="medicine", keywords="mobile applications", keywords="prognostics and health", keywords="syncope", abstract="Background: Syncope evaluation and management is associated with testing overuse and unnecessary hospitalizations. The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Syncope Guideline aims to standardize clinical practice and reduce unnecessary services. The use of clinical decision support (CDS) tools offers the potential to successfully implement evidence-based clinical guidelines. However, CDS tools that provide an evidence-based differential diagnosis (DDx) of syncope at the point of care are currently lacking. Objective: With input from diverse health systems, we developed and demonstrated the viability of a mobile app, the Multilevel Implementation Strategy for Syncope optImal care thrOugh eNgagement (MISSION) Syncope, as a CDS tool for syncope diagnosis and prognosis. Methods: Development of the app had three main goals: (1) reliable generation of an accurate DDx, (2) incorporation of an evidence-based clinical risk tool for prognosis, and (3) user-based design and technical development. To generate a DDx that incorporated assessment recommendations, we reviewed guidelines and the literature to determine clinical assessment questions (variables) and likelihood ratios (LHRs) for each variable in predicting etiology. The creation and validation of the app diagnosis occurred through an iterative clinician review and application to actual clinical cases. The review of available risk score calculators focused on identifying an easily applied and valid evidence-based clinical risk stratification tool. The review and decision-making factors included characteristics of the original study, clinical variables, and validation studies. App design and development relied on user-centered design principles. We used observations of the emergency department workflow, storyboard demonstration, multiple mock review sessions, and beta-testing to optimize functionality and usability. Results: The MISSION Syncope app is consistent with guideline recommendations on evidence-based practice (EBP), and its user interface (UI) reflects steps in a real-world patient evaluation: assessment, DDx, risk stratification, and recommendations. The app provides flexible clinical decision making, while emphasizing a care continuum; it generates recommendations for diagnosis and prognosis based on user input. The DDx in the app is deemed a pragmatic model that more closely aligns with real-world clinical practice and was validated using actual clinical cases. The beta-testing of the app demonstrated well-accepted functionality and usability of this syncope CDS tool. Conclusions: The MISSION Syncope app development integrated the current literature and clinical expertise to provide an evidence-based DDx, a prognosis using a validated scoring system, and recommendations based on clinical guidelines. This app demonstrates the importance of using research literature in the development of a CDS tool and applying clinical experience to fill the gaps in available research. It is essential for a successful app to be deliberate in pursuing a practical clinical model instead of striving for a perfect mathematical model, given available published evidence. This hybrid methodology can be applied to similar CDS tool development. ", doi="10.2196/25192", url="https://www.jmir.org/2021/11/e25192", url="http://www.ncbi.nlm.nih.gov/pubmed/34783669" } @Article{info:doi/10.2196/16824, author="Lasrado, Reena and Bielsten, Therese and Hann, Mark and Schumm, James and Reilly, Theresa Siobhan and Davies, Linda and Swarbrick, Caroline and Dowlen, Robyn and Keady, John and Hellstr{\"o}m, Ingrid", title="Developing a Management Guide (the DemPower App) for Couples Where One Partner Has Dementia: Nonrandomized Feasibility Study", journal="JMIR Aging", year="2021", month="Nov", day="16", volume="4", number="4", pages="e16824", keywords="dementia guide", keywords="self-management for couples with dementia", keywords="dementia self-help", keywords="dementia app", keywords="dementia resource", keywords="feasibility study", keywords="nonrandomized study", keywords="dementia intervention", abstract="Background: Promoting the health and well-being of couples where one partner has dementia is an overlooked area of care practice. Most postdiagnostic services currently lack a couple-centered approach and have a limited focus on the couple relationship. To help address this situation, we developed a tablet-based self-management guide (DemPower) focused on helping couples enhance their well-being and relationship quality. Objective: The aim of this study is to investigate the feasibility and acceptability of the DemPower app. Methods: A nonrandomized feasibility design was used to evaluate the DemPower intervention over 3 months among couples where a partner had a diagnosis of dementia. The study recruited 25 couples in the United Kingdom and 19 couples in Sweden. Outcome measures were obtained at baseline and postintervention. The study process and interventions were evaluated at various stages. Results: The study was completed by 48\% (21/44) of couples where one partner had dementia, of whom 86\% (18/21) of couples accessed all parts of the DemPower app. Each couple spent an average of 8 hours (SD 3.35 hours) using the app during the study period. In total, 90\% (19/21) of couples reported that all sections of DemPower were useful in addressing various aspects of daily life and helped to focus on how they interacted in their relationship. Of the 4 core subjects on which the DemPower app was structured, home and neighborhood received the highest number of visits. Couples used activity sections more often than the core subject pages. The perception of DemPower's utility varied with each couple's lived experience of dementia, geographic location, relationship dynamics, and opportunities for social interaction. A 5.2-point increase in the dementia quality of life score for people with dementia and a marginal increase in the Mutuality scale (+1.23 points) for caregiver spouses were found. Design and navigational challenges were reported in the DemPower app. Conclusions: The findings suggest that the DemPower app is a useful resource for couples where one partner has dementia and that the implementation of the app requires the support of memory clinics to reach couples at early diagnosis. Trial Registration: ISRCTN Registry ISRCTN10122979; http://www.isrctn.com/ISRCTN10122979 ", doi="10.2196/16824", url="https://aging.jmir.org/2021/4/e16824", url="http://www.ncbi.nlm.nih.gov/pubmed/34783666" } @Article{info:doi/10.2196/32521, author="Horvath, Mark and Grutman, Aurora and O'Malley, S. Stephanie and Gueorguieva, Ralitza and Khan, Nashmia and Brewer, A. Judson and Garrison, A. Kathleen", title="Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="16", volume="10", number="11", pages="e32521", keywords="smartband", keywords="smartphone", keywords="smoking", keywords="mindfulness", keywords="craving", keywords="mHealth", abstract="Background: Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective: This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods: Daily smokers (N=100, ?5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a ``mindful smoking'' exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a ``RAIN'' (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results: Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions: Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID): DERR1-10.2196/32521 ", doi="10.2196/32521", url="https://www.researchprotocols.org/2021/11/e32521", url="http://www.ncbi.nlm.nih.gov/pubmed/34783663" } @Article{info:doi/10.2196/26212, author="Whale, Katie and Beasant, Lucy and Wright, J. Anne and Yardley, Lucy and Wallace, M. Louise and Moody, Louise and Joinson, Carol", title="A Smartphone App for Supporting the Self-management of Daytime Urinary Incontinence in Adolescents: Development and Formative Evaluation Study of URApp", journal="JMIR Pediatr Parent", year="2021", month="Nov", day="15", volume="4", number="4", pages="e26212", keywords="incontinence", keywords="urinary incontinence", keywords="digital intervention", keywords="child health", keywords="pediatric", keywords="pediatric incontinence", keywords="smartphone", keywords="intervention development", keywords="mobile phone", abstract="Background: Daytime urinary incontinence (UI) is common in childhood and often persists into adolescence. UI in adolescence is associated with a range of adverse outcomes, including depressive symptoms, peer victimization, poor self-image, and problems with peer relationships. The first-line conservative treatment for UI is bladder training (standard urotherapy) that aims to establish a regular fluid intake and a timed schedule for toilet visits. The success of bladder training is strongly dependent on good concordance, which can be challenging for young people. Objective: This paper aims to describe the development of a smartphone app (URApp) that aims to improve concordance with bladder training in young people aged 11 to 19 years. Methods: URApp was designed by using participatory co-design methods and was guided by the person-based approach to intervention design. The core app functions were based on clinical guidance and included setting a daily drinking goal that records fluid intake and toilet visits, setting reminders to drink fluids and go to the toilet, and recording progress toward drinking goals. The development of URApp comprised the following four stages: a review of current smartphone apps for UI, participatory co-design workshops with young people with UI for gathering user requirements and developing wireframes, the development of a URApp prototype, and the user testing of the prototype through qualitative interviews with 23 young people with UI or urgency aged 10 to 19 years and 8 clinicians. The app functions and additional functionalities for supporting concordance and behavior change were iteratively optimized throughout the app development process. Results: Young people who tested URApp judged it to be a helpful way of supporting their concordance with a timed schedule for toilet visits and drinking. They reported high levels of acceptability and engagement. Preliminary findings indicated that some young people experienced improvements in their bladder symptoms, including a reduction in UI. Clinicians reported that URApp was clinically appropriate and aligned with the best practice guidelines for bladder training. URApp was deemed age appropriate, with all clinicians reporting that they would use it within their own clinics. Clinicians felt URApp would be of particular benefit to patients whose symptoms were not improving or those who were not engaging with their treatment plans. Conclusions: The next stage is to evaluate URApp in a range of settings, including pediatric continence clinics, primary care, and schools. This research is needed to test whether URApp is an effective (and cost-effective) solution for improving concordance with bladder training, reducing bladder symptoms, and improving the quality of life. ", doi="10.2196/26212", url="https://pediatrics.jmir.org/2021/4/e26212", url="http://www.ncbi.nlm.nih.gov/pubmed/34779780" } @Article{info:doi/10.2196/27896, author="Noorbergen, J. Tyler and Adam, P. Marc T. and Teubner, Timm and Collins, E. Clare", title="Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="10", volume="9", number="11", pages="e27896", keywords="co-design", keywords="mHealth", keywords="guidelines", keywords="qualitative study", keywords="mobile phone", abstract="Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development. Objective: Despite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems. Methods: Tapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development. Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact. Conclusions: System designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research. ", doi="10.2196/27896", url="https://mhealth.jmir.org/2021/11/e27896", url="http://www.ncbi.nlm.nih.gov/pubmed/34757323" } @Article{info:doi/10.2196/26424, author="Kim, Jihae Agnes and Yang, Jisun and Jang, Yihyun and Baek, Sang Joon", title="Acceptance of an Informational Antituberculosis Chatbot Among Korean Adults: Mixed Methods Research", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="9", volume="9", number="11", pages="e26424", keywords="tuberculosis", keywords="chatbot", keywords="technology acceptance model", keywords="mobile phone", abstract="Background: Tuberculosis (TB) is a highly infectious disease. Negative perceptions and insufficient knowledge have made its eradication difficult. Recently, mobile health care interventions, such as an anti-TB chatbot developed by the research team, have emerged in support of TB eradication programs. However, before the anti-TB chatbot is deployed, it is important to understand the factors that predict its acceptance by the population. Objective: This study aims to explore the acceptance of an anti-TB chatbot that provides information about the disease and its treatment to people vulnerable to TB in South Korea. Thus, we are investigating the factors that predict technology acceptance through qualitative research based on the interviews of patients with TB and homeless facility personnel. We are then verifying the extended Technology Acceptance Model (TAM) and predicting the factors associated with the acceptance of the chatbot. Methods: In study 1, we conducted interviews with potential chatbot users to extract the factors that predict user acceptance and constructed a conceptual framework based on the TAM. In total, 16 interviews with patients with TB and one focus group interview with 10 experts on TB were conducted. In study 2, we conducted surveys of potential chatbot users to validate the extended TAM. Survey participants were recruited among late-stage patients in TB facilities and members of web-based communities sharing TB information. A total of 123 responses were collected. Results: The results indicate that perceived ease of use and social influence were significantly predictive of perceived usefulness (P=.04 and P<.001, respectively). Perceived usefulness was predictive of the attitude toward the chatbot (P<.001), whereas perceived ease of use (P=.88) was not. Behavioral intention was positively predicted by attitude toward the chatbot and facilitating conditions (P<.001 and P=.03, respectively). The research model explained 55.4\% of the variance in the use of anti-TB chatbots. The moderating effect of TB history was found in the relationship between attitude toward the chatbot and behavioral intention (P=.01) and between facilitating conditions and behavioral intention (P=.02). Conclusions: This study can be used to inform future design of anti-TB chatbots and highlight the importance of services and the environment that empower people to use the technology. ", doi="10.2196/26424", url="https://mhealth.jmir.org/2021/11/e26424", url="http://www.ncbi.nlm.nih.gov/pubmed/34751667" } @Article{info:doi/10.2196/32847, author="Bricker, B. Jonathan and Levin, Michael and Lappalainen, Raimo and Mull, Kristin and Sullivan, Brianna and Santiago-Torres, Margarita", title="Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="9", volume="9", number="11", pages="e32847", keywords="mediation", keywords="engagement", keywords="digital", keywords="mHealth: smartphone", keywords="acceptance", keywords="smoking", keywords="cessation", keywords="app", keywords="randomized controlled trial", keywords="model", keywords="intervention", abstract="Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87\% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 ", doi="10.2196/32847", url="https://mhealth.jmir.org/2021/11/e32847", url="http://www.ncbi.nlm.nih.gov/pubmed/34751662" } @Article{info:doi/10.2196/29815, author="Lazard, J. Allison and Babwah Brennen, Scott J. and Belina, P. Stephanie", title="App Designs and Interactive Features to Increase mHealth Adoption: User Expectation Survey and Experiment", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="4", volume="9", number="11", pages="e29815", keywords="smartphone", keywords="interactive design", keywords="mobile apps", keywords="preventive health", keywords="mental models", keywords="prototypicality", keywords="attention", keywords="affordances", abstract="Background: Despite the ubiquity of smartphones, there is little guidance for how to design mobile health apps to increase use. Specifically, knowing what features users expect, grab their attention, encourage use (via predicted use or through positive app evaluations), and signal beneficial action possibilities can guide and focus app development efforts. Objective: We investigated what features users expect and how the design (prototypicality) impacts app adoption. Methods: In a web-based survey, we elicited expectations, including presence and placement, for 12 app features. Thereafter, participants (n=462) viewed 2 health apps (high prototypicality similar to top downloaded apps vs low prototypicality similar to research interventions) and reported willingness to download, attention, and predicted use of app features. Participants rated both apps (high and low) for aesthetics, ease of use, usefulness, perceived affordances, and intentions to use. Results: Most participants (425/462, 92\%) expected features for navigation or personal settings (eg, menu) in specific regions (eg, top corners). Features with summary graphs or statics were also expected by many (395-396 of 462, 86\%), with a center placement expectation. A feature to ``share with friends'' was least expected among participants (203/462, 44\%). Features fell into 4 unique categories based on attention and predicted use, including essential features with high (>50\% or >231 of 462) predicted use and attention (eg, calorie trackers), flashy features with high attention but lower predicted use (eg, links to specific diets), functional features with modest attention and low use (eg, settings), and mundane features with low attention and use (eg, discover tabs). When given a choice, 347 of 462 (75\%) participants would download the high-prototypicality app. High prototypicality apps (vs low) led to greater aesthetics, ease of use, usefulness, and intentions, (for all, P<.001). Participants thought that high prototypicality apps had more perceived affordances. Conclusions: Intervention designs that fail to meet a threshold of mHealth expectations will be dismissed as less usable or beneficial. Individuals who download health apps have shared expectations for features that should be there, as well as where these features should appear. Meeting these expectations can improve app evaluations and encourage use. Our typology should guide presence and placement of expected app features to signal value and increase use to impact preventive health behaviors. Features that will likely be used and are attention-worthy---essential, flashy, and functional---should be prioritized during app development. ", doi="10.2196/29815", url="https://mhealth.jmir.org/2021/11/e29815", url="http://www.ncbi.nlm.nih.gov/pubmed/34734829" } @Article{info:doi/10.2196/25749, author="Paquette, E. Catherine and Rubalcava, T. Dillon and Chen, Yun and Anand, Deepika and Daughters, B. Stacey", title="A Mobile App to Enhance Behavioral Activation Treatment for Substance Use Disorder: App Design, Use, and Integration Into Treatment in the Context of a Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Nov", day="3", volume="5", number="11", pages="e25749", keywords="substance use disorder", keywords="smartphone app", keywords="mHealth", keywords="behavioral activation", keywords="mobile phone", abstract="Background: Group-based formats typically used in low-resource substance use disorder (SUD) treatment settings result in little individual attention to help reinforce and guide skill use, which may contribute to poor posttreatment outcomes. Smartphone apps offer a convenient, user-friendly, and cost-effective tool that can extend the reach of effective SUD treatments. A smartphone app was developed and integrated into a group-based, brief behavioral activation (BA) treatment for SUD to increase engagement in treatment skills outside clinician-administered sessions. Objective: This study aims to describe the features of the app and its use and integration into treatment, report the participants' self-reported feasibility and acceptability of the app, and discuss challenges and provide recommendations for future smartphone app integration into behavioral treatments for SUD. Methods: A total of 56 individuals recruited from intensive outpatient SUD treatment received a smartphone-enhanced BA treatment, the Life Enhancement Treatment for Substance Use. Self-reported weekly app use and reasons for nonuse were assessed at posttreatment and at 1- and 3-month follow-ups. In addition, 2-tailed t tests and chi-square tests compared the self-reported use of each app component and overall app use over time. Results: Participant feedback suggested that the integration of the smartphone app into the Life Enhancement Treatment for Substance Use was feasible and well accepted, and participants found the app useful for planning value-based activities outside of sessions. Self-reported app engagement decreased over the follow-up period: 72\% (39/54) of participants reported using the app at posttreatment, decreasing to 69\% (37/54) at the 1-month follow-up and 37\% (20/54) at the 3-month follow-up. Participants reported forgetting to use the app as a primary reason for nonuse. Conclusions: This study provides support for the feasibility and acceptability of smartphone-enhanced BA treatment, offering promise for future research testing the integration of technology into SUD treatment. Design decisions may help streamline smartphone integration into treatment, for example, allowing participants to download the treatment app on their own phones or use a low-cost study smartphone (or offering both options). Long-term app engagement may be increased via built-in reminders, alerts, and in-app messages. Trial Registration: ClinicalTrials.gov NCT02707887; https://clinicaltrials.gov/ct2/show/study/NCT02707887 ", doi="10.2196/25749", url="https://formative.jmir.org/2021/11/e25749", url="http://www.ncbi.nlm.nih.gov/pubmed/34730535" } @Article{info:doi/10.2196/25392, author="Carmona, E. Nicole and Usyatynsky, Aleksandra and Kutana, Samlau and Corkum, Penny and Henderson, Joanna and McShane, Kelly and Shapiro, Colin and Sidani, Souraya and Stinson, Jennifer and Carney, E. Colleen", title="A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study", journal="JMIR Form Res", year="2021", month="Nov", day="1", volume="5", number="11", pages="e25392", keywords="youth", keywords="sleep", keywords="technology", keywords="mHealth", keywords="self-management", keywords="adolescents", keywords="young adults", keywords="mobile phone", abstract="Background: Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz's with Empirical Support). Objective: This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample. Methods: Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point. Results: In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode?4) on the items ``easy to use,'' ``easy to understand,'' ``time commitment,'' and ``overall satisfaction'' and was rated as credible (mode?4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41\% of participants), naps (17/83, 20\%), and morning lingering in bed (16/83, 19\%). AYAs accessed tips on difficulty winding down (24/83, 29\% of participants), being a night owl (17/83, 20\%), difficulty getting up (13/83, 16\%), and fatigue (13/83, 16\%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01). Conclusions: Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy. Trial Registration: ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294 ", doi="10.2196/25392", url="https://formative.jmir.org/2021/11/e25392", url="http://www.ncbi.nlm.nih.gov/pubmed/34723820" } @Article{info:doi/10.2196/20739, author="Chin, Yun Winnie Szu and Kurowski, Alicia and Gore, Rebecca and Chen, Guanling and Punnett, Laura and ", title="Use of a Mobile App for the Process Evaluation of an Intervention in Health Care: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Oct", day="28", volume="5", number="10", pages="e20739", keywords="mobile apps", keywords="usability testing", keywords="user experience design", keywords="mobile phone", keywords="mhealth", keywords="iterative testing", keywords="participatory research", keywords="user demographics", keywords="worker participation", abstract="Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers', developers', and users' mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app's 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data. ", doi="10.2196/20739", url="https://formative.jmir.org/2021/10/e20739", url="http://www.ncbi.nlm.nih.gov/pubmed/34709186" } @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/10.2196/23968, author="Halttu, Kirsi and Oinas-Kukkonen, Harri", title="Need for Cognition Among Users of Self-Monitoring Systems for Physical Activity: Survey Study", journal="JMIR Form Res", year="2021", month="Oct", day="14", volume="5", number="10", pages="e23968", keywords="self-monitoring", keywords="wearables", keywords="physical activity tracking", keywords="mHealth", keywords="need for cognition", keywords="persuasive design", keywords="tailoring", keywords="user research", keywords="mobile phone", abstract="Background: Need for cognition (NFC) is among the most studied personality traits in psychology. Despite its apparent relevance for engaging with technology and the use of information, it has not been studied in the context of self-monitoring systems and wearables for health. This study is the first to explore the relationship between NFC and commercial self-monitoring systems among healthy users. Objective: This study aims to explore the effect of NFC levels on the selection of self-monitoring systems and evaluation of system features of self-monitoring and feedback, as well as perceived credibility and perceived persuasiveness. We also assessed perceived behavior change in the form of self-reported activity after adopting the system. Methods: Survey data were collected in October 2019 among university students and personnel. The invitation to respond to the questionnaire was addressed to those who had used a digital system to monitor their physical activity for at least two months. The web-based questionnaire comprised the following 3 parts: details of system use, partially randomly ordered theoretical measurement items, and user demographics. The data were analyzed using structural equation modeling. The effect of NFC was assessed both as 3 groups (low, moderate, and high) and as a continuous moderator variable. Results: In all, 238 valid responses to the questionnaire were obtained. Individuals with high NFC reported all tested system features with statistically significantly higher scores. The NFC also had some effect on system selection. Hypothesized relationships with perceived credibility gained support in a different way for individuals with low and high NFC; for those with low NFC, credibility increased the persuasiveness of the system, but this effect was absent among individuals with high NFC. For users with high NFC, credibility was related to feedback and self-monitoring and perhaps continuously evaluated during prolonged use instead of being a static system property. Furthermore, the relationship between perceived persuasiveness and self-reported activity after adopting the system had a large effect size (Cohen f2=0.355) for individuals with high NFC, a small effect size for individuals with moderate NFC (Cohen f2=0.107), and a nonsignificant path (P=.16) for those with low NFC. We also detected a moderating effect of NFC in two paths on perceived persuasiveness but only among women. Our research model explained 59.2\%, 63.9\%, and 47.3\% of the variance in perceived persuasiveness of the system among individuals with low, moderate, and high NFC, respectively. Conclusions: The system choices of individuals seem to reflect their intrinsic motivations to engage with rich data, and commercial systems might themselves be a tailoring strategy. Important characteristics of the system, such as perceived credibility, have different roles depending on the NFC levels. Our data demonstrate that NFC as a trait that differentiates information processing has several implications for the selection, design, and tailoring of self-monitoring systems. ", doi="10.2196/23968", url="https://formative.jmir.org/2021/10/e23968", url="http://www.ncbi.nlm.nih.gov/pubmed/34647894" } @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/10.2196/26358, author="Ogundaini, Oaikhena Oluwamayowa and de la Harpe, Retha and McLean, Nyx", title="Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="13", volume="9", number="10", pages="e26358", keywords="mHealth", keywords="health care professionals", keywords="co-design", keywords="hospitals", keywords="ActAD model", keywords="work activity", keywords="Sub-Saharan Africa", keywords="referrals", keywords="VULA mobile app", keywords="WhatsApp", keywords="mobile phone", abstract="Background: There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle--income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings. Objective: This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, ``How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?'' Methods: A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model. Results: The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery. Conclusions: The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals. ", doi="10.2196/26358", url="https://mhealth.jmir.org/2021/10/e26358", url="http://www.ncbi.nlm.nih.gov/pubmed/34643540" } @Article{info:doi/10.2196/23663, author="Singh, Ajit Devinder Kaur and Goh, Wen Jing and Shaharudin, Iqbal Muhammad and Shahar, Suzana", title="A Mobile App (FallSA) to Identify Fall Risk Among Malaysian Community-Dwelling Older Persons: Development and Validation Study", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="12", volume="9", number="10", pages="e23663", keywords="fall risk", keywords="self-screening", keywords="mobile app", keywords="older person", abstract="Background: Recent falls prevention guidelines recommend early routine fall risk assessment among older persons. Objective: The purpose of this study was to develop a Falls Screening Mobile App (FallSA), determine its acceptance, concurrent validity, test-retest reliability, discriminative ability, and predictive validity as a self-screening tool to identify fall risk among Malaysian older persons. Methods: FallSA acceptance was tested among 15 participants (mean age 65.93 [SD 7.42] years); its validity and reliability among 91 participants (mean age 67.34 [SD 5.97] years); discriminative ability and predictive validity among 610 participants (mean age 71.78 [SD 4.70] years). Acceptance of FallSA was assessed using a questionnaire, and it was validated against a comprehensive fall risk assessment tool, the Physiological Profile Assessment (PPA). Participants used FallSA to test their fall risk repeatedly twice within an hour. Its discriminative ability and predictive validity were determined by comparing participant fall risk scores between fallers and nonfallers and prospectively through a 6-month follow-up, respectively. Results: The findings of our study showed that FallSA had a high acceptance level with 80\% (12/15) of older persons agreeing on its suitability as a falls self-screening tool. Concurrent validity test demonstrated a significant moderate correlation (r=.518, P<.001) and agreement (k=.516, P<.001) with acceptable sensitivity (80.4\%) and specificity (71.1\%). FallSA also had good reliability (intraclass correlation .948; 95\% CI .921-.966) and an internal consistency ($\alpha$=.948, P<.001). FallSA score demonstrated a moderate to strong discriminative ability in classifying fallers and nonfallers. FallSA had a predictive validity of falls with positive likelihood ratio of 2.27, pooled sensitivity of 82\% and specificity of 64\%, and area under the curve of 0.802. Conclusions: These results suggest that FallSA is a valid and reliable fall risk self-screening tool. Further studies are required to empower and engage older persons or care givers in the use of FallSA to self-screen for falls and thereafter to seek early prevention intervention. ", doi="10.2196/23663", url="https://mhealth.jmir.org/2021/10/e23663", url="http://www.ncbi.nlm.nih.gov/pubmed/34636740" } @Article{info:doi/10.2196/28136, author="Kruglova, Katya and O'Connell, Laura Siobhan Bernadette and Dawadi, Shrinkhala and Gelgoot, Noah Eden and Miner, A. Skye and Robins, Stephanie and Schinazi, Joy and Zelkowitz, Phyllis", title="An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study", journal="JMIR Form Res", year="2021", month="Oct", day="12", volume="5", number="10", pages="e28136", keywords="mHealth app", keywords="mHealth development process", keywords="infertility", keywords="intervention design", keywords="mobile phone", abstract="Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app's content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app's content based on participants' feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. ", doi="10.2196/28136", url="https://formative.jmir.org/2021/10/e28136", url="http://www.ncbi.nlm.nih.gov/pubmed/34636741" } @Article{info:doi/10.2196/27478, author="Jiang, Nan and Nguyen, Nam and Siman, Nina and Cleland, M. Charles and Nguyen, Trang and Doan, Thi Hue and Abroms, C. Lorien and Shelley, R. Donna", title="Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="8", volume="9", number="10", pages="e27478", keywords="smoking cessation", keywords="text messaging", keywords="mHealth", keywords="mobile health", keywords="low- and middle-income country", keywords="smoking", keywords="developing countries", keywords="SMS", keywords="Vietnam", abstract="Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8\%) reset the quit date and 19 (38\%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98\% [49/50] vs 82\% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20\% [10/50] vs 2\% [1/50]; P=.01), but the effect was not significant at 12 weeks (12\% [6/50] vs 6\% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 ", doi="10.2196/27478", url="https://mhealth.jmir.org/2021/10/e27478", url="http://www.ncbi.nlm.nih.gov/pubmed/34623318" } @Article{info:doi/10.2196/23204, author="Mauka, Wilhellmuss and Mbotwa, Christopher and Moen, K{\aa}re and Lichtwarck, Ochieng Hanne and Haaland, Inga and Kazaura, Method and Leyna, H. Germana and Leshabari, T. Melkizedeck and Mmbaga, J. Elia", title="Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach", journal="JMIR Form Res", year="2021", month="Oct", day="7", volume="5", number="10", pages="e23204", keywords="mHealth application", keywords="participatory design", keywords="HIV", keywords="pre-exposure prophylaxis", keywords="Africa", keywords="female sex workers", keywords="sex and gender minorities", abstract="Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app's design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 ", doi="10.2196/23204", url="https://formative.jmir.org/2021/10/e23204", url="http://www.ncbi.nlm.nih.gov/pubmed/34617904" } @Article{info:doi/10.2196/27358, author="Egan, J. Kieren and Hodgson, William and Dunlop, D. Mark and Imperatore, Gennaro and Kirk, Alison and Maguire, Roma", title="A Novel Mobile App (``CareFit'') to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study", journal="JMIR Form Res", year="2021", month="Oct", day="1", volume="5", number="10", pages="e27358", keywords="physical activity", keywords="Android", keywords="COVID-19", keywords="intervention", keywords="co-design", keywords="exercise", keywords="app", keywords="development", keywords="support", keywords="caregiver", abstract="Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, ``CareFit,'' by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. ", doi="10.2196/27358", url="https://formative.jmir.org/2021/10/e27358", url="http://www.ncbi.nlm.nih.gov/pubmed/34406969" } @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/10.2196/25558, author="Holst, Christine and Isabwe, Norbert Ghislain Maurice and Sukums, Felix and Ngowi, Helena and Kajuna, Flora and Radovanovi{\'c}, Danica and Mansour, Wisam and Mwakapeje, Elibariki and Cardellichio, Peter and Ngowi, Bernard and Noll, Josef and Winkler, Sylvia Andrea", title="Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="22", volume="9", number="9", pages="e25558", keywords="digital health", keywords="eHealth", keywords="mHealth", keywords="Tanzania", keywords="health education", keywords="HIV/AIDS", keywords="tuberculosis", keywords="cysticercosis", keywords="tapeworm", keywords="anthrax", keywords="mobile phone", abstract="Background: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. Objective: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. Methods: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania's national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. Results: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. Conclusions: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government's objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID): RR2-10.2196/25128 ", doi="10.2196/25558", url="https://mhealth.jmir.org/2021/9/e25558", url="http://www.ncbi.nlm.nih.gov/pubmed/34550081" } @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/10.2196/25878, 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/10.2196/23916, 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/10.2196/26434, 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/10.2196/25364, author="Vellinga, Akke and Farrell, Karen and Fallon, Roisin and Hare, Daniel and Sutton-Fitzpatrick, Una and Cormican, Martin", title="Presentation, Treatment, and Natural Course of Severe Symptoms of Urinary Tract Infections Measured by a Smartphone App: Observational and Feasibility Study", journal="J Med Internet Res", year="2021", month="Sep", day="3", volume="23", number="9", pages="e25364", keywords="urinary tract infections", keywords="general practice", keywords="smartphone application", keywords="mobile phone", abstract="Background: Urinary tract infections (UTIs) are one of the most common conditions in women. Current information on the presentation, management, and natural course of the infection is based on paper diaries filled out and subsequently posted by patients. Objective: The aim of this study is to explore the feasibility of a smartphone app to assess the natural course and management of UTIs. Methods: A smartphone app was developed to collect data from study participants presenting with symptoms of UTI in general practice. After initial demographic and treatment information, symptom severity was recorded by the patient after a reminder on their smartphone, which occurred twice daily for a period of 7 days or until symptom resolution. Results: A total of 181 women aged 18-76 years downloaded the smartphone app. The duration of symptoms was determined from the results of 178 participants. All patients submitted a urine sample, most patients were prescribed an antibiotic (163/181, 90.1\%), and 38.7\% (70/181) of the patients had a positive culture. Moderately bad or worse symptoms lasted a mean of 3.8 (SD 3.2; median 4) days, and 70.2\% (125/178) of the patients indicated that they were cured on day 4 after consultation. This compares with other research assessing symptom duration and management of UTIs using paper diaries. Patients were very positive about the usability of the smartphone app and often found the reminders supportive. On the basis of the feedback and the analysis of the data, some suggestions for improvement were made. Conclusions: Smartphone diaries for symptom scores over the course of infections are an efficient and acceptable means of collecting data in research. ", doi="10.2196/25364", url="https://www.jmir.org/2021/9/e25364", url="http://www.ncbi.nlm.nih.gov/pubmed/34477567" } @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/10.2196/22608, author="Oakley-Girvan, Ingrid and Davis, Watkins Sharon and Kurian, Allison and Rosas, G. Lisa and Daniels, Jena and Palesh, Gronskaya Oxana and Mesia, J. Rachel and Kamal, H. Arif and Longmire, Michelle and Divi, Vasu", title="Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study", journal="JMIR Form Res", year="2021", month="Aug", day="13", volume="5", number="8", pages="e22608", keywords="cancer", keywords="oncology", keywords="mHealth", keywords="caregiver", keywords="cancer survivor", keywords="mobile app", keywords="smartphone", keywords="feasibility", keywords="caregiver burden", keywords="symptom reporting", abstract="Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 ", doi="10.2196/22608", url="https://formative.jmir.org/2021/8/e22608", url="http://www.ncbi.nlm.nih.gov/pubmed/34398787" } @Article{info:doi/10.2196/22784, author="Siedlikowski, Maia and Curiale, Lianna and Rauch, Frank and Tsimicalis, Argerie", title="Experiences of Children With Osteogenesis Imperfecta in the Co-design of the Interactive Assessment and Communication Tool Sisom OI: Secondary Analysis of Qualitative Design Sessions", journal="JMIR Pediatr Parent", year="2021", month="Aug", day="10", volume="4", number="3", pages="e22784", keywords="child health", keywords="symptom assessment", keywords="communication", keywords="mobile applications", keywords="software", abstract="Background: Children with osteogenesis imperfecta (OI) experience a diversity of symptoms that expose them to difficult physical, mental, and social challenges. Sisom (DHealth) is an interactive assessment and communication tool designed to help children aged 6-12 years with chronic conditions express their symptoms. Recently, the co-design of the Sisom OI paper prototype was launched by seeking the perspectives of end users, including children with OI and their clinicians. Objective: The aim of this study is to describe the experiences that children with OI were prompted to share with researchers during the co-design of the Sisom OI paper prototype. Methods: A secondary analysis of qualitative data was conducted at a university-affiliated, pediatric, orthopedic hospital. The data sources consisted of interview transcripts, drawings, field notes, and observations derived from interviewing 12 children with OI who participated in the co-design of the Sisom OI paper prototype. The themes and subthemes identified from the data sources were generated using qualitative description. Results: Three themes were identified. The first, Relating to Others, described the balance between feeling different versus feeling similar to other children. The subthemes were Common OI Experience, Feeling Different, and Feeling Just Like Others. The second, Relating to Their Condition, described children's positive and negative interactions with their own condition and health care. The subthemes were Understanding Their Condition, Special Relationship with the Hospital, and Difficult Treatments and Procedures. The third, Reflecting on Capabilities, described children's recognition of their strengths and limitations. The subthemes were Perceiving Limitations, Overcoming Isolation, and Celebrating Strengths. Conclusions: This co-design process provided children with OI the space to not only contribute to the development of the end product but also eloquently describe their experiences. These findings, based on the descriptions given by the children themselves, offer us a unique understanding of what it means to grow up with OI. ", doi="10.2196/22784", url="https://pediatrics.jmir.org/2021/3/e22784", url="http://www.ncbi.nlm.nih.gov/pubmed/34383677" } @Article{info:doi/10.2196/24909, author="Hoevenaars, Dirk and Holla, M. Jasmijn F. and te Loo, Leonie and Koedijker, M. Johan and Dankers, Sarah and Houdijk, Han and Visser, Bart and Janssen, J. Thomas W. and de Groot, Sonja and Deutekom, Marije and ", title="Mobile App (WHEELS) to Promote a Healthy Lifestyle in Wheelchair Users With Spinal Cord Injury or Lower Limb Amputation: Usability and Feasibility Study", journal="JMIR Form Res", year="2021", month="Aug", day="9", volume="5", number="8", pages="e24909", keywords="mHealth", keywords="mobile app", keywords="lifestyle", keywords="usability", keywords="feasibility", keywords="wheelchair users", keywords="spinal cord injury", keywords="lower limb amputation", abstract="Background: Maintaining a healthy lifestyle is important for wheelchair users' well-being, as it can have a major impact on their daily functioning. Mobile health (mHealth) apps can support a healthy lifestyle; however, these apps are not necessarily suitable for wheelchair users with spinal cord injury or lower limb amputation. Therefore, a new mHealth app (WHEELS) was developed to promote a healthy lifestyle for this population. Objective: The objectives of this study were to develop the WHEELS mHealth app, and explore its usability, feasibility, and effectiveness. Methods: The WHEELS app was developed using the intervention mapping framework. Intervention goals were determined based on a needs assessment, after which behavior change strategies were selected to achieve these goals. These were applied in an app that was pretested on ease of use and satisfaction, followed by minor adjustments. Subsequently, a 12-week pre-post pilot study was performed to explore usability, feasibility, and effectiveness of the app. Participants received either a remote-guided or stand-alone intervention. Responses to semistructured interviews were analyzed using content analysis, and questionnaires (System Usability Score [SUS], and Usefulness, Satisfaction, and Ease) were administered to investigate usability and feasibility. Effectiveness was determined by measuring outcomes on physical activity, nutrition, sleep quality (Pittsburgh Sleep Quality Index), body composition, and other secondary outcomes pre and post intervention, and by calculating effect sizes (Hedges g). Results: Sixteen behavior change strategies were built into an app to change the physical activity, dietary, sleep, and relaxation behaviors of wheelchair users. Of the 21 participants included in the pilot study, 14 participants completed the study. The interviews and questionnaires showed a varied user experience. Participants scored a mean of 58.6 (SD 25.2) on the SUS questionnaire, 5.4 (SD 3.1) on ease of use, 5.2 (SD 3.1) on satisfaction, and 5.9 (3.7) on ease of learning. Positive developments in body composition were found on waist circumference (P=.02, g=0.76), fat mass percentage (P=.004, g=0.97), and fat-free mass percentage (P=.004, g=0.97). Positive trends were found in body mass (P=.09, g=0.49), BMI (P=.07, g=0.53), daily grams of fat consumed (P=.07, g=0.56), and sleep quality score (P=.06, g=0.57). Conclusions: The WHEELS mHealth app was successfully developed. The interview outcomes and usability scores are reasonable. Although there is room for improvement, the current app showed promising results and seems feasible to deploy on a larger scale. ", doi="10.2196/24909", url="https://formative.jmir.org/2021/8/e24909", url="http://www.ncbi.nlm.nih.gov/pubmed/34379056" } @Article{info:doi/10.2196/29184, author="Park, Sang Hyun and Kim, Il Kwang and Chung, Ho-Young and Jeong, Sungmoon and Soh, Young Jae and Hyun, Ho Young and Kim, Sun Hwa", title="A Worker-Centered Personal Health Record App for Workplace Health Promotion Using National Health Care Data Sets: Design and Development Study", journal="JMIR Med Inform", year="2021", month="Aug", day="4", volume="9", number="8", pages="e29184", keywords="personal health record app", keywords="workplace health promotion", keywords="Fast Healthcare Interoperability Resources", keywords="national health care data set", keywords="human-centered design", abstract="Background: Personal health record (PHR) technology can be used to support workplace health promotion, and prevent social and economic losses related to workers' health management. PHR services can not only ensure interoperability, security, privacy, and data quality, but also consider the user's perspective in their design. Objective: Using Fast Healthcare Interoperability Resources (FHIR) and national health care data sets, this study aimed to design and develop an app for providing worker-centered, interconnected PHR services. Methods: This study considered the user's perspective, using the human-centered design (HCD) methodology, to develop a PHR app suitable for occupational health. We developed a prototype after analyzing quantitative and qualitative data collected from workers and a health care professional group, after which we performed a usability evaluation. We structured workers' PHR items based on the analyzed data, and ensured structural and semantic interoperability using FHIR, Systematized Nomenclature of Medicine--Clinical Terms (SNOMED-CT), and Logical Observation Identifiers Names and Codes (LOINC). This study integrated workers' health information scattered across different Korean institutions through an interface method, and workers' PHRs were managed through a cloud server, using Azure API for FHIR. Results: In total, 562 workers from industrial parks participated in the quantitative study. The preferred data items for PHR were medication, number of steps walked, diet, blood pressure, weight, and blood glucose. The preferred features were ability to access medical checkup results, health information content provision, consultation record inquiry, and teleconsultation. The worker-centered PHR app collected data on, among others, life logs, vital signs, and medical checkup results; offered health care services such as reservation and teleconsultation; and provided occupational safety and health information through material safety data sheet search and health questionnaires. The app reflected improvements in user convenience and app usability proposed by 19 participants (7 health care professionals and 12 end users) in the usability evaluation. The After-Scenario Questionnaire (ASQ) was evaluated with a mean score of 5.90 (SD 0.34) out of 7, and the System Usability Scale (SUS) was evaluated a mean score of 88.7 (SD 4.83) out of 100. Conclusions: The worker-centered PHR app integrates workers' health information from different institutions and provides a variety of health care services from linked institutions through workers' shared PHR. This app is expected to increase workers' autonomy over their health information and support medical personnel's decision making regarding workers' health in the workplace. Particularly, the app will provide solutions for current major PHR challenges, and its design, which considers the user's perspective, satisfies the prerequisites for its utilization in occupational health. ", doi="10.2196/29184", url="https://medinform.jmir.org/2021/8/e29184", url="http://www.ncbi.nlm.nih.gov/pubmed/34346894" } @Article{info:doi/10.2196/24112, author="Derksen, E. Marloes and Jaspers, WM Monique and van Strijp, Sander and Fransen, P. Mirjam", title="Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study", journal="JMIR Form Res", year="2021", month="Aug", day="4", volume="5", number="8", pages="e24112", keywords="think aloud", keywords="heuristic evaluation", keywords="usability", keywords="mHealth", keywords="game elements", keywords="smoking prevention", keywords="user-centered design", keywords="mobile phone", abstract="Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. ", doi="10.2196/24112", url="https://formative.jmir.org/2021/8/e24112", url="http://www.ncbi.nlm.nih.gov/pubmed/34346895" } @Article{info:doi/10.2196/30450, author="Weber, J. Summer and Shearer, Elyse and Mulvaney, A. Shelagh and Schmidt, Douglas and Thompson, Chris and Jones, Jessica and Ahmad, Haseeb and Coe, Martina and Hull, C. Pamela", title="Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach", journal="JMIR Form Res", year="2021", month="Jul", day="30", volume="5", number="7", pages="e30450", keywords="WIC", keywords="mobile technology", keywords="maternal-child health", keywords="childhood obesity", keywords="nutrition", keywords="government programs", keywords="mobile app", keywords="user-centered design", keywords="low income", keywords="women", keywords="infant", keywords="child", keywords="formative", keywords="development", abstract="Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. ", doi="10.2196/30450", url="https://formative.jmir.org/2021/7/e30450", url="http://www.ncbi.nlm.nih.gov/pubmed/34328432" } @Article{info:doi/10.2196/31013, author="Davidson, C. Jennifer and Karadzhov, Dimitar and Wilson, Graham", title="Practitioners' and Policymakers' Successes, Challenges, Innovations, and Learning in Promoting Children's Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey", journal="JMIR Res Protoc", year="2021", month="Jul", day="29", volume="10", number="7", pages="e31013", keywords="mobile phones", keywords="smartphone app", keywords="qualitative", keywords="mixed method", keywords="international", keywords="survey", keywords="service providers", keywords="policy", keywords="practice", keywords="children's rights", keywords="well-being", keywords="COVID-19", keywords="pandemic", keywords="app", keywords="mHealth", keywords="children", abstract="Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children's human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children's Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children's well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners', managers', and policymakers' efforts to support children's well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies---the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents' sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 ", doi="10.2196/31013", url="https://www.researchprotocols.org/2021/7/e31013", url="http://www.ncbi.nlm.nih.gov/pubmed/34323850" } @Article{info:doi/10.2196/23303, author="Materia, T. Frank and Smyth, M. Joshua", title="Acceptability of Intervention Design Factors in mHealth Intervention Research: Experimental Factorial Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="26", volume="9", number="7", pages="e23303", keywords="mHealth", keywords="acceptability", keywords="implementation", keywords="health behavior", keywords="smartphone", keywords="mobile phone", keywords="wearable", abstract="Background: With the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies' scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist. Objective: This study aims to evaluate the impact of two common design factors in mHealth intervention research---requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content---on reported participant acceptability. Methods: A diverse US adult convenience sample (female: 104/255, 40.8\%; White: 208/255, 81.6\%; aged 18-74 years) was recruited to complete a web-based experiment. A 2{\texttimes}2 factorial design (number of devices{\texttimes}nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented. Results: Reported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested. Conclusions: The results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time. ", doi="10.2196/23303", url="https://mhealth.jmir.org/2021/7/e23303", url="http://www.ncbi.nlm.nih.gov/pubmed/34309563" } @Article{info:doi/10.2196/26297, author="Woolf, B. Thomas and Goheer, Attia and Holzhauer, Katherine and Martinez, Jonathan and Coughlin, W. Janelle and Martin, Lindsay and Zhao, Di and Song, Shanshan and Ahmad, Yanif and Sokolinskyi, Kostiantyn and Remayeva, Tetyana and Clark, M. Jeanne and Bennett, Wendy and Lehmann, Harold", title="Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e26297", keywords="mhealth", keywords="circadian", keywords="sleep", keywords="ecological momentary assessment", keywords="timing of eating", keywords="mobile applications", keywords="habits", keywords="body weight", keywords="surveys and questionnaires", abstract="Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ?4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. ", doi="10.2196/26297", url="https://formative.jmir.org/2021/7/e26297", url="http://www.ncbi.nlm.nih.gov/pubmed/34296999" } @Article{info:doi/10.2196/25926, author="Mhende, Josephine and Bell, A. Sharrill and Cottrell-Daniels, Cherell and Luong, Jackie and Streiff, Micah and Dannenfelser, Mark and Hayat, J. Matthew and Spears, Adams Claire", title="Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e25926", keywords="acceptability", keywords="addiction", keywords="African American", keywords="cessation", keywords="COVID-19", keywords="feasibility", keywords="income", keywords="low socioeconomic status", keywords="mHealth", keywords="mindfulness", keywords="minority", keywords="smoking", keywords="SMS", keywords="text messaging", keywords="treatment", abstract="Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program ``iQuit Mindfully'' was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8\%) were female, 19 (82.6\%) were African American, and 18 (78.3\%) had an annual income of