@Article{info:doi/10.2196/66846, author="King, Akilah and Omoniyi, Tayo and Zasadzinski, Lindsay and Gaspard, Cynthia and Gorman, Denesha and Saunders, Milda", title="Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) Education for Hospitalized African American Patients: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Apr", day="17", volume="14", pages="e66846", keywords="chronic kidney disease", keywords="computerized adaptive education", keywords="end-stage kidney disease", keywords="end-stage renal disease", keywords="glomerular filtration rate", keywords="kidney failure", keywords="usual hospital care", keywords="inpatient", abstract="Background: End-stage kidney disease (ESKD) or kidney failure is a condition where the kidneys lose the ability to function. African American individuals are 4 times as likely to develop ESKD compared to White American individuals. In addition, African American patients are less likely to have an optimal dialysis start and to choose renal replacement therapy modalities that align with their goals and values. Our prior work shows that culturally tailored, in-person education improves patient outcomes. This is the foundation for our innovative intervention using an African American virtual patient educator as an option for hospitalized patients with chronic kidney disease (CKD). Objective: The Interactive Computer-Adaptive Chronic Kidney Disease (I-C-CKD) study will determine whether the computerized adaptive education and usual hospital care impact the health literacy of African American patients with kidney disease. It will also assess how patients' lifestyle and commitment to health goals are impacted by the method of health literacy education. Methods: We will screen, recruit, and enroll hospitalized patients who self-identify as African American and have advanced CKD based on their estimated glomerular filtration rate. Eligible patients who verbally consented will be randomly assigned into either the computerized adaptive education intervention group or the control group (usual hospital care). Patients in the intervention group will receive a culturally tailored, adaptive education module. To analyze pretest, posttest, and follow-up survey results on patient CKD knowledge, ESKD treatment options, and health goals, we will use a paired, 2-tailed t test with a Bonferroni adjustment for multiple comparisons. Results: Recruitment for the I-C-CKD study began on May 2, 2023. We are currently recruiting and have enrolled 96 patients who completed both pretest and posttest surveys as of December 2024. This includes 50 patients in the control group and 46 patients in the intervention group. Data analysis has not occurred. Conclusions: African American individuals often receive less patient education about self-care and treatment options for CKD. We hope this study provides a solution to increase hospitalized African American patients' knowledge of CKD and motivation for CKD self-care through computerized adaptive education, reduce disparities, and improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT06364358; https://clinicaltrials.gov/study/NCT06364358 International Registered Report Identifier (IRRID): DERR1-10.2196/66846 ", doi="10.2196/66846", url="https://www.researchprotocols.org/2025/1/e66846" } @Article{info:doi/10.2196/71865, author="Kim, Minjin and Kim, Ellie and Lee, Hyeongsuk and Piao, Meihua and Rosen, Brittany and Allison, J. Jeroan and Zai, H. Adrian and Nguyen, L. Hoa and Shin, Dong-Soo and Kahn, A. Jessica", title="A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study", journal="Asian Pac Isl Nurs J", year="2025", month="Apr", day="7", volume="9", pages="e71865", keywords="human papillomavirus", keywords="HPV vaccination", keywords="artificial intelligence", keywords="AI", keywords="chatbot intervention", keywords="Korean Americans", keywords="usability testing", keywords="culturally tailored intervention", abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)--powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville's usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1\%), second-generation individuals (n=13, 61.9\%), and single (n=20, 95.2\%). HPV awareness was high (n=19, 90.5\%), vaccine knowledge was also high (n=18, 81.8\%), but only 11 (52.4\%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. ", doi="10.2196/71865", url="https://apinj.jmir.org/2025/1/e71865" } @Article{info:doi/10.2196/68242, author="Pereira, P. Ana and Janela, Dora and Areias, C. Anabela and Molinos, Maria and Tong, Xin and Bento, Virg{\'i}lio and Yanamadala, Vijay and Atherton, Jennesa and Dias Correia, Fernando and Costa, Fab{\'i}ola", title="Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="2", volume="13", pages="e68242", keywords="women's health", keywords="pelvic floor muscle training", keywords="physical therapy", keywords="menopause", keywords="digital therapeutics", keywords="biofeedback", keywords="mobile phone", abstract="Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ?40\%?50\% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire--short form 7, Urinary Impact Questionnaire--short form 7, Colorectal-Anal Impact Questionnaire--short form 7, and Pelvic Organ Prolapse Impact Questionnaire--short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6\% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69\%). The overall impact of pelvic floor symptoms in participants' daily lives decreased significantly (?19.55 points, 95\% CI ?22.22 to ?16.88; P<.001; response rate of 59.5\%, 95\% CI 54.9\%-63.9\%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (?18.09, 95\% CI ?19.99 to ?16.20 and ?15.08, 95\% CI ?17.52 to ?12.64, respectively; P<.001). Mental health also improved, with 76.1\% (95\% CI 60.7\%-84.9\%; unadjusted: 97/149, 65.1\%) and 54.1\% (95\% CI 39\%-68.5\%; unadjusted: 70/155, 45.2\%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms' burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 ", doi="10.2196/68242", url="https://mhealth.jmir.org/2025/1/e68242" } @Article{info:doi/10.2196/56798, author="Flaucher, Madeleine and Berzins, Sabrina and Jaeger, M. Katharina and Nissen, Michael and Rolny, Jana and Tri{\ss}ler, Patricia and Eckl, Sebastian and Eskofier, M. Bjoern and Leutheuser, Heike", title="Perception and Evaluation of a Knowledge Transfer Concept in a Digital Health Application for Patients With Heart Failure: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="31", volume="12", pages="e56798", keywords="health literacy", keywords="digital Literacy", keywords="user-centered design", keywords="digital health app", keywords="heart failure", keywords="mixed methods study", keywords="user centered deign", keywords="usability", keywords="patient engagement", keywords="mHealth app", keywords="development", abstract="Background: Digital health education can enhance the quality of life of patients with heart failure by providing accessible and tailored information, which is essential for effective self-care and self-management. Objective: This work aims to develop a mobile health knowledge transfer concept for heart failure in a user-centered design process grounded in theoretical frameworks. This approach centers on enhancing the usability, patient engagement, and meaningfulness of mobile health education in the context of heart failure. Methods: A user-centered design process was employed. First, semistructured stakeholder interviews were conducted with patients (n=9) and medical experts (n=5). The results were used to develop a health knowledge transfer concept for a mobile health app for heart failure. This concept was implemented as a digital prototype based on an existing German mobile health app for patients with heart failure. We used this prototype to evaluate our concept with patients with heart failure in a study composed of user testing and semistructured patient interviews (n=7). Results: Stakeholder interviews identified five themes relevant to mobile health education: individualization, content relevance, media diversity, motivation strategies, and trust-building mechanisms. The evaluation of our prototype showed that patients value the adaptation of content to individual interests and prior knowledge. Digital rewards such as badges and push notifications can increase motivation and engagement but should be used with care to avoid overload, irrelevance, and repetition. Conclusions: Our findings emphasize the importance of tailoring mobile health education to the specific needs and preferences of patients with heart failure. At the same time, they also highlight the careful implementation of motivation strategies to promote user engagement effectively. These implications offer guidance for developing more impactful interventions to improve health outcomes for this population. ", doi="10.2196/56798", url="https://humanfactors.jmir.org/2025/1/e56798" } @Article{info:doi/10.2196/63989, author="Kim, Mi Sun and Kim, Seul Da and Jang, Yoonsung and Kim, Kyoon Min and Yu, Eun-Seung and Han, Hyun Doug and Kim, Jun Hee", title="Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="26", volume="13", pages="e63989", keywords="breast cancer", keywords="mobile health", keywords="mHealth", keywords="health education", keywords="self-efficacy", keywords="psychological adjustments", keywords="mobile phone", abstract="Background: Numerous mobile apps have been developed for patients with cancer. However, there is still no comprehensive app for patients with breast cancer that integrates evidence-based medical information, psychological support, and schedule management through a multidisciplinary medical approach. Objective: We aimed to investigate whether a mobile app designed to assist in the self-management of patients with breast cancer is feasible and positively affects their self-efficacy and other psychological aspects. Methods: The Cancer Manager (CAMA) app was developed to assist in the self-management of patients with breast cancer and survivors of cancer according to cancer trajectory. Its functionalities include providing evidence-based digitalized information created by experts, managing patients' medication and medical appointment schedules, and providing a delayed question and answer system for patients to query health care professionals. In this nonrandomized intervention trial, we analyzed data from 66 patients with breast cancer, divided into experimental (CAMA: n=34, 52\%) and control (treatment as usual: n=32, 48\%) groups. Group allocation was determined based on the patient's willingness to use the app and access to compatible smartphones. Outcome measures included the Korean version of the Cancer Survivor Self-Efficacy Scale, the Korean version of the Mini-Mental Adjustment to Cancer (K-Mini-MAC) Scale, the World Health Organization Quality of Life Brief Version, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Menopause Emotional Symptoms Questionnaire (MESQ). A user satisfaction survey was also conducted. Results: Throughout the intervention period, the CAMA group (vs treatment as usual group) demonstrated significant improvements in the seeking help and support subscale of the Korean version of the Cancer Survivor Self-Efficacy Scale (F1,64=5.09; P=.03), the psychological well-being subscale of the World Health Organization Quality of Life Brief Version (F1,64=5.48; P=.02), the anxious preoccupation subscale (F1,64=5.49; P=.02) and positive attitude subscale (F1,64=5.44; P=.02) of the K-Mini-MAC Scale, PHQ-9 (F1,64=4.83; P=.03), GAD-7 (F1,64=5.48; P=.02), and MESQ (F1,64=4.30; P=.04). Changes in the anxious preoccupation subscale of the K-Mini-MAC Scale scores were positively correlated with changes in the PHQ-9 (r=0.46; P=.007) and GAD-7 (r=0.41; P=.02) scores and negatively correlated with changes in the positive attitude subscale of the K-Mini-MAC Scale scores (r=--0.36; P=.04). Changes in the PHQ-9 scores were positively correlated with changes in the GAD-7 (r=0.66; P<.001) and MESQ (r=0.35; P=.04) scores. The user satisfaction survey offered insights into the CAMA app's positive impact; trust-building outcomes; and opportunities for enhancement, such as the inclusion of communication tools and continued content enrichment. Conclusions: The mobile app for breast cancer self-management, CAMA, was deemed feasible and showed promise in improving the patients' self-efficacy regarding seeking help and support, positive attitude toward cancer, and psychological well-being. In addition, its use might help reduce anxious preoccupation with cancer, depressive mood, anxiety, and menopausal emotional symptoms. Trial Registration: Clinical Research Information Service KCT0007917; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23348 ", doi="10.2196/63989", url="https://mhealth.jmir.org/2025/1/e63989" } @Article{info:doi/10.2196/72675, author="Yang, Alina", title="Pediatric Hearts and Minds: Reimagining Health Education Through Play and Narrative", journal="JMIR Pediatr Parent", year="2025", month="Mar", day="13", volume="8", pages="e72675", keywords="congenital heart disease", keywords="children health literacy", keywords="health education", keywords="health education interventions", keywords="patient-centered care", keywords="design", keywords="pediatric", keywords="PRISMA", doi="10.2196/72675", url="https://pediatrics.jmir.org/2025/1/e72675" } @Article{info:doi/10.2196/65685, author="Shi, Xiaoyu and Wang, Yijun and Wang, Yuhong and Wang, Jun and Peng, Chen and Cheng, Siyi and Song, Lingpeng and Li, Rui and Guo, Fuding and Li, Zeyan and Duan, Shoupeng and Yang, Xiaomeng and Zhou, Liping and Jiang, Hong and Yu, Lilei", title="The Effectiveness of Digital Animation--Based Multistage Education for Patients With Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial", journal="J Med Internet Res", year="2025", month="Mar", day="11", volume="27", pages="e65685", keywords="animation education", keywords="digital health care", keywords="atrial fibrillation", keywords="catheter ablation", keywords="video", keywords="mHealth", keywords="digital care", keywords="digital health", keywords="digital animation", keywords="randomized clinical trial", keywords="RCT", keywords="digital education", keywords="outpatient", keywords="AFCA", keywords="atrial fibrillation catheter ablation", keywords="therapeutic", keywords="cardiac arrhythmia", keywords="Asian", keywords="animations", keywords="comics", abstract="Background: Digital education for outpatient patients with atrial fibrillation (AF) has gradually increased. However, research on digital education for patients undergoing atrial fibrillation catheter ablation (AFCA) is limited. Objective: This study aimed to develop a novel digital animation-based multistage education system and evaluate its quality-of-life benefits for patients with AFCA. Methods: This randomized controlled clinical trial included 208 patients with AF who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. The patients were randomly assigned to the digital animation intervention (n=104) and standard treatment (n=104) groups. The primary outcome was the difference in the quality of life of patients with atrial fibrillation (AF-QoL-18) scores at 3 months. Secondary outcomes included differences in scores on the 5-item Medication Adherence Report Scale (MARS-5), Self-rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at 3 months. Results: In the digital animation intervention group, the AF-QoL-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94), 3 months post discharge from the hospital. In the conventional treatment group, the AF-QoL-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18). The mean difference in AF-QoL-18 score change between the 2 groups was 1.41 (95\% CI 2.42-0.40, P=.006) at 3 months. The mean difference in MARS-5 score change was 1.76 (95\% CI 2.42-1.10, P<.001). The mean difference in SAS score was --2.91 (95\% CI --3.88 to --1.95, P<.001). Additionally, the mean difference in SDS score was --1.23 (95\% CI --0.02 to --2.44, P=.047). Conclusions: Our study introduces a novel digital animation educational approach that provides multidimensional, easily understandable, and multistage education for patients with AF undergoing catheter ablation. This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post discharge. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400081673; https://www.chictr.org.cn/showproj.html?proj=201059 ", doi="10.2196/65685", url="https://www.jmir.org/2025/1/e65685" } @Article{info:doi/10.2196/64171, author="Gaynor, Mathew and Hesketh, Kylie and Gebremariam, Kidane and Wynter, Karen and Laws, Rachel", title="Practicality of the My Baby Now App for Fathers by Fathers: Qualitative Case Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="21", volume="8", pages="e64171", keywords="fathers", keywords="parenting resources", keywords="health promotion", keywords="My Baby Now", keywords="MBN", keywords="app", keywords="mobile phone", abstract="Background: Evolving societal trends are resulting in fathers having an increasing influence on the health-related behaviors that children develop. Research shows that most fathers are committed to their role and when equipped with knowledge, can have a positive impact on their child's health. However, parenting resources typically target mothers, with fathers being excluded. While evolving mobile phone technology provides an efficient means for delivering parenting resources, many fathers find that mobile health (mHealth) technology does not provide material they can engage with. Objective: This study aimed to explore how to make parenting apps more engaging and useful for fathers using an existing parenting mHealth resource, the My Baby Now app, as a case study. Methods: A total of 14 purposefully selected, Australian fathers of 7 months to 5-year-old children took part in a qualitative study, comprising either focus groups or interviews. Recorded focus groups and interviews were transcribed verbatim, then coded using a combination of deductive and inductive methods. Reflexive thematic analysis was undertaken to identify patterns and themes. Results: Current parenting apps provide parenting information that can be unappealing for fathers. To improve paternal engagement with mHealth resources, fathers highlighted the need for father specific information, with an increase in positive imagery and positive descriptions of fathers in their parenting role. There should be father-exclusive domains such as forums, and also push notifications to provide positive reinforcement and encouragement for fathers. Conclusions: mHealth has the capacity to deliver information to fathers when needed. This reduces the risk of paternal frustration and disengagement from parenting. Further benefit will be gained by research to understand possible differences in mHealth app usage by fathers of differing socioeconomic position, cultural backgrounds, and family status, such as single fathers and same-sex couples. ", doi="10.2196/64171", url="https://pediatrics.jmir.org/2025/1/e64171", url="http://www.ncbi.nlm.nih.gov/pubmed/39982774" } @Article{info:doi/10.2196/66702, author="He, Lin and Jiang, Shaoqiang and Jiang, Tingting and Chen, Wanjun and Zheng, Jinlei and Wang, Hui and Chai, Chengliang", title="A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e66702", keywords="men who have sex with men", keywords="MSM", keywords="internet", keywords="recruit", keywords="HIV testing", keywords="community organization", keywords="strategy", keywords="China", keywords="mobile phone", abstract="Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66\%) were recruited through the mobile social media strategy. Overall, 1.4\% (66/4600) of participants tested positive for HIV, and 18.8\% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95\% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95\% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95\% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95\% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95\% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95\% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95\% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95\% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95\% CI 1.09-1.52). Conclusions: Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM. ", doi="10.2196/66702", url="https://www.jmir.org/2025/1/e66702" } @Article{info:doi/10.2196/60862, author="Hao, Haijing and Lee, W. Yang and Sharko, Marianne and Li, Qilu and Zhang, Yiye", title="Privacy Concerns Versus Personalized Health Content---Pregnant Individuals' Willingness to Share Personal Health Information on Social Media: Survey Study", journal="JMIR Form Res", year="2025", month="Feb", day="10", volume="9", pages="e60862", keywords="privacy concerns", keywords="trust", keywords="pregnancy", keywords="health information seeking", keywords="pregnant women", keywords="maternal", keywords="maternity", keywords="childbearing", keywords="web-based information", keywords="health information", keywords="mental health", keywords="internet", keywords="social support", keywords="technology", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="health informatics", keywords="social media", abstract="Background: Often lacking immediate access to care providers, pregnant individuals frequently turn to web-based sources for information to address their evolving physical and mental health needs. Social media has gained increasing prominence as a source of news and information despite privacy concerns and unique risks posed to the pregnant population. Objectives: This study investigated the extent to which patients may be willing to disclose personal health information to social media companies in exchange for more personalized health content. Methods: We designed and deployed an electronic survey to pregnant individuals worldwide electronically in 2023. We used the classical Internet Users' Information Privacy Concerns (IUIPC) model to examine how privacy concerns modulate pregnant individuals' behaviors and beliefs regarding risk and trust when using social media for health purposes. Results were analyzed using partial least squares structural equation modeling. Results: Among 317 respondents who initiated the survey, 84\% (265/317) of the respondents remained in the study, providing complete responses. Among them, 54.7\% (145/265) indicated willingness to provide their personalized health information for receiving personalized health content via social media, while 26\% (69/265) were uncertain and 19.3\% (51/265) were opposed. Our estimated IUIPC model results are statistically significant and qualitatively align with the classic IUIPC model for the general population, which was previously found in an e-commerce context. The structural model revealed that privacy concerns (IUIPC) negatively affected trusting beliefs ($\beta$=?0.408; P<.001) and positively influenced risk beliefs ($\beta$=0.442; P<.001). Trusting beliefs negatively impacted risk beliefs ($\beta$=?o.362; P<.001) and positively affected the intention to disclose personal health information ($\beta$=o.266; P<.001). Risk beliefs negatively influenced the intention to disclose ($\beta$=?0.281; P<.001). The model explained 41.5\% of the variance in the intention to disclose personal health information (R{\texttwosuperior}=0.415). In parallel with pregnant individuals' willingness to share, we find that they have heightened privacy concerns and their use of social media for information seeking is largely impacted by their trust in the platforms. This heightened concern significantly affects both their trusting beliefs, making them less inclined to trust social media companies, and their risk beliefs, leading them to perceive greater risks in sharing personal health information. However, within this population, an increase in trust toward social media companies leads to a more substantial decrease in perceived risks than what has been previously observed in the general population. Conclusions: We find that more than half of the pregnant individuals are open to sharing their personal health information to receive personalized content about health via social media, although they have more privacy concerns than the general population. This study emphasizes the need for policy regarding the protection of health data on social media for the pregnant population and beyond. ", doi="10.2196/60862", url="https://formative.jmir.org/2025/1/e60862" } @Article{info:doi/10.2196/68743, author="Shikino, Kiyoshi and Yamauchi, Kazuyo and Araki, Nobuyuki and Shimizu, Ikuo and Kasai, Hajime and Tsukamoto, Tomoko and Tajima, Hiroshi and Li, Yu and Onodera, Misaki and Ito, Shoichi", title="Understanding Community Health Care Through Problem-Based Learning With Real-Patient Videos: Single-Arm Pre-Post Mixed Methods Study", journal="JMIR Med Educ", year="2025", month="Jan", day="31", volume="11", pages="e68743", keywords="community health care", keywords="community-oriented medical education", keywords="mixed method", keywords="problem-based learning", keywords="real-patient video", abstract="Background: Japan faces a health care delivery challenge due to physician maldistribution, with insufficient physicians practicing in rural areas. This issue impacts health care access in remote areas and affects patient outcomes. Educational interventions targeting students' career decision-making can potentially address this problem by promoting interest in rural medicine. We hypothesized that community-based problem-based learning (PBL) using real-patient videos could foster students' understanding of community health care and encourage positive attitudes toward rural health care. Objective: This study investigated the impact of community-based PBL on medical students' understanding and engagement with rural health care, focusing on their knowledge, skills, and career orientation. Methods: Participants were 113 fourth-year medical students from Chiba University, engaged in a transition course between preclinical and clinical clerkships from October 24 to November 2, 2023. The students were randomly divided into 16 groups (7-8 participants per group). Each group participated in two 3-hour PBL sessions per week over 2 consecutive weeks. Quantitative data were collected using pre- and postintervention questionnaires, comprehension tests, and tutor-assessed rubrics. Self-assessment questionnaires evaluated the students' interest in community health care and their ability to envision community health care settings before and after the intervention. Qualitative data from the students' semistructured interviews after the PBL sessions assessed the influence of PBL experience on clinical clerkship in community hospitals. Statistical analysis included median (IQR), effect sizes, and P values for quantitative outcomes. Thematic analysis was used for qualitative data. Results: Of the 113 participants, 71 (62.8\%) were male and 42 (37.2\%) female. The total comprehension test scores improved significantly (pretest: median 4.0, IQR 2.5-5.0; posttest: median 5, IQR 4-5; P<.001; effect size r=0.528). Rubric-based assessments showed increased knowledge application (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.494) and self-directed learning (pretest: median 8, IQR 7-9; posttest: median 8, IQR 8-8; P<.001; r=0.553). Self-assessment questionnaires revealed significant improvements in the students' interest in community health care (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001) and their ability to envision community health care settings (median 3, IQR 3-4 to median 4, IQR 3-4; P<.001). Thematic analysis revealed key themes, such as ``empathy in patient care,'' ``challenges in home health care,'' and ``professional identity formation.'' Conclusions: Community-based PBL with real-patient videos effectively enhances medical students' understanding of rural health care settings, clinician roles, and the social needs of rural patients. This approach holds potential as an educational strategy to address physician maldistribution. Although this study suggests potential for fostering positive attitudes toward rural health care, further research is needed to assess its long-term impact on students' career trajectories. ", doi="10.2196/68743", url="https://mededu.jmir.org/2025/1/e68743" } @Article{info:doi/10.2196/59597, author="Nigro, Rose Alexandra and Osman, Alim and Saal, Charles Ryan and Smith, James Robert", title="Information Regarding Dermatology as Seen on the Social Media Platform TikTok", journal="JMIR Dermatol", year="2025", month="Jan", day="28", volume="8", pages="e59597", keywords="internet", keywords="social media", keywords="dermatology", keywords="TikTok", keywords="health care information", keywords="dermatological content", keywords="statistical analysis", keywords="dermatologists", keywords="online content", keywords="misinformation", keywords="engagement", keywords="health information", keywords="patient health", keywords="web platforms", keywords="patient education", keywords="digital health", keywords="online information", keywords="skin care", keywords="online videos", doi="10.2196/59597", url="https://derma.jmir.org/2025/1/e59597" } @Article{info:doi/10.2196/64814, author="Barbazi, Neda and Shin, Youn Ji and Hiremath, Gurumurthy and Lauff, Anne Carlye", title="Exploring Health Educational Interventions for Children With Congenital Heart Disease: Scoping Review", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="24", volume="8", pages="e64814", keywords="congenital heart disease", keywords="children health literacy", keywords="health education", keywords="health education interventions", keywords="patient-centered care", keywords="design", keywords="pediatric", keywords="PRISMA", abstract="Background: Congenital heart disease (CHD) is the most common birth defect, affecting 40,000 births annually in the United States. Despite advances in medical care, CHD is often a chronic condition requiring continuous management and education. Effective care management depends on children's understanding of their condition. This highlights the need for targeted health educational interventions to enhance health literacy among children with CHD. Objective: This scoping review aims to map and explore existing health educational interventions for children with CHD. The review identifies the types of interventions, target populations, delivery methods, and assessed outcomes. The goal is to consolidate fragmented research, identify gaps, and establish future research agendas. Methods: Comprehensive searches were conducted in February 2024 using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework across multiple databases: APA PsycINFO, MedlinePlus via Ovid, Web of Science, ACM Digital Library, Scopus, and EBSCOhost (CINAHL Complete, CINAHL Ultimate, Health Source: Nursing/Academic Edition, and ERIC). The search covered health care, design, and human-computer interaction disciplines to capture the interdisciplinary nature of CHD health educational interventions. There was no predefined time limit due to the limited number of relevant studies. Eligible studies were in English, published in peer-reviewed journals, and focused on primary data about educational health interventions for children with CHD. We extracted and synthesized data using thematic analysis. Results: The review identified 11 studies: 9 randomized controlled trials and 2 observational studies. These used 6 educational strategies: 3D patient-specific models (n=3), habit formation interventions (n=2), empowerment-based health education programs (n=2), rehabilitation interventions (n=2), web-based portals (n=1), and videotape presentations (n=1). Interventions ranged from brief outpatient sessions to 1.5-year programs, with follow-up from none to 24 months. Studies aimed to improve coping, self-management, and knowledge for children with CHD and their families. The most frequently used assessment method was the independent samples t test (n=4) for pre- and postassessments, and all 11 studies used questionnaires, 8 of which incorporated qualitative feedback. The target participants for these interventions were children aged 13 years and older (n=3), parents (n=2), and children of various ages and their parents (n=6). Outcomes included improved children's health literacy, reduced parental burden, and increased health care provider efficiency. Conclusions: This review underscores the critical need for tailored educational interventions for children with CHD. Current research mainly focuses on adolescents and relies heavily on parental involvement, possibly overlooking the specific needs of younger children younger than 13 years of age. It is essential to develop engaging, age-appropriate interventions that actively involve children with CHD in their health care journey. Effective health educational interventions are crucial in empowering these young patients and improving their long-term health outcomes. ", doi="10.2196/64814", url="https://pediatrics.jmir.org/2025/1/e64814" } @Article{info:doi/10.2196/56941, author="Specht, Lisa and Scheible, Raphael and Boeker, Martin and Farin-Glattacker, Erik and Kampel, Nikolas and Schm{\"o}lz, Marina and Sch{\"o}pf-Lazzarino, Andrea and Schulz, Stefan and Schlett, Christian and Thomczyk, Fabian and Voigt-Radloff, Sebastian and Wegner, Constanze and Wollmann, Katharina and Maun, Andy", title="Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis", journal="JMIR Hum Factors", year="2025", month="Jan", day="23", volume="12", pages="e56941", keywords="medical information", keywords="health information", keywords="search engine", keywords="user behavior", keywords="health literacy", keywords="digital health literacy", keywords="navigational needs", keywords="information-seeking behavior", keywords="evidence-based content", keywords="Germany", abstract="Background: The internet is a key source of health information, but the quality of content from popular search engines varies, posing challenges for users---especially those with low health or digital health literacy. To address this, the ``tala-med'' search engine was developed in 2020 to provide access to high-quality, evidence-based content. It prioritizes German health websites based on trustworthiness, recency, user-friendliness, and comprehensibility, offering category-based filters while ensuring privacy by avoiding data collection and advertisements. Objective: This study aims to evaluate the acceptance and usability of this independent, noncommercial search engine from the users' perspectives and their actual use of the search engine. Methods: For the questionnaire study, a cross-sectional study design was used. In total, 802 participants were recruited through a web-based panel and were asked to interact with the new search engine before completing a web-based questionnaire. Descriptive statistics and multiple regression analyses were used to assess participants' acceptance and usability ratings, as well as predictors of acceptance. Furthermore, from October 2020 to June 2021, we used the open-source web analytics platform Matomo to collect behavior-tracking data from consenting users of the search engine. Results: The study indicated positive findings on the acceptance and usability of the search engine, with more than half of the participants willing to reuse (465/802, 58\%) and recommend it (507/802, 63.2\%). Of the 802 users, 747 (93.1\%) valued the absence of advertising. Furthermore, 92.3\% (518/561), 93.9\% (553/589), 94.7\% (567/599), and 96.5\% (600/622) of those users who used the filters agreed at least partially that the filter functions were helpful in finding trustworthy, recent, user-friendly, or comprehensible results. Participants criticized some of the search results regarding the selection of domains and shared ideas for potential improvements (eg, for a clearer design). Regression analyses showed that the search engine was especially well accepted among older users, frequent internet users, and those with lower educational levels, indicating an effective targeting of segments of the population with lower health literacy and digital health literacy. Tracking data analysis revealed 1631 sessions, comprising 3090 searches across 1984 unique terms. Users performed 1.64 (SD 1.31) searches per visit on average. They prioritized the search terms ``corona,'' ``back pain,'' and ``cough.'' Filter changes were common, especially for recency and trustworthiness, reflecting the importance that users placed on these criteria. Conclusions: User questionnaires and behavior tracking showed the platform was well received, particularly by older and less educated users, especially for its advertisement-free design and filtering system. While feedback highlighted areas for improvement in design and filter functionality, the search engine's focus on transparency, evidence-based content, and user privacy shows promise in addressing health literacy and navigational needs. Future updates and research will further refine its effectiveness and impact on promoting access to quality health information. ", doi="10.2196/56941", url="https://humanfactors.jmir.org/2025/1/e56941" } @Article{info:doi/10.2196/54148, author="Li, Suya and Chen, Hui-Jun and Zhou, Jie and Zhouchen, Yi-Bei and Wang, Rong and Guo, Jinyi and Redding, R. Sharon and Ouyang, Yan-Qiong", title="Effectiveness of a Web-Based Medication Education Course on Pregnant Women's Medication Information Literacy and Decision Self-Efficacy: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Jan", day="22", volume="27", pages="e54148", keywords="decision self-efficacy", keywords="self-efficacy", keywords="decision efficacy", keywords="medication information literacy", keywords="information literacy", keywords="web-based medication education", keywords="medication education", keywords="web-based platforms", keywords="pregnant women", keywords="pregnancy", keywords="RCT", keywords="randomized controlled trial", abstract="Background: Medication-related adverse events are common in pregnant women, and most are due to misunderstanding medication information. The identification of appropriate medication information sources requires adequate medical information literacy (MIL). It is important for pregnant women to comprehensively evaluate the risk of medication treatment, self-monitor their medication response, and actively participate in decision-making to reduce medication-related adverse events. Objective: This study aims to examine the effectiveness of a medication education course on a web-based platform in improving pregnant women's MIL and decision self-efficacy. Methods: A randomized controlled trial was conducted. Pregnant women were recruited from January to June 2021 in the Department of Obstetrics and Gynecology of a large hospital in a major city in central China. A total of 108 participants were randomly divided into a control group (CG), which received routine prenatal care from nurses and physicians, and an intervention group (IG), which received an additional 3-week web-based medication education course based on the theory of planned behavior as part of routine prenatal care. Participants completed a Medication Information Literacy Scale and a decision self-efficacy questionnaire at baseline, upon completion of the intervention, and at a 4-week follow-up. Generalized estimation equations (GEE) were used to analyze the main effect (time and grouping) and interaction effect (grouping{\texttimes}time) of the 2 outcomes. The CONSORT-EHEALTH (V 1.6.1) checklist was used to guide the reporting of this randomized controlled trial. Results: A total of 91 pregnant women (48 in the IG and 43 in the CG) completed the questionnaires at the 3 time points. The results of GEE indicated that there was no statistically significant difference in time{\texttimes}group interactions of MIL between the 2 groups (F2=3.12; P=.21). The results of the main effect analysis showed that there were statistically significant differences in MIL between the 2 groups at T1 and T2 (F1=17.79; P<.001). Moreover, the results of GEE indicated that there was a significant difference in decision self-efficacy regarding the time factor, grouping factor, and time{\texttimes}group interactions (F2=21.98; P<.001). The results of the simple effect analysis indicated a statistically significant difference in decision self-efficacy between the 2 groups at T1 (F1=36.29; P<.001) and T2 (F1=36.27; P<.001) compared to T0. Results showed that MIL and decision self-efficacy in the IG were found to be significantly higher than those in the CG (d=0.81; P<.001 and d=1.26; P<.001, respectively), and they remained significantly improved at the 4-week follow-up (d=0.59; P<.001 and d=1.27; P<.001, respectively). Conclusions: Web-based medication education courses based on the theory of planned behavior can effectively improve pregnant women's MIL and decision self-efficacy, and they can be used as supplementary education during routine prenatal care. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041817; https://www.chictr.org.cn/showproj.html?proj=66685 ", doi="10.2196/54148", url="https://www.jmir.org/2025/1/e54148" } @Article{info:doi/10.2196/65372, author="Liao, Jiaman and Huang, Xueliang and Huang, Hao and Shen, Cuina and Li, Lixia and Li, Yushao and Zhan, Yiqiang", title="Analysis of ``Dr Ding Xiang'' on WeChat in China to Determine Factors Influencing Readership on Medical Social Media: Observational Study", journal="J Med Internet Res", year="2025", month="Jan", day="20", volume="27", pages="e65372", keywords="WeChat Official Accounts", keywords="Dr Ding Xiang", keywords="health communication", keywords="information dissemination", keywords="readership analysis", abstract="Background: With the rapid expansion of social media platforms, the demand for health information has increased substantially, leading to innovative approaches and new opportunities in health education. Objective: This study aims to analyze the characteristics of articles published on the ``Dr Ding Xiang'' WeChat official account (WOA), one of the most popular institutional accounts on the WeChat platform, to identify factors influencing readership engagement and to propose strategies for enhancing the effectiveness of health information dissemination. Methods: A total of 5286 articles published on the ``Dr Ding Xiang'' WOA from January 2021 to December 2021 were collected and analyzed. Additionally, a random sample of 324 articles was selected for detailed text analysis. Univariate analysis was conducted using the chi-square test, and multivariate analysis was performed using multivariable logistic regression. Results: In 2021, the total number of reads for ``Dr Ding Xiang'' articles reached 323,479,841, with an average of 61,196 reads per article. Articles exceeding 100,000 reads accounted for 33.90\% of the total. Most articles were published during the time slots of 8:00-10:00 AM, 11:30 AM to 1:30 PM, and 8:30-10:30 PM. Analysis indicated that the order of publication, style of the title sentence, number of likes, number of in-views, total likes on comments, and number of replies to comments were significantly associated with an article's number of reads. Text analysis further revealed that the article's reasoning approaches and concluding methods also had a significant impact on readership. Conclusions: To enhance readership and the effectiveness of health communication, health-focused WOAs should consider key factors such as optimal publication timing, engaging title design, and effective content structuring. Attention to these elements can improve user engagement and support the broader dissemination of health information. ", doi="10.2196/65372", url="https://www.jmir.org/2025/1/e65372" } @Article{info:doi/10.2196/65247, author="Krishnamurti, Tamar and Moon, Rachel and Richichi, Rudolph and Berger, Rachel", title="Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="14", volume="8", pages="e65247", keywords="SIDS", keywords="infant death", keywords="sleep", keywords="sudden infant death", keywords="US", keywords="United States", keywords="infant", keywords="infancy", keywords="baby", keywords="prenatal", keywords="safe sleep", keywords="breastfeeding", keywords="infant care", keywords="pregnancy", keywords="app", keywords="randomized controlled study", keywords="TodaysBaby", keywords="mobile health", keywords="mHealth", keywords="smartphone", abstract="Background: Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. Objective: This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. Methods: This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5\% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. Results: A total of 7572 pregnant persons were enrolled in the TodaysBaby Program---3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8\% with push notifications and 3.0\% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Conclusions: Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID---a leading cause of infant death after 1 month of age---appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact. ", doi="10.2196/65247", url="https://pediatrics.jmir.org/2025/1/e65247" } @Article{info:doi/10.2196/54241, author="Brzozowska, Martyna Justyna and Gotlib, Joanna", title="Social Media Potential and Impact on Changing Behaviors and Actions in Skin Health Promotion: Systematic Review", journal="J Med Internet Res", year="2025", month="Jan", day="6", volume="27", pages="e54241", keywords="skin", keywords="social media", keywords="prevention", keywords="behavioral intervention", keywords="skin cancer", keywords="sun protection", keywords="acne", abstract="Background: Social media is used as a tool for information exchange, entertainment, education, and intervention. Intervention efforts attempt to engage users in skin health. Objective: This review aimed to collect and summarize research assessing the impact of social media on skin health promotion activities undertaken by social media users. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, the following scientific databases were searched: Scopus, Web of Science, PubMed, Academic Search Ultimate (via EBSCO), Academic Research Source eJournals (via EBSCO), ERIC (via EBSCO), Health Source: Consumer Edition (via EBSCO), and Health Source: Nursing/Academic Edition (via EBSCO). Using ProQuest Dissertations and Theses, OpenGrey, Grey Literature Report, and MedNar, the search was supplemented with gray literature. Articles on skin care, skin health, skin diseases, skin protection, and educational activities promoting healthy skin on social media were selected for review (search date: February 6, 2023). The following qualification criteria were used: original research; research conducted on social media; and research topics regarding educational activities in skin health promotion, skin care, skin health, skin diseases, and skin protection. To assess the risk of bias, the following tools were used: the Cochrane Collaboration tool for risk-of-bias assessment (randomized controlled trials and quasi-experimental studies) and the Centre for Evidence-Based Medicine checklist (cross-sectional studies). Results: Altogether, 1558 works were considered, of which 23 (1.48\%) qualified, with 3 (13\%) studies on acne and 20 (87\%) on skin cancer, sunscreen, and tanning. Social media interventions were dealt with in 65\% (15/23) of the studies. The review made it possible to investigate cognitive and cognitive-behavioral interventions. In both observational and interventional studies, the most frequently discussed topics were skin exposure and protection against UV radiation and skin cancer. The analyzed research showed that social media is a source of information. Visualization has a strong impact on users. The involvement of social media users is measured through the amount of content shared and contributes to changing attitudes and behaviors regarding skin health. Conclusions: This review outlined the impact of social media, despite its heterogeneity, on users' skin health behaviors, attitudes, and actions. It identified strategies for digital interventions to promote skin health. In health sciences, a standardized tool is needed to assess the quality of social media digital interventions. This review has several limitations: only articles written in English were considered; ongoing studies were omitted; and there was a small number of interventional studies on acne and a lack of research on daily skin care, education, and antiaging activities on social media. Another limitation, resulting from the topic being too broad, was a failure to perform quantitative data analysis, resulting in the studies that qualified for the review being heterogeneous. ", doi="10.2196/54241", url="https://www.jmir.org/2025/1/e54241" } @Article{info:doi/10.2196/58306, author="Hansen, Steffen and Jensen, Secher Tue and Schmidt, Mette Anne and Str{\o}m, Janni and Vistisen, Peter and H{\o}ybye, Terp Mette", title="The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e58306", keywords="public health", keywords="health information", keywords="patient information", keywords="animation video", keywords="digital health", keywords="visualization", keywords="memory", keywords="recall", keywords="education", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="systematic", keywords="PRISMA", abstract="Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (?18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials---3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and T{\"u}rkiye, respectively---met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73\%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display\_record.php?RecordID=380016 ", doi="10.2196/58306", url="https://www.jmir.org/2024/1/e58306" } @Article{info:doi/10.2196/55300, author="Peerawong, Thanarpan and Phenwan, Tharin and Makita, Meiko and Supanichwatana, Sojirat and Puttarak, Panupong and Siammai, Naowanit and Sunthorn, Prakaidao", title="Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study", journal="JMIR Cancer", year="2024", month="Dec", day="24", volume="10", pages="e55300", keywords="cannabis", keywords="medical cannabis", keywords="Thailand", keywords="critical discourse analysis", keywords="mixed method study", keywords="breast cancer", keywords="digital literacy", keywords="legislation", keywords="health literacy", abstract="Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis--related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis--related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34\%), government sources (16/62, 26\%), health care providers (12/62, 19\%), and alternative medicine providers (12/62, 19\%). Most of the contents (30/62, 48\%) were uploaded to YouTube, whereas 31\% (19/62) appeared on websites and Facebook. Forty of 62 content items (64\%) were news-related and generic cannabis advertisements while 8 of 62 (13\%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ``high'' when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81\% and 98\%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis--related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. ", doi="10.2196/55300", url="https://cancer.jmir.org/2024/1/e55300" } @Article{info:doi/10.2196/58757, author="Onishi, Ryuta", title="Parental Information-Use Strategies in a Digital Parenting Environment and Their Associations With Parental Social Support and Self-Efficacy: Cross-Sectional Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="19", volume="7", pages="e58757", keywords="parenting", keywords="information use", keywords="digital society", keywords="online information", keywords="social support", keywords="self-efficacy", keywords="parents", keywords="surveys", keywords="information seeking", keywords="information behaviors", keywords="resources", keywords="children", keywords="youth", keywords="pediatric", abstract="Background: In today's digital society, the acquisition of parenting information through online platforms such as social networking sites (SNSs) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of parental social support and self-efficacy. Methods: An internet-based survey was administered to fathers and mothers of children aged 0-3 years. Convenience sampling, facilitated by an internet-based survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics, frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals), availability of parental social support, and parental self-efficacy. The Partitioning Around Medoids (PAM) clustering algorithm was used to identify patterns in parenting information use. Results: A total of 4 clusters were identified: multisource gatherers (n=161), offline-centric gatherers (n=105), online-centric gatherers (n=86), and minimal information gatherers (n=68). The availability of parental social support was perceived to be relatively higher among multisource and offline-centric gatherers compared with online-centric and minimal information gatherers. Parental self-efficacy was highest among multisource gatherers, followed by offline-centric and online-centric gatherers, and lowest among minimal information gatherers. Conclusions: This study contributes to the evidence that online information can effectively complement offline information in addressing parenting challenges, although its ability to fully replace offline sources remains limited. Parenting support professionals are encouraged to understand parents' current information use strategies and actively foster their social relationships, helping them to adopt more diverse and comprehensive approaches to information use. ", doi="10.2196/58757", url="https://pediatrics.jmir.org/2024/1/e58757" } @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/10.2196/60283, author="Muenster, Mika Roxana and Gangi, Kai and Margolin, Drew", title="Alternative Health and Conventional Medicine Discourse About Cancer on TikTok: Computer Vision Analysis of TikTok Videos", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e60283", keywords="misinformation", keywords="social media", keywords="TikTok", keywords="alternative health", keywords="cancer", keywords="computer vision", abstract="Background: Health misinformation is abundant online and becoming an increasingly pressing concern for both oncology practitioners and patients with cancer. On social media platforms, including the popular audiovisual app TikTok, the flourishing alternative health industry is further contributing to the spread of misleading and often harmful information, endangering patients' health and outcomes and sowing distrust of the medical community. The prevalence of false and potentially dangerous treatments on a platform that is used as a quasi--search engine by young people poses a serious risk to the health of patients with cancer. Objective: This study seeks to examine how cancer discourse on TikTok differs between alternative health and conventional medicine videos. It aims to look beyond mere facts and falsehoods that TikTok users may utter to understand the visual language and format used in the support of both misleading and truthful narratives, as well as other messages. Methods: Using computer vision analysis and subsequent qualitative close reading of 831 TikTok videos, this study examined how alternative health and conventional medicine videos on cancer differ with regard to the visual language used. Videos were examined for the length of time and prominence in which faces are displayed, as well as for the background setting, location, and dominant color scheme. Results: The results show that the alt-health and conventional health samples made different use of the audiovisual affordances of TikTok. First, videos from the alternative health sample were more likely to contain a single face that was prominently featured (making up at least 7.5\% of the image) for a substantial period of time (35\% of the shots), with these testimonial-style videos making up 28.5\% (93/326) of the sample compared to 18.6\% (94/505) of the conventional medicine sample. Alternative health videos predominantly featured cool tones (P<.001) and were significantly more likely to be filmed outdoors (P<.001), whereas conventional medicine videos were more likely to be shot indoors and feature warm tones such as red, orange, or yellow. Conclusions: The findings of this study contribute to an increased understanding of misinformation as not merely a matter of individual falsehoods but also a phenomenon whose effects might be transported through emotive as well as rational means. They also point to influencer practices and style being an important contributing factor in the declining health of the information environment around cancer and its treatment. The results suggest that public health efforts must extend beyond correcting false statements by injecting factual information into the online cancer discourse and look toward incorporating both visual and rational strategies. ", doi="10.2196/60283", url="https://www.jmir.org/2024/1/e60283" } @Article{info:doi/10.2196/55161, author="Wetzel, Anna-Jasmin and Preiser, Christine and M{\"u}ller, Regina and Joos, Stefanie and Koch, Roland and Henking, Tanja and Haumann, Hannah", title="Unveiling Usage Patterns and Explaining Usage of Symptom Checker Apps: Explorative Longitudinal Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e55161", keywords="self-triage", keywords="eHealth", keywords="self-diagnosis", keywords="mHealth", keywords="mobile health", keywords="usage", keywords="patterns", keywords="predicts", keywords="prediction", keywords="symptoms checker", keywords="apps", keywords="applications", keywords="explorative longitudinal study", keywords="self care", keywords="self management", keywords="self-rated", keywords="mixed method", keywords="circumstances", keywords="General Linear Mixed Models", keywords="GLMM", keywords="qualitative data", keywords="content analysis", keywords="Kuckartz", keywords="survey", keywords="participants", keywords="users", abstract="Background: Symptom checker apps (SCA) aim to enable individuals without medical training to classify perceived symptoms and receive guidance on appropriate actions, such as self-care or seeking professional medical attention. However, there is a lack of detailed understanding regarding the contexts in which individuals use SCA and their opinions on these tools. Objective: This mixed methods study aims to explore the circumstances under which medical laypeople use SCA and to identify which aspects users find noteworthy after using SCA. Methods: A total of 48 SCA users documented their medical symptoms, provided open-ended responses, and recorded their SCA use along with other variables over 6 weeks in a longitudinal study. Generalized linear mixed models with and those without regularization were applied to consider the hierarchical structure of the data, and the models' outcomes were evaluated for comparison. Qualitative data were analyzed through Kuckartz qualitative content analysis. Results: Significant predictors of SCA use included the initial occurrence of symptoms, day of measurement (odds ratio [OR] 0.97), self-rated health (OR 0.80, P<.001), and the following International Classification in Primary Care-2--classified symptoms, that are general and unspecified (OR 3.33, P<.001), eye (OR 5.56, P=.001), cardiovascular (OR 8.33, P<.001), musculoskeletal (OR 5.26, P<.001), and skin (OR 4.76, P<.001). The day of measurement and self-rated health showed minor importance due to their small effect sizes. Qualitative analysis highlighted four main themes: (1) reasons for using SCA, (2) diverse affective responses, (3) a broad spectrum of behavioral reactions, and (4) unmet needs including a lack of personalization. Conclusions: The emergence of new and unfamiliar symptoms was a strong determinant for SCA use. Specific International Classification in Primary Care--rated symptom clusters, particularly those related to cardiovascular, eye, skin, general, and unspecified symptoms, were also highly predictive of SCA use. The varied applications of SCA fit into the concept of health literacy as bricolage, where SCA is leveraged as flexible tools by patients based on individual and situational requirements, functioning alongside other health care resources. ", doi="10.2196/55161", url="https://www.jmir.org/2024/1/e55161" } @Article{info:doi/10.2196/57687, author="Orr, Noreen and Rogers, Morwenna and Stein, Abigail and Thompson Coon, Jo and Stein, Kenneth", title="Reviewing the Evidence Base for Topical Steroid Withdrawal Syndrome in the Research Literature and Social Media Platforms: An Evidence Gap Map", journal="J Med Internet Res", year="2024", month="Dec", day="6", volume="26", pages="e57687", keywords="topical steroid withdrawal syndrome", keywords="evidence gap map", keywords="social media", keywords="blogs", keywords="Instagram", keywords="Reddit", keywords="topical corticosteroids", abstract="Background: Within the dermatological community, topical steroid withdrawal syndrome (TSWS) is a medically contested condition with a limited research base. Published studies on TSWS indicate that it is a distinct adverse effect of prolonged use of topical corticosteroids, but there is a paucity of high-quality research evidence. Among the ``patient community,'' awareness has been increasing, with rapid growth in social media posts on TSWS and the introduction of online communities such as the International Topical Steroid Awareness Network. This evidence gap map (EGM) was developed in response to recent calls for research to better understand TSWS and aims to be an important resource to guide both researchers and clinicians in the prioritization of research topics for further research. Objective: This study aims to identify the range, extent, and type of evidence on TSWS in the research literature and social media platforms using an EGM. Methods: The MEDLINE and Embase (Ovid), CINAHL (EBSCOhost), and ProQuest Dissertations \& Theses and Conference Proceedings Citation Index (CPCI-Science and CPCI-Social Science \& Humanities via Web of Science) databases were searched. The final search was run in November 2023. Study titles, abstracts, and full texts were screened by 2 reviewers, and a third was consulted to resolve any differences. Blogging sites WordPress, Medium, and Blogspot and Google were searched; Instagram and Reddit were searched for the 100 most recent posts on specific dates in February 2023. Blog titles, Instagram posts, and Reddit posts were screened for relevance by 2 reviewers. A data extraction tool was developed on EPPI-Reviewer, and data extraction was undertaken by one reviewer and checked by a second; any inconsistencies were resolved through discussion. We did not undertake quality appraisal of the included studies. EPPI-Reviewer and EPPI-Mapper were used to generate the interactive EGM. Results: Overall, 81 academic publications and 223 social media posts were included in the EGM. The research evidence mainly addressed the physical symptoms of TSWS (skin), treatments, and, to a lesser extent, risk factors and disease mechanisms. The social media evidence primarily focused on the physical symptoms (skin and nonskin), mental health symptoms, relationships, activities of everyday living, beliefs and attitudes, and treatments. Conclusions: The EGM shows that research evidence is growing on TSWS but remains lacking in several important areas: longer-term prospective observational studies to assess the safety of prolonged use of topical corticosteroids and to prevent addiction; qualitative research to understand the lived experience of TSWS; and longitudinal research on the patient's ``TSWS journey'' to healing. The inclusion of social media evidence is a methodological innovation in EGMs, recognizing the increased presence of \#topicalsteroidwithdrawal on social media and how it can be used to better understand the patient perspective and ultimately, provide better care for people with TSWS. ", doi="10.2196/57687", url="https://www.jmir.org/2024/1/e57687" } @Article{info:doi/10.2196/60380, author="Wu, Yibo and Zhang, Jinzi and Ge, Pu and Duan, Tingyu and Zhou, Junyu and Wu, Yiwei and Zhang, Yuening and Liu, Siyu and Liu, Xinyi and Wan, Erya and Sun, Xinying", title="Application of Chatbots to Help Patients Self-Manage Diabetes: Systematic Review and Meta-Analysis", journal="J Med Internet Res", year="2024", month="Dec", day="3", volume="26", pages="e60380", keywords="artificial intelligence", keywords="chatbot", keywords="diabetes", keywords="health education", keywords="self-management", keywords="systematic review", abstract="Background: The number of people with diabetes is on the rise globally. Self-management and health education of patients are the keys to control diabetes. With the development of digital therapies and artificial intelligence, chatbots have the potential to provide health-related information and improve accessibility and effectiveness in the field of patient self-management. Objective: This study systematically reviews the current research status and effectiveness of chatbots in the field of diabetes self-management to support the development of diabetes chatbots. Methods: A systematic review and meta-analysis of chatbots that can help patients with diabetes with self-management was conducted. PubMed and Web of Science databases were searched using keywords around diabetes, chatbots, conversational agents, virtual assistants, and more. The search period was from the date of creation of the databases to January 1, 2023. Research articles in English that fit the study topic were selected, and articles that did not fit the study topic or were not available in full text were excluded. Results: In total, 25 studies were included in the review. In terms of study type, all articles could be classified as systematic design studies (n=8, 32\%), pilot studies (n=8, 32\%), and intervention studies (n=9, 36\%). Many articles adopted a nonrandomized controlled trial design in intervention studies (n=6, 24\%), and there was only 1 (4\%) randomized controlled trial. In terms of research strategy, all articles can be divided into quantitative studies (n=10, 40\%), mixed studies (n=6, 24\%), and qualitative studies (n=1, 4\%). The evaluation criteria for chatbot effectiveness can be divided into technical performance evaluation, user experience evaluation, and user health evaluation. Most chatbots (n=17, 68\%) provided education and management focused on patient diet, exercise, glucose monitoring, medications, and complications, and only a few studies (n=2, 8\%) provided education on mental health. The meta-analysis found that the chatbot intervention was effective in lowering blood glucose (mean difference 0.30, 95\% CI 0.04-0.55; P=.02) and had no significant effect in reducing weight (mean difference 1.41, 95\% CI --2.29 to 5.11; P=.46) compared with the baseline. Conclusions: Chatbots have potential for the development of self-management for people with diabetes. However, the evidence level of current research is low, and higher level research (such as randomized controlled trials) is needed to strengthen the evidence base. More use of mixed research in the research strategy is needed to fully use the strengths of both quantitative and qualitative research. Appropriate and innovative theoretical frameworks should be used in the research to provide theoretical support for the study. In addition, researchers should focus on the personalized and user-friendly interactive features of chatbots, as well as improvements in study design. ", doi="10.2196/60380", url="https://www.jmir.org/2024/1/e60380" } @Article{info:doi/10.2196/60949, author="Hammarberg, Karin and Bandyopadhyay, Mridula and Nguyen, Hau and Cicuttini, Flavia and Stanzel, Andrea Karin and Brown, Helen and Hickey, Martha and Fisher, Jane", title="Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study", journal="Interact J Med Res", year="2024", month="Dec", day="2", volume="13", pages="e60949", keywords="health promotion", keywords="healthy aging", keywords="self-management", keywords="midlife", keywords="menopause", keywords="internet", keywords="video", keywords="animation", keywords="survey", keywords="questionnaire", keywords="education", keywords="women", keywords="gynecology", abstract="Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72\%) completed all questions. Almost all (from 321/353, 91\% to 334/363, 92\%) agreed that the information in the videos was ``very easy to understand.'' The proportions reporting that all or some of the information in the video was new to them varied between videos from 36\% (137/386) to 66\% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70\% (271/386) to 89\% (331/373), and between 61\% (235/386) and 70\% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80\% vs 208/318, 65\%; P=.051 for video 3; and 36/44, 80\% vs 197/309, 64\%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. ", doi="10.2196/60949", url="https://www.i-jmr.org/2024/1/e60949", url="http://www.ncbi.nlm.nih.gov/pubmed/39621404" } @Article{info:doi/10.2196/49305, author="Backman, Anna and Roll-Pettersson, Lise and Mellblom, Are and Norman-Claesson, Elisabet and Sundqvist, Emma and Zander, Eric and Vigerland, Sarah and Hirvikoski, Tatja", title="Internet-Delivered Psychoeducation (SCOPE) for Transition-Aged Autistic Youth: Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Nov", day="28", volume="26", pages="e49305", keywords="autism", keywords="internet based", keywords="young adult", keywords="intervention", keywords="digital communication", keywords="life satisfaction", keywords="codeveloped", keywords="ASD", keywords="autism spectrum disorder", keywords="autistic", keywords="RCT", keywords="randomized controlled trial", keywords="randomized", keywords="psychoeducation", keywords="patient education", abstract="Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants' understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module's topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants' autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: --0.13, 95\% CI --1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363 ", doi="10.2196/49305", url="https://www.jmir.org/2024/1/e49305" } @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/10.2196/54679, 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/10.2196/51900, author="Deinboll, Anne and Moe, Fredriksen Cathrine and Ludvigsen, Spliid Mette", title="Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e51900", keywords="eHealth", keywords="electronic health records", keywords="hemodialysis", keywords="patient participation", keywords="renal dialysis", keywords="renal insufficiency", keywords="chronic", keywords="mobile phone", abstract="Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients' limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 ", doi="10.2196/51900", url="https://www.jmir.org/2024/1/e51900" } @Article{info:doi/10.2196/57328, author="Ferguson, Caleb and William, Scott and Allida, M. Sabine and Fulcher, Jordan and Jenkins, J. Alicia and Lattimore, Jo-Dee and Loch, L-J and Keech, Anthony", title="The Development of Heart Failure Electronic-Message Driven Tips to Support Self-Management: Co-Design Case Study", journal="JMIR Cardio", year="2024", month="Nov", day="7", volume="8", pages="e57328", keywords="heart failure", keywords="co-design", keywords="smartphone", keywords="app design", keywords="patient education", keywords="e-TIPS", keywords="electronic-message driven tips", abstract="Background: Heart failure (HF) is a complex syndrome associated with high morbidity and mortality and increased health care use. Patient education is key to improving health outcomes, achieved by promoting self-management to optimize medical management. Newer digital tools like SMS text messaging and smartphone apps provide novel patient education approaches. Objective: This study aimed to partner with clinicians and people with lived experience of HF to identify the priority educational topic areas to inform the development and delivery of a bank of electronic-message driven tips (e-TIPS) to support HF self-management. Methods: We conducted 3 focus groups with cardiovascular clinicians, people with lived experience of HF, and their caregivers, which consisted of 2 stages: stage 1 (an exploratory qualitative study to identify the unmet educational needs of people living with HF; previously reported) and stage 2 (a co-design feedback session to identify educational topic areas and inform the delivery of e-TIPS). This paper reports the findings of the co-design feedback session. Results: We identified 5 key considerations in delivering e-TIPS and 5 relevant HF educational topics for their content. Key considerations in e-TIP delivery included (1) timing of the e-TIPS; (2) clear and concise e-TIPS; (3) embedding a feedback mechanism; (4) distinguishing actionable and nonactionable e-TIPS; and (5) frequency of e-TIP delivery. Relevant educational topic areas included the following: (1) cardiovascular risk reduction, (2) self-management, (3) food and nutrition, (4) sleep hygiene, and (5) mental health. Conclusions: The findings from this co-design case study have provided a foundation for developing a bank of e-TIPS. These will now be evaluated for usability in the BANDAIDS e-TIPS, a single-group, quasi-experimental study of a 24-week e-TIP program (personalized educational messages) delivered via SMS text messaging (ACTRN12623000644662). ", doi="10.2196/57328", url="https://cardio.jmir.org/2024/1/e57328" } @Article{info:doi/10.2196/56475, author="Tian, Xiaojuan and Liu, Yan and Zhang, Jiahua and Yang, Lixiao and Feng, Linyao and Qi, Aidong and Liu, Hanjiazi and Liu, Pengju and Li, Ying", title="Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="4", volume="12", pages="e56475", keywords="WeChat", keywords="nutrition management", keywords="ovarian cancer", keywords="chemotherapy", keywords="mobile health", abstract="Background: As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. Objective: This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Methods: Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times?T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. Results: A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75\%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). Conclusions: This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy. Trial Registration: ClinicalTrials.gov NCT06379191; https://clinicaltrials.gov/study/NCT06379191 ", doi="10.2196/56475", url="https://mhealth.jmir.org/2024/1/e56475" } @Article{info:doi/10.2196/62762, author="Fabens, Isabella and Makhele, Calsile and Igaba, Kibiribiri Nelson and Hlongwane, Sizwe and Phohole, Motshana and Waweru, Evelyn and Oni, Femi and Khwepeya, Madalitso and Sardini, Maria and Moyo, Khumbulani and Tweya, Hannock and Wafula, Barasa Mourice and Pienaar, Jacqueline and Ndebele, Felex and Setswe, Geoffrey and Dong, Qi Tracy and Feldacker, Caryl", title="WhatsApp Versus SMS for 2-Way, Text-Based Follow-Up After Voluntary Medical Male Circumcision in South Africa: Exploration of Messaging Platform Choice", journal="JMIR Form Res", year="2024", month="Oct", day="16", volume="8", pages="e62762", keywords="2-way texting", keywords="text messages", keywords="WhatsApp", keywords="digital health innovations", keywords="male circumcision", keywords="South Africa", keywords="quality improvement", abstract="Background: Telehealth is growing, especially in areas where access to health facilities is difficult. We previously used 2-way texting (2wT) via SMS to improve the quality of postoperative care after voluntary medical male circumcision in South Africa. In this study, we offered males aged 15 years and older WhatsApp or SMS as their message delivery and interaction platform to explore user preferences and behaviors. Objective: The objectives of this process evaluation embedded within a larger 2wT expansion trial were to (1) explore 2wT client preferences, including client satisfaction, with WhatsApp or SMS; (2) examine response rates (participation) by SMS and WhatsApp; and (3) gather feedback from the 2wT implementation team on the WhatsApp approach. Methods: Males aged 15 years and older undergoing voluntary medical male circumcision in program sites could choose their follow-up approach, selecting 2wT via SMS or WhatsApp or routine care (in-person postoperative visits). The 2wT system provided 1-way educational messages and an open 2-way communication channel between providers and clients. We analyzed quantitative data from the 2wT database on message delivery platforms (WhatsApp vs SMS), response rates, and user behaviors using chi-square tests, z tests, and t tests. The team conducted short phone calls with WhatsApp and SMS clients about their perceptions of this 2wT platform using a short, structured interview guide. We consider informal reflections from the technical team members on the use of WhatsApp. We applied an implementation science lens using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to focus results on practice and policy improvement. Results: Over a 2-month period---from August to October, 2023---337 males enrolled in 2wT and were offered WhatsApp or SMS and were included in the analysis. For 2wT reach, 177 (53\%) participants chose WhatsApp as their platform (P=.38). Mean client age was 30 years, and 253 (75\%) participants chose English for automated messages. From quality assurance calls, almost all respondents (87/89, 98\%) were happy with the way they were followed up. For effectiveness, on average for the days on which responses were requested, 58 (33\%) WhatsApp clients and 44 (28\%) SMS clients responded (P=.50). All 2wT team members believed WhatsApp limited the automated message content, language choices, and inclusivity as compared with the SMS-based 2wT approach. Conclusions: When presented with a choice of 2wT communication platform, clients appear evenly split between SMS and WhatsApp. However, WhatsApp requires a smartphone and data plan, potentially reducing reach at scale. Clients using both platforms responded to 2wT interactive prompts, demonstrating similar effectiveness in engaging clients in follow-up. For telehealth interventions, digital health designers should maintain an SMS-based platform and carefully consider adding WhatsApp as an option for clients, using an implementation science approach to present evidence that guides the best implementation approach for their setting. ", doi="10.2196/62762", url="https://formative.jmir.org/2024/1/e62762", url="http://www.ncbi.nlm.nih.gov/pubmed/39412842" } @Article{info:doi/10.2196/50370, author="Trnka, Pavel and Aldaghi, Tahmineh and Muzik, Jan", title="Categorization of mHealth Coaching Technologies for Children or Adolescents With Type 1 Diabetes: Systematic Review", journal="JMIR Pediatr Parent", year="2024", month="Oct", day="10", volume="7", pages="e50370", keywords="type 1 diabetes", keywords="adolescents", keywords="children", keywords="parents", keywords="mHealth", keywords="information technology", keywords="PRISMA", abstract="Background: Managing type 1 diabetes in children and adolescents can be difficult for parents, health care professionals, and even patients. However, over the last decades, the quality of services provided to patients with diabetes has increased due to advances in IT. Objective: This study aims to comprehensively document the range of IT tools used in the management of diabetes among children and adolescents, with a focus on identifying the technologies most commonly used based on their frequency. In addition, the study aims to explore relevant methodologies for developing diabetes technology and provide valuable information to developers by delineating essential phases of the design process. Methods: The literature search was focused on MEDLINE (PubMed), Web of Science, and Google Scholar for relevant studies. Keywords such as ``type 1 diabetes,'' ``adolescents,'' ``kids,'' ``mHealth,'' ``children,'' and ``coaching'' were combined using Boolean operators. The inclusion criteria were open access, English-language papers published between 2012 and 2023 focusing on patients younger than 18 years and aligned with our research goal. The exclusion criteria included irrelevant topics and papers older than 18 years. By applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 2080 studies were recognized, and after selection, 33 papers were agreed upon between the researchers. Results: Four primary categories were defined: types of IT, methodology identification, purpose identification, and feature determination. Among these, mobile health (mHealth) apps emerged as the predominant type of information, garnering 27 mentions. In particular, user-centered design was identified as the most prevalent methodology, cited 22 times. The primary purpose of self-monitoring blood glucose values was mentioned 20 times, while patient education was the highest among common characteristics, with 23 mentions. Conclusions: Based on our research, we advocate for developers to focus on creating an mHealth app that integrates gamification techniques to develop innovative diabetes management solutions. This app should include vital functionalities such as blood glucose monitoring, strategies to improve hemoglobin A1c levels, carbohydrate tracking, and comprehensive educational materials for patients and caregivers. By prioritizing these features, developers can enhance the usability and effectiveness of the technology, thereby better supporting children or adolescents with diabetes in their daily management endeavors. ", doi="10.2196/50370", url="https://pediatrics.jmir.org/2024/1/e50370" } @Article{info:doi/10.2196/53146, author="Hong, Minji and Rajaguru, Vasuki and Kim, KyungYi and Jang, Suk-Yong and Lee, Gyu Sang", title="Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Oct", day="10", volume="26", pages="e53146", keywords="menstruation", keywords="dysmenorrhea", keywords="period tracker app, menstrual cycle management, health care application, millennial", keywords="Gen Z", keywords="mobile phone", abstract="Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3\%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users' needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. ", doi="10.2196/53146", url="https://www.jmir.org/2024/1/e53146" } @Article{info:doi/10.2196/56606, author="Herrijgers, Corinne and Verboon, Peter and Florence, Eric and Vandebosch, Heidi and Poels, Karolien and Platteau, Tom", title="Assessing the Effectiveness of an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Single-Case and Pre-Post Experimental Design Study", journal="JMIR Form Res", year="2024", month="Oct", day="4", volume="8", pages="e56606", keywords="mobile health", keywords="chemsex", keywords="men who have sex with men", keywords="MSM", keywords="harm reduction", keywords="behavioral change", keywords="self-efficacy", keywords="risk behavior", keywords="sexual health", keywords="digital intervention", keywords="health education", keywords="mobile phone", abstract="Background: This study focuses on the Budd app, a mobile health intervention designed for gay, bisexual, and other men who have sex with men who participate in chemsex. Chemsex, the use of psychoactive drugs in a sexual context, presents substantial health risks including increased HIV transmission and mental health issues. Addressing these risks requires innovative interventions tailored to the unique needs of this population. Objective: This study aims to evaluate the effectiveness of the Budd app in promoting drug harm reduction practices among its users, focusing on knowledge, behavioral intention, risk behavior awareness, and self-efficacy. Methods: The study used a mixed methods approach, combining a single-case experimental design and a pre-post study. A total of 10 participants from an outpatient clinic were recruited, and each attended the clinic 3 times. During the first visit, participants installed a restricted version of the Budd app, which allowed them to report daily mood and risk behavior after chemsex sessions. Phase A (baseline) lasted at least 2 weeks depending on chemsex participation. In the second visit, participants gained full access to the Budd app, initiating phase B (intervention). Phase B lasted at least 6 weeks, depending on chemsex participation, with identical data input as phase A. Participants completed pre- and postintervention surveys assessing behavioral determinants during the first and third visit. Results: The study observed an increased knowledge about chemsex substances postintervention, with a mean percentage improvement in knowledge scores of 20.59\% (SD 13.3\%) among participants. Behavioral intention and self-efficacy showed mixed results, with some participants improving while others experienced a decrease. There was also a variable impact on awareness of risk behavior, with half of the participants reporting a decrease postintervention. Despite these mixed results, the app was generally well-received, with participants engaging with the app's features an average of 50 times during the study. Conclusions: The Budd app showed effectiveness in enhancing knowledge about chemsex substances among gay, bisexual, and other men who have sex with men. However, its impact on safe dosing behavior, behavioral intention, self-efficacy, and risk behavior awareness was inconsistent. These findings suggest that while educational interventions can increase knowledge, translating this into behavioral change is more complex and may require more participants, a longer follow-up period, and additional strategies and support mechanisms. ", doi="10.2196/56606", url="https://formative.jmir.org/2024/1/e56606", url="http://www.ncbi.nlm.nih.gov/pubmed/39365642" } @Article{info:doi/10.2196/55815, author="Chernick, S. Lauren and Bugaighis, Mona and Daylor, Victoria and Hochster, Daniel and Rosen, Evan and Schnall, Rebecca and Stockwell, S. Melissa and Bell, L. David", title="A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach", journal="JMIR Form Res", year="2024", month="Oct", day="4", volume="8", pages="e55815", keywords="sexual health", keywords="adolescent health", keywords="sex education", keywords="emergency medicine", keywords="health planning", keywords="sexual behavior", keywords="SMS text messaging", keywords="mHealth", keywords="mobile app", keywords="condom use", keywords="user-centered design", abstract="Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric's content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen's heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. ", doi="10.2196/55815", url="https://formative.jmir.org/2024/1/e55815", url="http://www.ncbi.nlm.nih.gov/pubmed/39365657" } @Article{info:doi/10.2196/56559, author="Staras, S. Stephanie A. and Tauscher, Justin and Vinson, Michelle and Thompson, A. Lindsay and Gerend, A. Mary and Shenkman, A. Elizabeth", title="Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment", journal="JMIR Form Res", year="2024", month="Sep", day="19", volume="8", pages="e56559", keywords="participatory design", keywords="think-aloud", keywords="implementation science", keywords="adolescent vaccination", keywords="human papillomavirus vaccine", keywords="usability", keywords="eHealth", abstract="Background: In the United States, only 58\% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents' vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app's usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75\%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child's vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75\% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents' children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44\%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. ", doi="10.2196/56559", url="https://formative.jmir.org/2024/1/e56559" } @Article{info:doi/10.2196/53805, author="Liu, Ming and Wu, Xiaoqian and Li, Ziyu and Tan, Dongmei and Huang, Cheng", title="Assessment of Eye Care Apps for Children and Adolescents Based on the Mobile App Rating Scale: Content Analysis and Quality Assessment", journal="JMIR Mhealth Uhealth", year="2024", month="Sep", day="13", volume="12", pages="e53805", keywords="Mobile apps", keywords="Eye care", keywords="Myopia", keywords="MARS", keywords="Children", keywords="Adolescent", keywords="Quality Assessment", keywords="Content Analysis", keywords="mhealth", keywords="China", abstract="Background: In China, the current situation of myopia among children and adolescents is very serious. Prevention and control of myopia are inhibited by the lack of medical resources and the low awareness about eye care. Nevertheless, mobile apps provide an effective means to solve these problems. Since the health app market in China is still immature, it has become particularly important to conduct a study to assess the quality of eye-care apps to facilitate the development of better eye-care service strategies. Objective: This study aimed to evaluate the quality, functionality, medical evidence, and professional background of eye-care apps targeting children and adolescents in the Chinese app stores. Methods: A systematic search on iOS and Android app stores was performed to identify eye-care apps for children and adolescents. The general characteristics, development context, and functional features of the apps were described. Quality assessment of the apps was completed by 2 independent researchers using the Mobile App Rating Scale. Results: This study included 29 apps, of which 17 (59\%) were developed by commercial organizations and 12 (41\%) had a design with relevant scientific basis. The main built-in functions of these apps include self-testing (18/29, 62\%), eye exercises (16/29, 55\%), and eye-care education (16/29, 55\%). The mean overall quality of eye-care apps was 3.49 (SD 0.33), with a score ranging from 2.89 to 4.39. The overall Mobile App Rating Scale score exhibited a significant positive correlation with the subscale scores (r=0.81-0.91; P<.001). In addition, although most apps provided basic eye-care features, there are some deficiencies. For example, only a few apps were developed with the participation of medical organizations or professional ophthalmologists, and most of the apps were updated infrequently, failing to provide the latest eye-care information and technology in a timely manner. Conclusions: In general, the quality of eye-care apps for children and teenagers in Chinese app stores is good. These apps fulfill users' needs for eye-care services to a certain extent, but they still suffer from insufficient medical background, low user engagement, and untimely updates. In order to further improve the effectiveness of eye-care apps, cooperation with medical institutions and professional ophthalmologists should be strengthened to enhance the scientific and authoritative nature of the apps. At the same time, interactive features and regular updates should be added to enhance user participation and the continuity of the apps. This study provides a reference for future development or improvement of eye-care apps, which can help promote myopia prevention and control. ", doi="10.2196/53805", url="https://mhealth.jmir.org/2024/1/e53805" } @Article{info:doi/10.2196/59013, author="Goeldner, Moritz and Gehder, Sara", title="Digital Health Applications (DiGAs) on a Fast Track: Insights From a Data-Driven Analysis of Prescribable Digital Therapeutics in Germany From 2020 to Mid-2024", journal="J Med Internet Res", year="2024", month="Aug", day="29", volume="26", pages="e59013", keywords="digital health application", keywords="DiGA", keywords="data-driven analysis", keywords="clinical evidence", keywords="health economics", keywords="positive care effect", keywords="medical benefit", keywords="patient-relevant structural and procedural improvements", keywords="pSVV", keywords="digital health care act", abstract="Background: This study aimed to analyze the rapidly evolving ecosystem of digital health applications (Digitale Gesundheitsanwendung; DiGAs) in Germany, spurred by the 2019 Digital Healthcare Act. With over 73 million people in Germany now having access to DiGAs, these prescribable digital health apps and web-based applications represent a substantial stride in health care modernization, supporting both patients and health care providers with digital solutions for disease management and care improvement. Objective: Through a data-driven approach, this research aimed to unpack the complexities of DiGA market dynamics, economic factors, and clinical evidence, offering insights into their impact over the past years. Methods: The analysis draws from a range of public data sources, including the DiGA directory, statutory health insurance reports, app store feedback, and clinical study results. Results: As of July 1, 2024, there are 56 DiGAs listed by the Federal Institute for Drugs and Medical Devices (Bundesinstitut f{\"u}r Arzneimittel und Medizinprodukte), divided into 35 permanently and 21 preliminarily listed applications. Our findings reveal that a majority of DiGAs extend beyond the intended 1-year period to achieve permanent listing, reflecting the extensive effort required to demonstrate clinical efficacy. Economic analysis uncovered a dynamic pricing landscape, with initial prices ranging from approximately {\texteuro}200 to {\texteuro}700 ({\texteuro}1=US \$1.07), averaging at a median of {\texteuro}514 for a 3-month DiGA prescription. Following negotiations or arbitration board decisions, prices typically see a 50\% reduction, settling at a median of {\texteuro}221. Prescription data offer valuable insights into DiGA acceptance, with total prescriptions jumping from around 41,000 in the first period to 209,000 in the latest reporting period. The analysis of the top 15 DiGAs, representing 82\% of the total prescriptions, shows that these best-performing apps receive from a minimum of 8 to a maximum of 77 daily prescriptions, with native apps and early market entrants achieving higher rates. Clinical evidence from all 35 permanently listed DiGAs indicates a uniform preference for randomized controlled trials to validate primary end points, with no noteworthy use of alternative study designs encouraged in the Digital Healthcare Act and related regulations. Moreover, all evaluated DiGAs focused on medical benefits, with health status improvement as a key end point, suggesting an underuse of patient-relevant structural and procedural improvement in demonstrating health care impact. Conclusions: This study highlights the growth and challenges within the DiGA sector, suggesting areas for future research, such as the exploration of new study designs and the potential impact of patient-relevant structural and procedural improvements. For DiGA manufacturers, the strategic advantage of early market entry is emphasized. Overall, this paper underscores the evolving landscape of digital health, advocating for a nuanced understanding of digital health technology integration in Germany and beyond. ", doi="10.2196/59013", url="https://www.jmir.org/2024/1/e59013" } @Article{info:doi/10.2196/56611, author="Jamil, Aini Nor and Dhanaseelan, Jashwiny and Buhari, Athirah Nurin", title="Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="26", volume="7", pages="e56611", keywords="osteoporosis", keywords="bone health", keywords="adolescent", keywords="knowledge", keywords="calcium", keywords="physical activity", keywords="e-book", keywords="effectiveness", keywords="educational", keywords="teens", keywords="youth", keywords="bone fragility", keywords="bone", keywords="Malaysia", keywords="online questionnaire", keywords="sociodemographic", keywords="calcium intake", keywords="diet", keywords="behavior change", abstract="Background: Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility. Objective: This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia. Methods: A total of 72 adolescents (female: n=51, 71\%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book. Results: There was a significant increase in the median knowledge score, which was 40.6\% (IQR 31.3\%-46.9\%) during the pretest and 71.9\% (IQR 53.9\%-81.3\%) during the posttest (P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98\%) and exhibited sedentary behavior (pretest: 51/62, 82\%; posttest: 48/62, 77\%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97\%), liked the graphics (71/72, 99\%), and approved of the layout (60/72, 83\%) and font size (66/72, 92\%) used. Conclusions: The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change. ", doi="10.2196/56611", url="https://pediatrics.jmir.org/2024/1/e56611" } @Article{info:doi/10.2196/53355, author="Chen, Tingting and Zhao, Wenbo and Pei, Qianqian and Chen, Yanru and Yin, Jinmei and Zhang, Min and Wang, Cheng and Zheng, Jing", title="Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Aug", day="9", volume="12", pages="e53355", keywords="hemodialysis", keywords="hypertension", keywords="home blood pressure monitoring", keywords="eHealth", keywords="randomized controlled trial", abstract="Background: Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. Objective: This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. Methods: A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Results: Of the 165 patients enrolled in the program (n=84, 50.9\% in the web-based HBPM group and n=81, 49.1\% in the control group), 145 (87.9\%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30\% (25/84) to 48\% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37\% (30/81) to 25\% (20/81; $\chi$22=16.82, P<.001; odds ratio 5.11, 95\% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; $\beta$=?6.09, 95 \% CI ?10.94 to ?1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; $\beta$=?4.93, 95\% CI ?7.93 to ?1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=?9.18, P<.001), HBPM Perception Scale (t163=?10.65, P<.001), and HBPM Adherence Scale (t163=?8.04, P<.001) were significantly higher after 6 months of intervention. Conclusions: The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings. Trial Registration: China Clinical Trial Registration Center ChiCTR2100051535; https://www.chictr.org.cn/showproj.html?proj=133286 ", doi="10.2196/53355", url="https://mhealth.jmir.org/2024/1/e53355" } @Article{info:doi/10.2196/46220, author="Lonati, Caterina and Wellhausen, Marie and Pennig, Stefan and R{\"o}hr{\ss}en, Thomas and Kircelli, Fatih and Arendt, Svenja and Tschulena, Ulrich", title="The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals", journal="JMIR Med Educ", year="2024", month="Aug", day="6", volume="10", pages="e46220", keywords="peritoneal dialysis", keywords="virtual reality", keywords="patient education", keywords="patient training", keywords="chronic kidney disease", keywords="nursing", keywords="qualitative assessment", abstract="Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay{\textbullet}safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay{\textbullet}safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay{\textbullet}safe MyTraining VR ranged from 2 to 5 for each professional. The stay{\textbullet}safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents' perspective, the technology improved patients' learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient's needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients' acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay{\textbullet}safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. ", doi="10.2196/46220", url="https://mededu.jmir.org/2024/1/e46220", url="http://www.ncbi.nlm.nih.gov/pubmed/39106093" } @Article{info:doi/10.2196/51206, author="Mateo-Orcajada, Adri{\'a}n and Vaquero-Crist{\'o}bal, Raquel and Mota, Jorge and Abenza-Cano, Luc{\'i}a", title="Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="30", volume="12", pages="e51206", keywords="body composition", keywords="detraining", keywords="new technologies", keywords="physical education subject", keywords="physical fitness", keywords="youth", abstract="Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3\%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD --0.170; P<.001), maximal oxygen uptake (MD --1.006; P<.001), countermovement jump test (MD --1.337; P=.04), curl-up test (MD --3.791; P<.001), and push-up test (MD --1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 ", doi="10.2196/51206", url="https://mhealth.jmir.org/2024/1/e51206" } @Article{info:doi/10.2196/51307, author="Grahlher, Kristin and Morgenstern, Matthis and Pietsch, Benjamin and Gomes de Matos, Elena and Rossa, Monika and Lochb{\"u}hler, Kirsten and Daubmann, Anne and Thomasius, Rainer and Arnaud, Nicolas", title="Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="23", volume="12", pages="e51307", keywords="prevention", keywords="vocational students", keywords="adolescents", keywords="mobile intervention", keywords="voluntary commitment", keywords="substance use", keywords="internet-related problems", keywords="mobile phone", keywords="adolescent", keywords="youths", keywords="student", keywords="students", keywords="use", abstract="Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (``Meine Zeit ohne'') has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants' characteristics, and (3) to study how variations in app use were related to participants' baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (``congruent use'': eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6\%; mean age 19.0, SD 3.5 years; 830/1458, 56.9\% male) of them provided full data. Of these 1458 students, 894 (61.3\%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6\% female). Of these 894 students, 466 (52.1\%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1\%). A total of 407 (45.5\%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users' characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x ", doi="10.2196/51307", url="https://mhealth.jmir.org/2024/1/e51307" } @Article{info:doi/10.2196/56894, author="Chua, Xin Joelle Yan and Choolani, Mahesh and Chee, Ing Cornelia Yin and Yi, Huso and Chan, Huak Yiong and Lalor, Gabrielle Joan and Chong, Seng Yap and Shorey, Shefaly", title="Parents' Perceptions of Their Parenting Journeys and a Mobile App Intervention (Parentbot---A Digital Healthcare Assistant): Qualitative Process Evaluation", journal="J Med Internet Res", year="2024", month="Jun", day="21", volume="26", pages="e56894", keywords="perinatal", keywords="parents", keywords="mobile app", keywords="chatbot", keywords="qualitative study", keywords="interviews", keywords="experiences", keywords="mobile phone", abstract="Background: Parents experience many challenges during the perinatal period. Mobile app--based interventions and chatbots show promise in delivering health care support for parents during the perinatal period. Objective: This descriptive qualitative process evaluation study aims to explore the perinatal experiences of parents in Singapore, as well as examine the user experiences of the mobile app--based intervention with an in-built chatbot titled Parentbot---a Digital Healthcare Assistant (PDA). Methods: A total of 20 heterosexual English-speaking parents were recruited via purposive sampling from a single tertiary hospital in Singapore. The parents (control group: 10/20, 50\%; intervention group: 10/20, 50\%) were also part of an ongoing randomized trial between November 2022 and August 2023 that aimed to evaluate the effectiveness of the PDA in improving parenting outcomes. Semistructured one-to-one interviews were conducted via Zoom from February to June 2023. All interviews were conducted in English, audio recorded, and transcribed verbatim. Data analysis was guided by the thematic analysis framework. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to guide the reporting of data. Results: Three themes with 10 subthemes describing parents' perceptions of their parenting journeys and their experiences with the PDA were identified. The main themes were (1) new babies, new troubles, and new wonders; (2) support system for the parents; and (3) reshaping perinatal support for future parents. Conclusions: Overall, the PDA provided parents with informational, socioemotional, and psychological support and could be used to supplement the perinatal care provided for future parents. To optimize users' experience with the PDA, the intervention could be equipped with a more sophisticated chatbot, equipped with more gamification features, and programmed to deliver personalized care to parents. Researchers and health care providers could also strive to promote more peer-to-peer interactions among users. The provision of continuous, holistic, and family-centered care by health care professionals could also be emphasized. Moreover, policy changes regarding maternity and paternity leaves, availability of infant care centers, and flexible work arrangements could be further explored to promote healthy work-family balance for parents. ", doi="10.2196/56894", url="https://www.jmir.org/2024/1/e56894" } @Article{info:doi/10.2196/55578, author="Lee, Hoon Ye and Kim, Hyungsook and Hwang, Juhee and Noh, Sihyeon", title="Effectiveness of Mobile-Based Progressive and Fixed Physical Activity on Depression, Stress, Anxiety, and Quality of Life Outcomes Among Adults in South Korea: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="12", volume="12", pages="e55578", keywords="depressive symptoms", keywords="mental health", keywords="mobile-based exercise", keywords="non--face-to-face physical activity", keywords="progressive exercise", keywords="mobile phone", abstract="Background: Depression acts as a significant obstacle to the overall well-being of individuals. Given the significant consequences, timely recognition and proactive steps to manage symptoms of depression become essential. Such actions not only reduce personal distress but also play a crucial role in reducing its far-reaching impact on society as a whole. Objective: In response to this concern, the objective of this study was to explore the use of mobile-based interventions as a possible remedy. More specifically, this study aimed to investigate the effectiveness of 2 types of physical activity (PA), progressive and fixed, within a mobile-based app on depression, perceived stress, anxiety, physical health, and psychological health, aiming to contribute to the optimization of mental health benefits. Methods: Participants (N=60; mean age 25.29, SD 6.10 years) were recruited using a combination of web-based and offline methods, and the study lasted for 8 weeks. The baseline and posttest questionnaires were administered to all participants. The participants were randomly assigned to 1 of the 3 groups: progressive group (n=20; performing mobile-based progressive PA), fixed group (n=20; performing mobile-based fixed intensity PA), and control group C (n=20). Data analysis involved comparing scores between the experimental and control groups using a one-way ANOVA, paired sample t tests (2-tailed), and repeated measures ANOVA with a 3 (group){\texttimes}2 (time) design. Results: The findings revealed significant improvements in mental health indicators among participants engaged in both fixed and progressive PA groups compared with the control group. However, the fixed PA group demonstrated more significant reductions in symptoms. Specifically, the progressive PA group showed significant reductions in depression (F1,36=6.941; P=.01; $\eta$p2=0.16) and perceived stress (F1,36=5.47; P=.03; $\eta$p2=0.13), while the fixed PA group exhibited significant reductions in depression (F1,37=5.36; P=.03; $\eta$p2=0.12), perceived stress (F1,37=7.81; P=.008; $\eta$p2=0.17), and general anxiety disorder (F1,37=5.45; P=.03; $\eta$p2=0.13) compared with the control group. Conclusions: This study underscores the potential of mobile-based PA in improving mental health outcomes. The findings offer significant insights for mental health professionals and researchers aiming to optimize mental well-being through innovative mobile therapies. Trial Registration: Clinical Research Information Service KCT0009100; https://tinyurl.com/mr33fmur ", doi="10.2196/55578", url="https://mhealth.jmir.org/2024/1/e55578", url="http://www.ncbi.nlm.nih.gov/pubmed/38865705" } @Article{info:doi/10.2196/50087, author="van Dijk, R. Merle and van der Marel, Anne-Fleur and van Rheenen-Flach, E. Leonie and Ganzevoort, Wessel and Moll, Etelka and Scheele, Fedde and Velzel, Joost", title="YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="Jun", day="6", volume="8", pages="e50087", keywords="YouTube", keywords="ECV", keywords="external cephalic version", keywords="breech", keywords="education", keywords="video", keywords="cesarean", keywords="health education", keywords="childbirth", keywords="patient information", keywords="cross-sectional study", keywords="cesarean delivery", keywords="implementation", keywords="usefulness", keywords="medical information", keywords="pregnancy", keywords="pregnant women", keywords="engagement", abstract="Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14\% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80\% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. ", doi="10.2196/50087", url="https://formative.jmir.org/2024/1/e50087", url="http://www.ncbi.nlm.nih.gov/pubmed/38843520" } @Article{info:doi/10.2196/49510, author="Ameyaw, Kwabena Edward and Amoah, Adusei Padmore and Ezezika, Obidimma", title="Effectiveness of mHealth Apps for Maternal Health Care Delivery: Systematic Review of Systematic Reviews", journal="J Med Internet Res", year="2024", month="May", day="29", volume="26", pages="e49510", keywords="mHealth", keywords="mobile health", keywords="maternal health", keywords="telemedicine", keywords="technology", keywords="health care", keywords="newborn", keywords="systematic review", keywords="database", keywords="mHealth impact", keywords="mHealth effectiveness", keywords="health care applications", abstract="Background: Globally, the use of mobile health (mHealth) apps or interventions has increased. Robust synthesis of existing systematic reviews on mHealth apps may offer useful insights to guide maternal health clinicians and policy makers. Objective: This systematic review aims to assess the effectiveness or impact of mHealth apps on maternal health care delivery globally. Methods: We systematically searched Scopus, Web of Science (Core Collection), MEDLINE or PubMed, CINAHL, and Cochrane Database of Systematic Reviews using a predeveloped search strategy. The quality of the reviews was independently assessed by 3 reviewers, while study selection was done by 2 independent raters. We presented a narrative synthesis of the findings, highlighting the specific mHealth apps, where they are implemented, and their effectiveness or outcomes toward various maternal conditions. Results: A total of 2527 documents were retrieved, out of which 16 documents were included in the review. Most mHealth apps were implemented by sending SMS text messages with mobile phones. mHealth interventions were most effective in 5 areas: maternal anxiety and depression, diabetes in pregnancy, gestational weight management, maternal health care use, behavioral modification toward smoking cessation, and controlling substance use during pregnancy. We noted that mHealth interventions for maternal health care are skewed toward high-income countries (13/16, 81\%). Conclusions: The effectiveness of mHealth apps for maternity health care has drawn attention in research and practice recently. The study showed that research on mHealth apps and their use dominate in high-income countries. As a result, it is imperative that low- and middle-income countries intensify their commitment to these apps for maternal health care, in terms of use and research. Trial Registration: PROSPERO CRD42022365179; https://tinyurl.com/e5yxyx77 ", doi="10.2196/49510", url="https://www.jmir.org/2024/1/e49510", url="http://www.ncbi.nlm.nih.gov/pubmed/38810250" } @Article{info:doi/10.2196/54124, author="Cunningham, C. Adam and Prentice, Carley and Peven, Kimberly and Wickham, Aidan and Bamford, Ryan and Radovic, Tara and Klepchukova, Anna and Fomina, Maria and Cunningham, Katja and Hill, Sarah and Hantsoo, Liisa and Payne, Jennifer and Zhaunova, Liudmila and Ponzo, Sonia", title="Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="May", day="2", volume="12", pages="e54124", keywords="digital health", keywords="health literacy", keywords="menstrual cycle", keywords="period tracking app", keywords="women's health", keywords="PMS", keywords="PMDD", keywords="tracking", keywords="app", keywords="application", keywords="tracking app", keywords="tracking application", keywords="menstrual", keywords="women", keywords="efficacy", keywords="general health", keywords="wellbeing", keywords="randomized controlled trial", keywords="awareness", keywords="symptoms", keywords="manage", keywords="management", keywords="premenstrual", keywords="premenstrual syndrome", keywords="premenstrual dysphoric disorder", keywords="reproductive", keywords="reproductive health", keywords="health management", keywords="communication", keywords="pregnancy", keywords="quality of life", keywords="productivity", keywords="education", keywords="functionality", abstract="Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one's own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D?=1.11; t311=5.73, P<.001; PMS or PMDD: D?=1.20; t115=3.76, P<.001) and menstrual health awareness (D?=3.97; t311=7.71, P<.001), health and well-being (D?=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D?=--7.08; t115=--5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D?=1.01; t311=5.08, P<.001), communication about health (D?=0.93; t311=2.41, P=.002), menstrual cycle stigma (D?=--0.61; t311=--2.73, P=.007), and fear of unplanned pregnancies (D?=--0.22; t311=--2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D?=--1.67; t144=--2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq ", doi="10.2196/54124", url="https://mhealth.jmir.org/2024/1/e54124", url="http://www.ncbi.nlm.nih.gov/pubmed/38696773" } @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/10.2196/55847, author="Lv, Xiaolei and Zhang, Xiaomeng and Li, Yuan and Ding, Xinxin and Lai, Hongchang and Shi, Junyu", title="Leveraging Large Language Models for Improved Patient Access and Self-Management: Assessor-Blinded Comparison Between Expert- and AI-Generated Content", journal="J Med Internet Res", year="2024", month="Apr", day="25", volume="26", pages="e55847", keywords="large language model", keywords="artificial intelligence", keywords="public oral health", keywords="health care access", keywords="patient education", abstract="Background: While large language models (LLMs) such as ChatGPT and Google Bard have shown significant promise in various fields, their broader impact on enhancing patient health care access and quality, particularly in specialized domains such as oral health, requires comprehensive evaluation. Objective: This study aims to assess the effectiveness of Google Bard, ChatGPT-3.5, and ChatGPT-4 in offering recommendations for common oral health issues, benchmarked against responses from human dental experts. Methods: This comparative analysis used 40 questions derived from patient surveys on prevalent oral diseases, which were executed in a simulated clinical environment. Responses, obtained from both human experts and LLMs, were subject to a blinded evaluation process by experienced dentists and lay users, focusing on readability, appropriateness, harmlessness, comprehensiveness, intent capture, and helpfulness. Additionally, the stability of artificial intelligence responses was also assessed by submitting each question 3 times under consistent conditions. Results: Google Bard excelled in readability but lagged in appropriateness when compared to human experts (mean 8.51, SD 0.37 vs mean 9.60, SD 0.33; P=.03). ChatGPT-3.5 and ChatGPT-4, however, performed comparably with human experts in terms of appropriateness (mean 8.96, SD 0.35 and mean 9.34, SD 0.47, respectively), with ChatGPT-4 demonstrating the highest stability and reliability. Furthermore, all 3 LLMs received superior harmlessness scores comparable to human experts, with lay users finding minimal differences in helpfulness and intent capture between the artificial intelligence models and human responses. Conclusions: LLMs, particularly ChatGPT-4, show potential in oral health care, providing patient-centric information for enhancing patient education and clinical care. The observed performance variations underscore the need for ongoing refinement and ethical considerations in health care settings. Future research focuses on developing strategies for the safe integration of LLMs in health care settings. ", doi="10.2196/55847", url="https://www.jmir.org/2024/1/e55847", url="http://www.ncbi.nlm.nih.gov/pubmed/38663010" } @Article{info:doi/10.2196/44463, author="Liu, Zhuo and Sun, Xin and Guo, Zhen-Ni and Sun, Ye and Yang, Yi and Yan, Xiuli", title="Effects of a Planned Web-Based Educational Intervention Based on the Health Belief Model for Patients With Ischemic Stroke in Promoting Secondary Prevention During the COVID-19 Lockdown in China: Quasi-Experimental Study", journal="JMIR Mhealth Uhealth", year="2024", month="Apr", day="24", volume="12", pages="e44463", keywords="health belief model", keywords="health education", keywords="secondary prevention", keywords="stroke", keywords="medication adherence", keywords="patient education", keywords="web-based education", keywords="digital intervention", keywords="promotion", keywords="stroke patients", keywords="ischemic", keywords="prevention", keywords="quasi-experimental study", keywords="education", keywords="control group", keywords="health management", keywords="management", keywords="systolic blood pressure", keywords="blood pressure", keywords="effectiveness", abstract="Background: Some common modified vascular risk factors remain poorly controlled among stroke survivors, and educational programs may help improve these conditions. Objective: This study aimed to evaluate the effect of a planned web-based educational intervention based on the health belief model (HBM) in promoting secondary prevention among patients with ischemic stroke. Methods: An evaluation-blinded quasi-experimental trial with a historical control group was conducted. Patients admitted from March to June 2020 were assigned to the historical control group, and patients admitted from July to October 2020 were assigned to the intervention group. The control group received routine health management. The intervention group received 6 additional sessions based on the HBM via Tencent Meeting, an audio and video conferencing application, within 3 months after discharge. Sessions were held every 2 weeks, with each session lasting approximately 40 minutes. These sessions were conducted in small groups, with about 8 to 10 people in each group. The primary outcomes were changes in blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1c), and the proportion of patients achieving the treatment target. The secondary outcomes were medication adherence, assessed with the Morisky Medicine Adherence Scale (MMAS), and disability, assessed with the modified Rankin scale. Results: In total, 315 patients experiencing their first-ever stroke were analyzed. More patients in the intervention group had controlled BP (41.9\% vs 28.4\%; adjusted odds ratio [aOR] 1.93; P=.01), LDL-C (83.1\% vs 67.7\%; aOR 2.66; P=.001), and HbA1c (91.9\% vs 83.9\%; aOR: 3.37; P=.04) levels as well as a significant postintervention decrease in the systolic BP (adjusted $\beta$ ?3.94; P=.02), LDL-C (adjusted $\beta$ ?0.21; P=.008), and HbA1c (adjusted $\beta$ ?0.27; P<.001), compared with control groups. Significant between-group differences were observed in medication adherence (79.4\% vs 63.2\%; aOR 2.31; P=.002) but not in favorable functional outcomes. Conclusions: A web-based education program based on the HBM may be more effective than current methods used to educate patients having strokes on optimal vascular risk factors and medication adherence. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000040804; https://www.chictr.org.cn/showproj.html?proj=62431 ", doi="10.2196/44463", url="https://mhealth.jmir.org/2024/1/e44463" } @Article{info:doi/10.2196/47012, author="Wang, Ying and Chen, Yanling and Song, Yuqing and Chen, Hong and Guo, Xin and Ma, Ling and Liu, Huan", title="The Impact of mHealth-Based Continuous Care on Disease Knowledge, Treatment Compliance, and Serum Uric Acid Levels in Chinese Patients With Gout: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Apr", day="11", volume="12", pages="e47012", keywords="mHealth", keywords="continuous care", keywords="gout", keywords="treat-to-target", keywords="uric acid", keywords="Chinese", keywords="awareness", keywords="management", keywords="intervention", keywords="disease management", keywords="compliance", keywords="mobile health", abstract="Background: In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues. Objective: This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels. Methods: This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention. Results: Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50\%) and control (n=60, 50\%) groups. Of the 120 participants, 93 (77.5\%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time ($\beta$=0.617, 95\% CI 0.104-1.129; P=.02 and $\beta$=1.300, 95\% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week ($\beta$=1.667, 95\% CI ?3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week ($\beta$=6.287, 95\% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43). Conclusions: Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout. Trial Registration: Chinese Clinical Trials Registry ChiCTR2100042712; https://www.chictr.org.cn/showproj.html?proj=121002 ", doi="10.2196/47012", url="https://mhealth.jmir.org/2024/1/e47012" } @Article{info:doi/10.2196/52996, author="Shin, Jung-hye and Shields, Rachael and Lee, Jenny and Skrove, Zachary and Tredinnick, Ross and Ponto, Kevin and Fields, Beth", title="Quality and Accessibility of Home Assessment mHealth Apps for Community Living: Systematic Review", journal="JMIR Mhealth Uhealth", year="2024", month="Mar", day="11", volume="12", pages="e52996", keywords="mobile app", keywords="mobile applications", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="mobile phone", keywords="mobile app rating system", keywords="occupational therapy", keywords="home assessment", keywords="web accessibility", keywords="aging in place", keywords="accessible", keywords="accessibility", keywords="quality", keywords="rating", keywords="gerontology", keywords="geriatric", keywords="geriatrics", keywords="older adult", keywords="older adults", keywords="elder", keywords="elderly", keywords="older person", keywords="older people", keywords="ageing", keywords="aging", keywords="systematic", keywords="synthesis", keywords="syntheses", keywords="PRISMA", keywords="Google Play", keywords="content analysis", keywords="functionality", keywords="WCAG", abstract="Background: Home assessment is a critical component of successful home modifications, enabling individuals with functional limitations to age in place comfortably. A high-quality home assessment tool should facilitate a valid and reliable assessment involving health care and housing professionals, while also engaging and empowering consumers and their caregivers who may be dealing with multiple functional limitations. Unlike traditional paper-and-pencil assessments, which require extensive training and expert knowledge and can be alienating to consumers, mobile health (mHealth) apps have the potential to engage all parties involved, empowering and activating consumers to take action. However, little is known about which apps contain all the necessary functionality, quality appraisal, and accessibility. Objective: This study aimed to assess the functionality, overall quality, and accessibility of mHealth home assessment apps. Methods: mHealth apps enabling home assessment for aging in place were identified through a comprehensive search of scholarly articles, the Apple (iOS) and Google Play (Android) stores in the United States, and fnd.io. The search was conducted between November 2022 and January 2023 following a method adapted from PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Reviewers performed a content analysis of the mobile app features to evaluate their functionality, overall quality, and accessibility. The functionality assessment used a home assessment component matrix specifically developed for this study. For overall quality, the Mobile Application Rating Scale (MARS) was used to determine the apps' effectiveness in engaging and activating consumers and their caregivers. Accessibility was assessed using the Web Content Accessibility Guidelines (WCAG) 2.1 (A and AA levels). These 3 assessments were synthesized and visualized to provide a comprehensive evaluation. Results: A total of 698 apps were initially identified. After further screening, only 6 apps remained. Our review revealed that none of the apps used thoroughly tested assessment tools, offered all the functionality required for reliable home assessment, achieved the ``good'' quality threshold as measured by the MARS, or met the accessibility criteria when evaluated against WCAG 2.1. However, DIYModify received the highest scores in both the overall quality and accessibility assessments. The MapIt apps also showed significant potential due to their ability to measure the 3D environment and the inclusion of a desktop version that extends the app's functionality. Conclusions: Our review revealed that there are very few apps available within the United States that possess the necessary functionality, engaging qualities, and accessibility to effectively activate consumers and their caregivers for successful home modification. Future app development should prioritize the integration of reliable and thoroughly tested assessment tools as the foundation of the development process. Furthermore, efforts should be made to enhance the overall quality and accessibility of these apps to better engage and empower consumers to take necessary actions to age in place. ", doi="10.2196/52996", url="https://mhealth.jmir.org/2024/1/e52996", url="http://www.ncbi.nlm.nih.gov/pubmed/38466987" } @Article{info:doi/10.2196/51057, author="Robertson, C. Michael and Cox-Martin, Emily and Basen-Engquist, Karen and Lyons, J. Elizabeth", title="Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2024", month="Feb", day="9", volume="12", pages="e51057", keywords="survivors of cancer", keywords="exercise", keywords="acceptance and commitment therapy", keywords="fatigue", keywords="mindfulness", keywords="motivation", keywords="behavioral sciences", abstract="Background: People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective: The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods: Of the intervention's 8 weekly modules, 7 (88\%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results: Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77\%), and mostly overweight or obese (54/75, 72\%). Of the 407 responses to the item prompting personal reflection, 70 (17.2\%) were rated as reflection level 0 (ie, description), 247 (60.7\%) were level 1 (ie, reflective description), 74 (18.2\%) were level 2 (ie, dialogic reflection), 14 (3.4\%) were level 3 (ie, transformative reflection), and 2 (0.5\%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95\% CI 0.02-0.50) and decreases in sleep disturbance (B=?1.04, SE 0.50, 95\% CI ?0.06 to ?2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95\% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95\% CI 0.06-1.04). Conclusions: We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy. ", doi="10.2196/51057", url="https://mhealth.jmir.org/2024/1/e51057", url="http://www.ncbi.nlm.nih.gov/pubmed/38335025" } @Article{info:doi/10.2196/45942, author="Buss, Helen Vera and Barr, Margo and Parker, M. Sharon and Kabir, Alamgir and Lau, S. Annie Y. and Liaw, Siaw-Teng and Stocks, Nigel and Harris, F. Mark", title="Mobile App Intervention of a Randomized Controlled Trial for Patients With Obesity and Those Who Are Overweight in General Practice: User Engagement Analysis Quantitative Study", journal="JMIR Mhealth Uhealth", year="2024", month="Feb", day="9", volume="12", pages="e45942", keywords="health literacy", keywords="primary health care", keywords="mobile application", keywords="overweight", keywords="vulnerable populations", keywords="health behavior", keywords="mHealth", keywords="obesity", keywords="weight loss", keywords="mysnapp app", keywords="mobile phone", abstract="Background: The Health eLiteracy for Prevention in General Practice trial is a primary health care--based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching. Objective: This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months. Methods: In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics. Results: Of the 120 participants who received the intervention, 62 (52\%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months. Conclusions: Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023239 ", doi="10.2196/45942", url="https://mhealth.jmir.org/2024/1/e45942", url="http://www.ncbi.nlm.nih.gov/pubmed/38335014" } @Article{info:doi/10.2196/46397, author="Mizuta, Rami and Maeda, Noriaki and Tashiro, Tsubasa and Suzuki, Yuta and Kuroda, Sayo and Ishida, Ayano and Oda, Sakura and Watanabe, Tomoya and Tamura, Yuki and Komiya, Makoto and Urabe, Yukio", title="Effectiveness of Metaverse Space--Based Exercise Video Distribution in Young Adults: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="16", volume="12", pages="e46397", keywords="exercise video distribution", keywords="exercise", keywords="metaverse", keywords="physical activity", keywords="web-based intervention", abstract="Background: In response to the serious lack of physical activity among young adults, recent attempts have been made to encourage young people to exercise through exercise video distribution. However, merely distributing videos does not lead to improved physical activity levels. Metaverse space, which enables web-based interaction through avatars, allows users to watch exercise videos in the same space as other avatars. Objective: This study explored whether exercise video distribution using metaverse space is effective in improving physical activity levels, along with mental health and locomotive function, among young people. Methods: In this parallel-group randomized controlled trial participants were recruited using printed poster displays. A total of 48 young adults aged between 18 and 30 years were assigned to 3 groups of 16 each: the metaverse, YouTube, and control group. To encourage exercise, the metaverse group was given an exercise video each week with a load of around 4-8 metabolic equivalents of tasks (METs) for 8 videos delivered in the metaverse space. The YouTube group was sent a URL on YouTube every week to view exercise videos with the same content as the metaverse group. The control group was given no special instructions. The intervention period was 8 weeks. Pre- and postintervention physical activity, well-being, locomotive syndrome risk tests, and social capital were measured. Although this study was not blinded to the participants, the measurers did not know to which group the participants belonged. Mixed model repeated-measures analyses and a post hoc Wilcoxon signed rank sum test were performed to detect the effects of the intervention in all groups. Results: The results of the mixed model repeated-measures analyses showed a significant interaction between groups and before and after the intervention for total physical activity (metaverse group: pre 737.1, SD 609.5 METs/week, post 1575.4, SD 1071.8 METs/week; YouTube group: pre 661.7, SD 710.7 METs/week, post 911.9, SD 1103.3 METs/week; and control group: pre 930.6, SD 665.1 METs/week, post 844.7, SD 701.8 METs/week; P=.04) but none for the indicators of well-being (P=.40), locomotive function scale (P=.17), and social capital (P=.23). A post hoc test showed a significant increase in physical activity in the metaverse group before and after the intervention (P=.006). Conclusions: This study is the first to show that delivering exercise videos through metaverse space can increase physical activity in young adults by providing a gathering space for individuals similarly motivated for exercise practice. This way, the sense of isolation during exercise is reduced compared with merely distributing videos on YouTube. The use of metaverse space in health promotion is likely to spread, and this study provides a useful reference for its exploration. Trial Registration: ClinicalTrials.gov NCT06019156; https://ichgcp.net/clinical-trials-registry/NCT06019156 ", doi="10.2196/46397", url="https://mhealth.jmir.org/2024/1/e46397", url="http://www.ncbi.nlm.nih.gov/pubmed/38227355" } @Article{info:doi/10.2196/51361, author="Nguyen, C. Quynh and Aparicio, M. Elizabeth and Jasczynski, Michelle and Channell Doig, Amara and Yue, Xiaohe and Mane, Heran and Srikanth, Neha and Gutierrez, Marin Francia Ximena and Delcid, Nataly and He, Xin and Boyd-Graber, Jordan", title="Rosie, a Health Education Question-and-Answer Chatbot for New Mothers: Randomized Pilot Study", journal="JMIR Form Res", year="2024", month="Jan", day="12", volume="8", pages="e51361", keywords="chatbot", keywords="health information", keywords="maternal and child health", keywords="health disparities", keywords="health equity", keywords="health informatics", keywords="preventive health care", keywords="postpartum care", keywords="patient education", keywords="newborn care", keywords="prenatal care", keywords="mobile phone", abstract="Background: Stark disparities exist in maternal and child outcomes and there is a need to provide timely and accurate health information. Objective: In this pilot study, we assessed the feasibility and acceptability of a health chatbot for new mothers of color. Methods: Rosie, a question-and-answer chatbot, was developed as a mobile app and is available to answer questions about pregnancy, parenting, and child development. From January 9, 2023, to February 9, 2023, participants were recruited using social media posts and through engagement with community organizations. Inclusion criteria included being aged ?14 years, being a woman of color, and either being currently pregnant or having given birth within the past 6 months. Participants were randomly assigned to the Rosie treatment group (15/29, 52\% received the Rosie app) or control group (14/29, 48\% received a children's book each month) for 3 months. Those assigned to the treatment group could ask Rosie questions and receive an immediate response generated from Rosie's knowledgebase. Upon detection of a possible health emergency, Rosie sends emergency resources and relevant hotline information. In addition, a study staff member, who is a clinical social worker, reaches out to the participant within 24 hours to follow up. Preintervention and postintervention tests were completed to qualitatively and quantitatively evaluate Rosie and describe changes across key health outcomes, including postpartum depression and the frequency of emergency room visits. These measurements were used to inform the clinical trial's sample size calculations. Results: Of 41 individuals who were screened and eligible, 31 (76\%) enrolled and 29 (71\%) were retained in the study. More than 87\% (13/15) of Rosie treatment group members reported using Rosie daily (5/15, 33\%) or weekly (8/15, 53\%) across the 3-month study period. Most users reported that Rosie was easy to use (14/15, 93\%) and provided responses quickly (13/15, 87\%). The remaining issues identified included crashing of the app (8/15, 53\%), and users were not satisfied with some of Rosie's answers (12/15, 80\%). Mothers in both the Rosie treatment group and control group experienced a decline in depression scores from pretest to posttest periods, but the decline was statistically significant only among treatment group mothers (P=.008). In addition, a low proportion of treatment group infants had emergency room visits (1/11, 9\%) compared with control group members (3/13, 23\%). Nonetheless, no between-group differences reached statistical significance at P<.05. Conclusions: Rosie was found to be an acceptable, feasible, and appropriate intervention for ethnic and racial minority pregnant women and mothers of infants owing to the chatbot's ability to provide a personalized, flexible tool to increase the timeliness and accessibility of high-quality health information to individuals during a period of elevated health risks for the mother and child. Trial Registration: ClinicalTrials.gov NCT06053515; https://clinicaltrials.gov/study/NCT06053515 ", doi="10.2196/51361", url="https://formative.jmir.org/2024/1/e51361", url="http://www.ncbi.nlm.nih.gov/pubmed/38214963" } @Article{info:doi/10.2196/49302, author="B{\'e}jar, Mar{\'i}a Luis and Mesa-Rodr{\'i}guez, Pedro and Garc{\'i}a-Perea, Dolores Mar{\'i}a", title="Short-Term Effect of a Health Promotion Intervention Based on the Electronic 12-Hour Dietary Recall (e-12HR) Smartphone App on Adherence to the Mediterranean Diet Among Spanish Primary Care Professionals: Randomized Controlled Clinical Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="8", volume="12", pages="e49302", keywords="primary care professionals", keywords="Mediterranean diet", keywords="smartphone applications", keywords="smartphone apps", keywords="health promotion", keywords="Mediterranean diet adherence", keywords="food group", abstract="Background: The World Health Organization has called for addressing the growing burden of noncommunicable diseases (NCDs) by promoting healthy lifestyles among the population. Regarding patient health, primary care professionals (PCPs) are the first line of care who can positively influence patients' behavior and lifestyle habits. However, a significant percentage of PCPs do not lead a healthy lifestyle. Therefore, addressing their health behaviors may be the key to substantially increasing health promotion advice in general practice. The Mediterranean diet has been extensively studied, and there is strong evidence of it being a dietary pattern for the prevention of NCDs, in addition to its significant environmental, sociocultural, and local economics benefits. Objective: This study focused only on the dietary aspect of the PCPs' lifestyle. The primary objective was to evaluate the effect of using the Electronic 12-Hour Dietary Recall (e-12HR) smartphone app to improve diet, specifically to promote adherence to the Mediterranean diet (AMD), among PCPs. The secondary objectives were to establish the usability of the e-12HR app and to determine AMD among PCPs. Methods: An individual-level randomized, controlled, and single-blind clinical trial was conducted with 2 parallel groups: a control group (CG), using the nonfeedback version of the e-12HR app, and an intervention group (IG), using the feedback version of the e-12HR app. The level of human involvement was fully automated through the use of the app. There was a 28-day follow-up period. Participants were PCPs (medicine or nursing) recruited offline at one of the selected primary care centers (Andalusia, Spain, Southern Europe), of both sexes, over 18 years old, possessing a smartphone, and having smartphone literacy. Results: The study response rate was 73\% (71 of 97 PCPs), with 27 (38\%) women and 44 (62\%) men: 40 (56\%) PCPs in the CG and 31 (44\%) in the IG. At baseline, AMD was medium (mean Mediterranean Diet Serving Score [MDSS] index 9.45, range 0-24), with 47 (66\%) PCPs with a medium/high MDSS index. There were significant statistical improvements (CG vs IG, in favor of the IG) at week 4 (no significant statistical differences at baseline): +25.6\% for the MDSS index (P=.002) and +213.1\% for the percentage with a medium/high MDSS index (P=.001). In relation to specific food groups, there were significant statistical improvements for fruits (+33.8\%, P=.02), vegetables (+352\%, P=.001), nuts (+184\%, P=.02), and legumes (+75.1\%, P=.03). The responses to the usability rating questionnaire were satisfactory. Conclusions: The results support recommending the use of the e-12HR app as a tool to contribute to improving diet and preventing NCDs among PCPs, while positively influencing patient dietary behavior and preventing diet-related NCDs among patients. Trial Registration: ClinicalTrials.gov NCT05532137; https://clinicaltrials.gov/study/NCT05532137 ", doi="10.2196/49302", url="https://mhealth.jmir.org/2024/1/e49302", url="http://www.ncbi.nlm.nih.gov/pubmed/38190226" } @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/10.2196/43105, author="Singh, Akanksha and Schooley, Benjamin and Patel, Nitin", title="Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2023", month="Dec", day="14", volume="11", pages="e43105", keywords="patient engagement", keywords="chatbot", keywords="population health", keywords="health recommender systems", keywords="conversational recommender systems", keywords="design factors", keywords="COVID-19", abstract="Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19--related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. ", doi="10.2196/43105", url="https://mhealth.jmir.org/2023/1/e43105", url="http://www.ncbi.nlm.nih.gov/pubmed/38096007" } @Article{info:doi/10.2196/49950, author="Anaje, Chioma Chetanna and Okpala, Ifeanyi Chibuzo and Enechukwu, Anne Nkechi and Ezejiofor, Ifeanyi Ogochukwu and Malachy, Echezona Divinefavour and Nwiyi, Kenechukwu Obumneme", title="The Impact of WhatsApp as a Health Education Tool in Albinism: Interventional Study", journal="JMIR Dermatol", year="2023", month="Nov", day="21", volume="6", pages="e49950", keywords="WhatsApp", keywords="oculocutaneous albinism", keywords="health education", keywords="smartphone", keywords="mobile phone", keywords="teledermatology", keywords="photodermatoses", keywords="digital health intervention", keywords="photoprotection", keywords="West Africa", keywords="social media", keywords="albinism", keywords="albino", keywords="skin", keywords="dermatology", keywords="melanin", keywords="patient education", keywords="sun", keywords="sunscreen", keywords="discussion group", keywords="digital health education", abstract="Background: Oculocutaneous albinism is a congenital disorder that causes hypopigmentation of the skin, hair, and eyes due to a lack of melanin. People with albinism are at increased risk of developing skin complications, such as solar keratosis and skin cancers, leading to higher morbidity. As education is crucial in managing albinism, leveraging information technology, such as WhatsApp, can provide an effective intervention for digital health education. Objective: This study aims to assess the impact of WhatsApp as a tool for providing health education among people with albinism. Methods: The design of the study was interventional. The intervention consisted of weekly health education sessions conducted in a WhatsApp group for the duration of 4 weeks. The topics discussed were knowledge of albinism, sun protection practices, the use of sunscreen, and myths about albinism. They were all covered in 4 WhatsApp sessions held in 4 separate days. A web-based questionnaire was filled out before and after the intervention by the participants. Mann-Whitney U test was used to compare the pre- and postknowledge scores. Spearman correlation was used to correlate data. Results: The mean age of the study participants was 28.28 (SD 11.57) years. The number of participants was 140 in the preintervention period and 66 in the postintervention period. A statistically significant increase in overall knowledge (P=.01), knowledge of sunscreen (P=.01), and knowledge of sun protection (P<.01) was observed following the intervention. Before the intervention, a positive correlation was observed between age (r=0.17; P=.03) and education level (r=0.19; P=.02) with participants' overall knowledge. However, after the intervention, there was no significant correlation between knowledge and age or education level. A percentage increase of 5.23\% was observed in the overall knowledge scores following the intervention. Conclusions: WhatsApp is an effective tool for educating people with albinism and can act as an alternative to the conventional methods of health education. It shows promising outcomes irrespective of the health literacy level of people with albinism. This educational intervention can positively impact behavior change and translate to consistent sun protection practices. The limitations of this study include the possibility of social desirability bias and data security. ", doi="10.2196/49950", url="https://derma.jmir.org/2023/1/e49950", url="http://www.ncbi.nlm.nih.gov/pubmed/37988154" } @Article{info:doi/10.2196/51852, author="Chung, Hsueh-Wen and Tai, Chen-Jei and Chang, Polun and Su, Wen-Lin and Chien, Li-Yin", title="Authors' Reply: Concerns on Generalizability", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="21", volume="11", pages="e51852", keywords="mHealth app", keywords="mobile health", keywords="mHealth", keywords="app", keywords="prediabetes", keywords="traditional Chinese medicine", keywords="TCM", keywords="health-related quality of life", keywords="body constitution", keywords="meridian energy", doi="10.2196/51852", url="https://mhealth.jmir.org/2023/1/e51852", url="http://www.ncbi.nlm.nih.gov/pubmed/37733412" } @Article{info:doi/10.2196/50280, author="Lin, Yongjian", title="Concerns on Generalizability", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="21", volume="11", pages="e50280", keywords="mHealth app", keywords="mobile health", keywords="mHealth", keywords="app", keywords="prediabetes", keywords="traditional Chinese medicine", keywords="TCM", keywords="health-related quality of life", keywords="body constitution", keywords="meridian energy", doi="10.2196/50280", url="https://mhealth.jmir.org/2023/1/e50280", url="http://www.ncbi.nlm.nih.gov/pubmed/37733387" } @Article{info:doi/10.2196/52204, author="Feng, Yuheng and Li, Xiaohong", title="Authors' Reply: Methodological Considerations for a Diabetes Family-Based eHealth Intervention", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="18", volume="11", pages="e52204", keywords="public health", keywords="type 2 diabetes mellitus", keywords="intervention", keywords="randomized controlled trial", keywords="community health center", doi="10.2196/52204", url="https://mhealth.jmir.org/2023/1/e52204", url="http://www.ncbi.nlm.nih.gov/pubmed/37721796" } @Article{info:doi/10.2196/48652, author="Bro?, Jan and Campbell, D. Matthew and Krollov{\'a}, Pavl{\'i}na and Michalec, Juraj", title="Methodological Considerations for a Diabetes Family-Based eHealth Intervention", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="18", volume="11", pages="e48652", keywords="public health", keywords="type 2 diabetes mellitus", keywords="intervention", keywords="randomized controlled trial", keywords="community health center", doi="10.2196/48652", url="https://mhealth.jmir.org/2023/1/e48652", url="http://www.ncbi.nlm.nih.gov/pubmed/37721787" } @Article{info:doi/10.2196/46143, author="V{\"a}yrynen, Elina and Hakola, Sanna and Keski-Salmi, Anniina and J{\"a}ms{\"a}, Hannaleena and Vainionp{\"a}{\"a}, Raija and Karki, Saujanya", title="The Use of Patient-Oriented Mobile Phone Apps in Oral Health: Scoping Review", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="6", volume="11", pages="e46143", keywords="oral health", keywords="dentistry", keywords="mobile apps", keywords="mobile health", keywords="mHealth", keywords="mobile phone", abstract="Background: Oral health is a significant part of general health. Poor oral health can influence an individual's appearance, self-esteem, eating, and speaking. The use of mobile phone apps has been growing in the field of medicine, including dentistry. However, to date, there is no evidence related to the availability of mobile apps focusing on various branches of dentistry. Objective: The aim of this study was to review the scientific literature on the use of patient-oriented mobile phone apps in oral health and summarize the key findings. Methods: A scoping review of published scientific literature on the use of patient-oriented mobile phone apps in oral health was conducted in accordance with the Joanna Briggs Institute. A search was performed in PubMed and Scopus for studies published between January 2000 and June 2021 that were written in English. All study types except for those reporting developmental protocols were included in this review. In total, 2 reviewers independently screened the studies using the eligibility criteria. The study protocol was registered in the Open Science Framework registries in June 2021. Results: The initial search yielded a total of 977 studies, 45 (4.6\%) of which met the inclusion criteria. All the studies (45/45, 100\%) were published after 2009. Most studies (31/45, 69\%) concerned oral health promotion using mobile phone apps, followed by behavior management (5/45, 11\%). More than half (23/45, 51\%) of the included studies were conducted in Asian countries. Overall, 31\% (14/45) of the studies focused on adolescents. A total of 51\% (23/45) of the studies were randomized controlled trials (RCTs). Approximately 39\% (9/23) of the included RCT studies reported a substantial reduction in dental plaque, and 26\% (6/23) of the studies reported significant improvement in gingival health. Regarding dental anxiety management, 13\% (3/23) of the RCT studies reported a significant decrease in mean heart rate and lower Facial Image Scale scores. Conclusions: According to the literature, the use of mobile apps in oral health is increasing among patients, mainly children and adolescents. Many studies that have used mobile apps have focused on promoting oral health. However, other areas such as diagnostic and remote consultations (teledentistry) have until recently been neglected despite their great potential. ", doi="10.2196/46143", url="https://mhealth.jmir.org/2023/1/e46143", url="http://www.ncbi.nlm.nih.gov/pubmed/37672331" } @Article{info:doi/10.2196/47473, author="Mitchell, Siobhan Ellen and Fabry, Alexander and Ho, Suh Annabell and May, N. Christine and Baldwin, Matthew and Blanco, Paige and Smith, Kyle and Michaelides, Andreas and Shokoohi, Mostafa and West, Michael and Gotera, Kim and El Massad, Omnya and Zhou, Anna", title="The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study", journal="JMIR Mhealth Uhealth", year="2023", month="Aug", day="24", volume="11", pages="e47473", keywords="mobile health", keywords="mHealth", keywords="obesity", keywords="overweight", keywords="Noom Weight", keywords="digital weight loss intervention", keywords="health care resource utilization", keywords="costs", keywords="electronic health record", keywords="EHR", keywords="insurance claims", keywords="inverse probability of treatment weighting", keywords="IPTW", keywords="mobile phone", abstract="Background: The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. Objective: This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. Methods: Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non--Noom Weight users aged between 18 and 80 years with a BMI of ?25 kg/m{\texttwosuperior} and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. Results: Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] ?US \$20.10, 95\% CI ?US \$30.08 to ?US \$10.12), less outpatient costs (MD ?US \$124.33, 95\% CI ?US \$159.76 to ?US \$88.89), less overall prescription costs (MD ?US \$313.82, 95\% CI ?US \$565.42 to ?US \$62.21), and less overall health care costs (MD ?US \$450.39, 95\% CI ?US \$706.28 to ?US \$194.50) per user than non--Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD ?0.03, 95\% CI ?0.04 to ?0.03), fewer outpatient visits (MD ?0.78, 95\% CI ?0.93 to ?0.62), fewer surgeries (MD ?0.01, 95\% CI ?0.01 to 0.00), and fewer prescriptions (MD ?1.39, 95\% CI ?1.76 to ?1.03) per user than non--Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD ?US \$1139.52, 95\% CI ?US \$1972.21 to ?US \$306.83) and lower overall health care costs (MD ?US \$1219.06, 95\% CI ?US \$2061.56 to ?US \$376.55) per user than non--Noom Weight users. The key differences were associated with reduced prescription use. Conclusions: Noom Weight use is associated with lower HRU and costs than non--Noom Weight use, with potential cost savings of up to US \$1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight. ", doi="10.2196/47473", url="https://mhealth.jmir.org/2023/1/e47473", url="http://www.ncbi.nlm.nih.gov/pubmed/37616049" } @Article{info:doi/10.2196/39929, author="Blakeslee, B. Sarah and Vieler, Kristin and Horak, Ingo and Stritter, Wiebke and Seifert, Georg", title="Planting Seeds for the Future: Scoping Review of Child Health Promotion Apps for Parents", journal="JMIR Mhealth Uhealth", year="2023", month="Jul", day="20", volume="11", pages="e39929", keywords="scoping review", keywords="child health promotion", keywords="parents", keywords="mobile apps", keywords="health apps", keywords="digital prevention", keywords="behavior change", keywords="mHealth", abstract="Background: Increasingly, parents use child health promotion apps to find health information. An overview of child health promotion apps for parents currently does not exist. The scope of child health topics addressed by parent apps is thus needed, including how they are evaluated. Objective: This scoping review aims to describe existing reported mobile health (mHealth) parent apps of middle- to high-income countries that promote child health. The focus centers on apps developed in the last 5 years, showing how the reported apps are evaluated, and listing reported outcomes found. Methods: A scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines to identify parent apps or web-based programs on child health promotion published between January 2016 and June 2021 in 5 databases: PubMed, ERIC, IEEE Xplore, Web of Science, and Google Scholar. Separate sources were sought through an expert network. Included studies were summarized and analyzed through a systematic and descriptive content analysis, including keywords, year of publication, country of origin, aims/purpose, study population/sample size, intervention type, methodology/method(s), broad topic(s), evaluation, and study outcomes. Results: In total, 39 studies met the inclusion criteria from 1040 database and 60 expert-identified studies. Keywords reflected the health topics and app foci. About 64\% (25/39) of included studies were published after 2019 and most stemmed from the United States, Australian, and European-based research. Studies aimed to review or evaluate apps or conducted app-based study interventions. The number of participants ranged from 7 to 1200. Quantitative and qualitative methods were used. Interventions included 28 primary studies, 6 app feasibility studies, and 5 app or literature reviews. Eight separate topics were found: parental feeding and nutrition, physical activity, maternal-child health, parent-child health, healthy environment, dental health, mental health, and sleep. Study intervention evaluations cited behavior change theories in 26 studies and evaluations were carried out with a variety of topic-specific, adapted, self-developed, or validated questionnaires and evaluation tools. To evaluate apps, user input and qualitative evaluations were often combined with surveys and frequently rated with the Mobile App Rating Scale. Outcomes reported some positive effects, while several intervention studies saw no effect at all. Effectively evaluating changes in behavior through apps, recruiting target groups, and retaining app engagement were challenges cited. Conclusions: New parents are a key target group for child health apps, but evaluating child health promotion apps remains a challenge. Whether tailored to parent needs or adapted to the specific topic, apps should be rooted in a transparent theoretical groundwork. Applicable lessons for parent apps from existing research are to tailor app content, include intuitive and adaptive features, and embed well-founded parameters for long-term effect evaluation on child health promotion. ", doi="10.2196/39929", url="https://mhealth.jmir.org/2023/1/e39929", url="http://www.ncbi.nlm.nih.gov/pubmed/37471125" } @Article{info:doi/10.2196/47524, author="Tsimicalis, Argerie and Stinson, Jennifer and Thorstad, Kelly and Rauch, Frank and Hamdy, Reggie and Chougui, Khadidja and Addab, Sofia and Palomo, Telma and Bernstein, Mitchell and Dahan-Oliel, Noemi and Veilleux, Louis-Nicolas and Massochin Nunes Pinto, Laura and Passos dos Santos, Raissa", title="The Design, Development, and Usability Testing of an eHealth Program for Youths With Osteogenesis Imperfecta: Protocol for a 2-Phase User-Centered Mixed Methods Study", journal="JMIR Res Protoc", year="2023", month="Jun", day="23", volume="12", pages="e47524", keywords="eHealth program", keywords="osteogenesis imperfecta", keywords="self-management", keywords="youth", keywords="transition of care", abstract="Background: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called ``Teens Taking Charge: Managing OI Online,'' hereafter named ``Teens OI.'' This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. Objective: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. Methods: A user-centered design is presently in progress to design and develop Teens OI. A ``Website Design and Development Council'' (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. Results: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. Conclusions: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths' openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. International Registered Report Identifier (IRRID): DERR1-10.2196/47524 ", doi="10.2196/47524", url="https://www.researchprotocols.org/2023/1/e47524", url="http://www.ncbi.nlm.nih.gov/pubmed/37351933" } @Article{info:doi/10.2196/41099, author="Chung, Hsueh-Wen and Tai, Chen-Jei and Chang, Polun and Su, Wen-Lin and Chien, Li-Yin", title="The Effectiveness of a Traditional Chinese Medicine--Based Mobile Health App for Individuals With Prediabetes: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Jun", day="20", volume="11", pages="e41099", keywords="mHealth app", keywords="prediabetes", keywords="traditional Chinese medicine", keywords="health-related quality of life", keywords="body constitution", keywords="meridian energy", abstract="Background: Traditional Chinese medicine (TCM) theories assert that body constitution and meridian energy lay the foundation for disease prevention. TCM-based health concepts have not yet been incorporated into mobile health (mHealth) apps for individuals with prediabetes. Objective: The aim of this study was to examine the effectiveness of a TCM mHealth app for individuals with prediabetes. Methods: This randomized controlled trial recruited 121 individuals with prediabetes at a teaching hospital in New Taipei City between February 2020 and May 2021. The participants were randomly assigned to?the TCM mHealth app group (n=42), ordinary mHealth app group (n=41), or control group (n=38). All participants received the usual care that included 15-20 minutes of health education about the disease, along with healthy diet and exercise encouragement. The ordinary mHealth app included physical activity (PA), diet, and disease education, along with individual records. The TCM mHealth app additionally included qi and body constitution information, along with constitution-based PA and diet advice. The control group received the usual care alone and did not have access to any app. Data were collected at baseline, at the end of the 12-week intervention, and 1 month after the intervention. Body constitution, including yang-deficiency, yin-deficiency, and phlegm-stasis, was measured according to the Body Constitution Questionnaire, with higher scores indicating a greater deficiency. Body energy was examined using the Meridian Energy Analysis Device. The Short-Form 36 questionnaire was used to evaluate health-related quality of life (HRQOL), which yielded physical component scores and mental component scores, with higher scores indicating better physical and mental aspects of HRQOL, respectively. Results: Compared to the control group, the TCM mHealth app group showed greater improvement in hemoglobin A1c (HbA1c), yang-deficiency and phlegm-stasis body constitution, and BMI; however, no significant differences were found in these outcomes between the TCM mHealth app and ordinary mHealth app groups. The TCM mHealth app group showed better improvement in body energy and mental component scores than the ordinary mHealth app group. There were no significant differences in fasting plasma glucose, yin-deficiency body constitution, Dietary Approaches to Stop Hypertension dietary behavior, and total PA among the three groups after the intervention. Conclusions: Use of either the ordinary or TCM mHealth app improved HRQOL among individuals with prediabetes. Compared to the outcomes of controls not using any app, use of the TCM mHealth app was effective at improving HbA1c, BMI, yang-deficiency and phlegm-stasis body constitution, and HRQOL. Moreover, using the TCM mHealth app seemed to improve the body energy and HRQOL more than when using the ordinary mHealth app. Further studies with a larger sample size and longer follow-up period may be necessary to determine whether the differences favoring the TCM app are clinically meaningful. Trial Registration: ClinicalTrials.gov NCT04096989; https://clinicaltrials.gov/ct2/show/NCT04096989 ", doi="10.2196/41099", url="https://mhealth.jmir.org/2023/1/e41099", url="http://www.ncbi.nlm.nih.gov/pubmed/37338977" } @Article{info:doi/10.2196/45531, author="Liu, Wei and Yu, Xiaojuan and Wang, Jiangyuan and Zhou, Tianmeng and Yu, Ting and Chen, Xuyong and Xie, Shasha and Han, Fuman and Wang, Zi", title="Improving Kidney Outcomes in Patients With Nondiabetic Chronic Kidney Disease Through an Artificial Intelligence--Based Health Coaching Mobile App: Retrospective Cohort Study", journal="JMIR Mhealth Uhealth", year="2023", month="Jun", day="1", volume="11", pages="e45531", keywords="chronic kidney disease", keywords="self-management", keywords="mobile apps", keywords="end-stage kidney disease", keywords="eHealth intervention", keywords="kidney", keywords="efficacy", keywords="eHealth care", keywords="dialysis", keywords="deep-learning", keywords="artificial intelligence", keywords="patient care", abstract="Background: Chronic kidney disease (CKD) is a global health burden. However, the efficacy of different modes of eHealth care in facilitating self-management for patients with CKD is unclear. Objective: The aim of this study was to evaluate the effectiveness of a mobile app--based intelligent care system in improving the kidney outcomes of patients with CKD. Methods: Our study was a retrospective analysis based on the KidneyOnline intelligent system developed in China. Patients with CKD but not dependent on dialysis who registered on the KidneyOnline app between January 2017 and January 2021 were screened. Patients in the the KidneyOnline intelligent system group and those in the conventional care group were 1:1 matched according to their baseline characteristics. The intervention group received center-based follow-up combined with the KidneyOnline intelligent patient care system, which was a nurse-led, patient-oriented collaborative management system. Health-related data uploaded by the patients were integrated using deep learning optical character recognition (OCR). Artificial intelligence (AI)--generated personalized recipes, lifestyle intervention suggestions, early warnings, real-time questions and answers, and personalized follow-up plans were also provided. Patients in the conventional group could get professional suggestions from the nephrologists through regular clinical visits, but they did not have access to the service provided by AI and the health coach team. Patients were followed for at least 3 months after recruitment or until death or start of renal replacement therapy. Results: A total of 2060 eligible patients who registered on the KidneyOnline app from 2017 to 2021 were enrolled for the analysis. Of those, 902 (43.8\%) patients were assessed for survival analysis after propensity score matching, with 451(50\%) patients in the KidneyOnline intelligent patient care system group and 451(50\%) patients in the conventional care group. After a mean follow-up period of 15.8 (SD 9.5) months, the primary composite kidney outcome occurred in 28 (6\%) participants in the KidneyOnline intelligent patient care system group and 32 (7\%) in the conventional care group, with a hazard ratio of 0.391 (95\% CI 0.231-0.660; P<.001). Subgroup survival analysis demonstrated that the KidneyOnline care system significantly reduced the risk of composite kidney outcome, irrespective of age, sex, baseline estimated glomerular filtration rate (eGFR), and proteinuria. In addition, the mean arterial pressure (MAP) significantly decreased from 88.9 (SD 10.5) mmHg at baseline to 85.6 (SD 7.9) mmHg at 6 months (P<.001) in the KidneyOnline intelligent patient care system group and from 89.3 (SD 11.1) mmHg to 87.5 (SD 8.2) mmHg (P=.002) in the conventional CKD care group. Conclusions: The utilization of the KidneyOnline intelligent care system was associated with reduced risk of unfavorable kidney outcomes in nondiabetic patients with CKD. ", doi="10.2196/45531", url="https://mhealth.jmir.org/2023/1/e45531", url="http://www.ncbi.nlm.nih.gov/pubmed/37261895" } @Article{info:doi/10.2196/40193, author="Lacroix, Joyca and Tatousek, Jan and Den Teuling, Niek and Visser, Thomas and Wells, Charles and Wylie, Paul and Rosenberg, Russell and Bogan, Richard", title="Effectiveness of an Intervention Providing Digitally Generated Personalized Feedback and Education on Adherence to Continuous Positive Airway Pressure: Randomized Controlled Trial", journal="J Med Internet Res", year="2023", month="May", day="22", volume="25", pages="e40193", keywords="therapy adherence", keywords="personalized feedback", keywords="personalized education", keywords="tailored communication", keywords="psychological profile", keywords="continuous positive airway pressure therapy", keywords="CPAP therapy", keywords="obstructive sleep apnea", abstract="Background: Many people worldwide experience obstructive sleep apnea, which is associated with medical and psychological problems. Continuous positive airway pressure (CPAP) is an efficacious therapy for obstructive sleep apnea, but its effect is limited by nonadherence. Studies show that personalized education and feedback can increase CPAP adherence. Moreover, tailoring the style of information to the psychological profile of a patient has been shown to enhance the impact of interventions. Objective: This study aimed to assess the effect of an intervention providing digitally generated personalized education and feedback on CPAP adherence and the additional effect of tailoring the style of the education and feedback to an individual's psychological profile. Methods: This study was a 90-day, multicenter, parallel, single-blinded, and randomized controlled trial with 3 conditions: personalized content in a tailored style (PT) in addition to usual care (UC), personalized content in a nontailored style (PN) in addition to UC, and UC. To test the effect of personalized education and feedback, the PN + PT group was compared with the UC group. To test the additional effect of tailoring the style to psychological profiles, the PN and PT groups were compared. Overall, 169 participants were recruited from 6 US sleep clinics. The primary outcome measures were adherence based on minutes of use per night and on nights of use per week. Results: We found a significant positive effect of personalized education and feedback on both primary adherence outcome measures. The difference in the estimated average adherence based on minutes of use per night between the PT + PN and UC groups on day 90 was 81.3 minutes in favor of the PT + PN group (95\% CI ?134.00 to ?29.10; P=.002). The difference in the average adherence based on nights of use per week between the PT + PN and UC groups at week 12 was 0.9 nights per week in favor of the PT + PN group (difference in odds ratio 0.39, 95\% CI 0.21-0.72; P=.003). We did not find an additional effect of tailoring the style of the intervention to psychological profiles on the primary outcomes. The difference in nightly use between the PT and PN groups on day 90 (95\% CI ?28.20 to 96.50; P=.28) and the difference in nights of use per week between the PT and PN groups at week 12 (difference in odds ratio 0.85, 95\% CI 0.51-1.43; P=.054) were both nonsignificant. Conclusions: The results show that personalized education and feedback can increase CPAP adherence substantially. Tailoring the style of the intervention to the psychological profiles of patients did not further increase adherence. Future research should investigate how the impact of interventions can be enhanced by catering to differences in psychological profiles. Trial Registration: ClinicalTrials.gov NCT02195531; https://clinicaltrials.gov/ct2/show/NCT02195531 ", doi="10.2196/40193", url="https://www.jmir.org/2023/1/e40193", url="http://www.ncbi.nlm.nih.gov/pubmed/37213195" } @Article{info:doi/10.2196/40561, author="Haricharan, Jensen Hanne and Hacking, Damian and Lau, Kwan Yan and Heap, Marion", title="Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging--Based Information Campaign: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2023", month="May", day="22", volume="6", pages="e40561", keywords="SMS text messages", keywords="cell phones", keywords="mobile health", keywords="mHealth", keywords="health information", keywords="health literacy", keywords="healthy behavior", keywords="maternal health", keywords="antenatal care", keywords="Deaf", keywords="South Africa", abstract="Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging--based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants' knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging--based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women's knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people's health knowledge. However, attention should be paid to Deaf participants' specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe ", doi="10.2196/40561", url="https://pediatrics.jmir.org/2023/1/e40561", url="http://www.ncbi.nlm.nih.gov/pubmed/37213174" } @Article{info:doi/10.2196/41148, author="Trzebi?ski, Wojciech and Claessens, Toni and Buhmann, Jeska and De Waele, Aur{\'e}lie and Hendrickx, Greet and Van Damme, Pierre and Daelemans, Walter and Poels, Karolien", title="The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults", journal="JMIR Form Res", year="2023", month="May", day="8", volume="7", pages="e41148", keywords="COVID-19", keywords="vaccinations", keywords="chatbot", keywords="empathy", keywords="autonomy support", keywords="perceived user autonomy", keywords="chatbot patronage intention", keywords="vaccination intention", keywords="conversational agent", keywords="public health", keywords="digital health intervention", keywords="health promotion", abstract="Background: Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context. Objective: This study aims to investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy support using COVID-19 vaccination chatbots. Methods: This experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used a 2 (empathy/autonomy support expression: present vs absent) {\texttimes} 2 (chatbot expertise cues: expert endorser vs layperson endorser) between-subject design. Chatbot conversation quality was assessed through actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from --5 to 5 (VIS). Results: There was a negative interaction effect of chatbot empathy/autonomy support expression and conversation fallback (CF; the percentage of chatbot answers ``I do not understand'' in a conversation) on PUA (PROCESS macro, model 1, B=--3.358, SE 1.235, t186=2.718, P=.007). Specifically, empathy/autonomy support expression had a more negative effect on PUA when the CF was higher (conditional effect of empathy/autonomy support expression at the CF level of +1SD: B=--.405, SE 0.158, t186=2.564, P=.011; conditional effects nonsignificant for the mean level: B=--0.103, SE 0.113, t186=0.914, P=.36; conditional effects nonsignificant for the --1SD level: B=0.031, SE=0.123, t186=0.252, P=.80). Moreover, an indirect effect of empathy/autonomy support expression on CPI via PUA was more negative when CF was higher (PROCESS macro, model 7, 5000 bootstrap samples, moderated mediation index=--3.676, BootSE 1.614, 95\% CI --6.697 to --0.102; conditional indirect effect at the CF level of +1SD: B=--0.443, BootSE 0.202, 95\% CI --0.809 to --0.005; conditional indirect effects nonsignificant for the mean level: B=--0.113, BootSE 0.124, 95\% CI --0.346 to 0.137; conditional indirect effects nonsignificant for the --1SD level: B=0.034, BootSE 0.132, 95\% CI --0.224 to 0.305). Indirect effects of empathy/autonomy support expression on VIS via PUA were marginally more negative when CF was higher. No effects of chatbot expertise cues were found. Conclusions: The findings suggest that expressing empathy/autonomy support using a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users' questions. The paper adds to the literature on vaccination chatbots by exploring the conditional effects of chatbot empathy/autonomy support expression. The results will guide policy makers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy. ", doi="10.2196/41148", url="https://formative.jmir.org/2023/1/e41148", url="http://www.ncbi.nlm.nih.gov/pubmed/37074978" } @Article{info:doi/10.2196/45856, author="Marcos Anton, Gemma and Puig Llobet, Montserrat and Lluch Canut, Teresa and Sanchez Ortega, Aurelia Maria and Piazuelo Pont, Merc{\`e} and Moreno-Arroyo, M{\textordfeminine}Carmen", title="mHealth to Improve Experience, Adherence to Pharmacological Treatment, and Positive Mental Health in Patients Diagnosed With Femur Fractures: Protocol for a Quasi-Experimental Study", journal="JMIR Res Protoc", year="2023", month="Apr", day="28", volume="12", pages="e45856", keywords="education", keywords="patient experience", keywords="medication adherence", keywords="mental health", keywords="nurse", keywords="mHealth", keywords="mobile health", keywords="protocol", keywords="prognosis", keywords="pharmacological treatment", keywords="femur fracture", keywords="femur", keywords="diagnosis", keywords="quality of care", keywords="care", keywords="psychological", keywords="efficacy", keywords="training", keywords="pathology", abstract="Background: Considering the prognosis of femur fractures worldwide, the ageing of our society, and the problems in adherence to treatment found in these patients, it is believed that mobile health can have a positive impact on the process and quality of care. Objective: We aim to evaluate the effectiveness of a pharmacological educational nurse intervention with Myplan app with regard to knowledge, adherence to pharmacological treatment, and positive mental health of patients with femur fractures. Methods: A nonrandomized, quasi-experimental study will be carried out with a pretest-posttest control group. It will include 278 older patients diagnosed with femur fractures, with a Glasgow Coma Scale of 15 and access to mobile devices. Patients with psychological pathologies and cognitive impairment or patients treated in isolation will be excluded. Study variables are as follows: sociodemographic variables (AdHoc Form), patient experience (Patient Experience Questionnaire-15), adherence to pharmacological treatment (Morisky-Green questionnaire), and positive mental health (Positive Mental Health questionnaire). The measurements will be taken 24 hours after admission, upon discharge, and 25 days after discharge. Results: Enrollment commenced in October 2022. Data collection will be completed in April 2023. Conclusions: The results of this study will offer evidence of the effectiveness of a pharmacological educational nurse intervention by means of a free smartphone app. If its efficacy is demonstrated and the results are acceptable, it could mean an improvement in the care of patients with femur fractures, and this technology could be used to guide other training interventions in patients with other pathologies. Trial Registration: ClinicalTrials.gov NCTT05669040; https://clinicaltrials.gov/ct2/show/NCTT05669040 International Registered Report Identifier (IRRID): DERR1-10.2196/45856 ", doi="10.2196/45856", url="https://www.researchprotocols.org/2023/1/e45856", url="http://www.ncbi.nlm.nih.gov/pubmed/37115614" } @Article{info:doi/10.2196/42679, author="Bernard, M. Renaldo and Seijas, Vanessa and Davis, Micheal and Volkova, Anel and Diviani, Nicola and L{\"u}scher, Janina and Sabariego, Carla", title="Mobile Health Self-management Support for Spinal Cord Injury: Systematic Literature Review", journal="JMIR Mhealth Uhealth", year="2023", month="Apr", day="26", volume="11", pages="e42679", keywords="mobile phone", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="telemedicine", keywords="telehealth", keywords="spinal cord injury", keywords="self-management", keywords="internet-based intervention", keywords="World Wide Web", keywords="systematic review", abstract="Background: Self-management plays a critical role in maintaining and improving the health of persons with spinal cord injury (SCI). Despite their potential, existing mobile health (mHealth) self-management support (SMS) tools for SCI have not been comprehensively described in terms of their characteristics and approaches. It is important to have an overview of these tools to know how best to select, further develop, and improve them. Objective: The objective of this systematic literature review was to identify mHealth SMS tools for SCI and summarize their characteristics and approaches to offering SMS. Methods: A systematic review of the literature published between January 2010 and March 2022 was conducted across 8 bibliographic databases. The data synthesis was guided by the self-management task taxonomy by Corbin and Strauss, the self-management skill taxonomy by Lorig and Holman, and the Practical Reviews in Self-Management Support taxonomy. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards guided the reporting. Results: A total of 24 publications reporting on 19 mHealth SMS tools for SCI were included. These tools were introduced from 2015 onward and used various mHealth technologies and multimedia formats to provide SMS using 9 methods identified by the Practical Reviews in Self-Management Support taxonomy (eg, social support and lifestyle advice and support). The identified tools focused on common SCI self-management areas (eg, bowel, bladder, and pain management) and overlooked areas such as sexual dysfunction problems and environmental problems, including barriers in the built environment. Most tools (12/19, 63\%) unexpectedly supported a single self-management task instead of all 3 tasks (ie, medical, role, and emotional management), and emotional management tasks had very little support. All self-management skills (eg, problem-solving, decision-making, and action planning) had coverage, but a single tool addressed resource use. The identified mHealth SMS tools were similar in terms of number, introduction period, geographical distribution, and technical sophistication compared with SMS tools for other chronic conditions. Conclusions: This systematic literature review provides one of the first descriptions of mHealth SMS tools for SCI in terms of their characteristics and approaches to offering SMS. This study's findings highlight a need for increased coverage of key SMS for SCI components; adopting comparable usability, user experience, and accessibility evaluation methods; and related research to provide more detailed reporting. Future research should consider other data sources such as app stores and technology-centric bibliographic databases to complement this compilation by identifying other possibly overlooked mHealth SMS tools. A consideration of this study's findings is expected to support the selection, development, and improvement of mHealth SMS tools for SCI. ", doi="10.2196/42679", url="https://mhealth.jmir.org/2023/1/e42679", url="http://www.ncbi.nlm.nih.gov/pubmed/37099372" } @Article{info:doi/10.2196/40427, author="Zhaunova, Liudmila and Bamford, Ryan and Radovic, Tara and Wickham, Aidan and Peven, Kimberly and Croft, Jazz and Klepchukova, Anna and Ponzo, Sonia", title="Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey", journal="JMIR Mhealth Uhealth", year="2023", month="Apr", day="26", volume="11", pages="e40427", keywords="health knowledge", keywords="menstrual cycle", keywords="pregnancy", keywords="period-tracking app", keywords="digital health", keywords="women's health", abstract="Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle-- and pregnancy-tracking mobile apps are promising tools for improving women's awareness of and attitudes toward their reproductive health; however, there is little information about subscribers' perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98\%) and pregnancy (698/824, 84.7\%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant ($\chi$21=4.2, P=.04; $\chi$21=52.3, P<.001, respectively) and pregnancy tracking ($\chi$21=19.3, P<.001; $\chi$21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy ($\chi$21=4.2; P=.04) and to learn more about their body ($\chi$21=10.8; P=.001) and sexual health ($\chi$21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health ($\chi$21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. ", doi="10.2196/40427", url="https://mhealth.jmir.org/2023/1/e40427", url="http://www.ncbi.nlm.nih.gov/pubmed/37099370" } @Article{info:doi/10.2196/44661, author="Murray, B. Jennifer and Sharp, Alexander and Munro, Sarah and Janssen, A. Patricia", title="Expectant Parents' Preferences for Teaching by Texting: Development and Usability Study of SmartMom", journal="JMIR Form Res", year="2023", month="Apr", day="18", volume="7", pages="e44661", keywords="pregnancy", keywords="pregnant", keywords="prenatal", keywords="patient education", keywords="text message", keywords="SMS text messaging", keywords="prenatal education", keywords="mHealth", keywords="evidence-based health care", keywords="mobile app", keywords="Canada", keywords="mobile health", keywords="preference", keywords="focus group", keywords="information need", keywords="user need", abstract="Background: Prenatal education encourages healthy behavioral choices and reduces rates of adverse birth outcomes. The use of mobile health (mHealth) technologies during pregnancy is increasing and changing how pregnant people acquire prenatal education. SmartMom is an evidence-based prenatal education SMS text messaging program that overcomes barriers to prenatal class attendance, including rural or remote location, cost, stigma among participants, lack of instructors, and cessation of classes during the COVID-19 pandemic. Objective: We sought to explore perceived information needs and preferences for the content and structure of prenatal education mHealth programs among persons enrolled in or eligible to enroll in SmartMom. Methods: This was a qualitative focus group study conducted as part of a development and usability study of the SmartMom program. Participants were older than 19 years of age, Canadian residents, fluent in English, and either currently pregnant or pregnant within the last year. We asked open-ended questions about information-seeking behaviors during pregnancy, the nature of the information that participants were seeking, how they wanted to receive information, and if SmartMom was meeting these needs. Focus groups took place via videoconference technology (Zoom) between August and December 2020. We used reflexive thematic analysis to identify themes that emerged from the data and the constant comparison method to compare initial coding to emerging themes. Results: We conducted 6 semistructured focus groups with 16 participants. All participants reported living with a partner and owning a cell phone. The majority (n=13, 81\%) used at least 1 app for prenatal education. Our analysis revealed that ``having reliable information is the most important thing'' (theme 1); pregnant people value inclusive, local, and strength-based information (theme 2); and SMS text messages are a simple, easy, and timely modality (``It was nice to have that [information] fed to you''; theme 3). Participants perceived that SmartMom SMS text messages met their needs for prenatal education and were more convenient than using apps. SmartMom's opt-in supplemental message streams, which allowed users to tailor the program to their needs, were viewed favorably. Participants also identified that prenatal education programs were not meeting the needs of diverse populations, such as Indigenous people and LGBTQIA2S+ (lesbian, gay, bisexual, transgender, queer and/or questioning, intersex, asexual, Two-Spirit plus) communities. Conclusions: The shift toward digital prenatal education, accelerated by the COVID-19 pandemic, has resulted in a plethora of web- or mobile technology--based programs, but few of these have been evaluated. Participants in our focus groups revealed concerns about the reliability and comprehensiveness of digital resources for prenatal education. The SmartMom SMS text messaging program was viewed as being evidence-based, providing comprehensive content without searching, and permitting tailoring to individual needs through opt-in message streams. Prenatal education must also meet the needs of diverse populations. ", doi="10.2196/44661", url="https://formative.jmir.org/2023/1/e44661", url="http://www.ncbi.nlm.nih.gov/pubmed/37071451" } @Article{info:doi/10.2196/40420, author="Feng, Yuheng and Zhao, Yuxi and Mao, Linqi and Gu, Minmin and Yuan, Hong and Lu, Jun and Zhang, Qi and Zhao, Qian and Li, Xiaohong", title="The Effectiveness of an eHealth Family-Based Intervention Program in Patients With Uncontrolled Type 2 Diabetes Mellitus (T2DM) in the Community Via WeChat: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Mar", day="20", volume="11", pages="e40420", keywords="public health", keywords="type 2 diabetes mellitus", keywords="intervention", keywords="randomized controlled trial", keywords="community health center", abstract="Background: Intervention based on family support and risk perception can enhance type 2 diabetes mellitus (T2DM) patients' self-care activities. In addition, eHealth education is considered to improve family members' support for patients with T2DM. However, there is little evidence from rigorously designed studies on the effectiveness of an intervention combining these approaches. Objective: This randomized controlled trial (RCT) aimed to assess the effectiveness of an eHealth family-based health education intervention for patients with T2DM to improve their glucose control, risk perception, and self-care behaviors. Methods: This single-center, 2-parallel-group RCT was conducted between 2019 and 2020. Overall, 228 patients were recruited from Jiading District, Shanghai, and randomly divided into intervention and control groups. The intervention group received an eHealth family intervention based on community management via WeChat, whereas the control group received usual care. The primary outcome was the glycated hemoglobin (HbA1c) level of the patients with T2DM, and the secondary outcomes were self-management behavior (general and specific diet, exercise, blood sugar testing, foot care, and smoking), risk perception (risk knowledge, personal control, worry, optimism bias, and personal risk), and family support (supportive and nonsupportive behaviors). A 2-tailed paired-sample t test was used to compare the participants at baseline and follow-up within the control and intervention groups. An analysis of covariance was used to measure the intervention effect. Results: In total, 225 patients with T2DM were followed up for 1 year. After intervention, they had significantly lower HbA1c values ($\beta$=--.69, 95\% CI --0.99 to --0.39; P<.001). They also had improved general diet ($\beta$=.60, 95\% CI 0.20 to 1.00; P=.003), special diet ($\beta$=.71, 95\% CI 0.34 to 1.09; P<.001), blood sugar testing ($\beta$=.50, 95\% CI 0.02 to 0.98; P=.04), foot care ($\beta$=1.82, 95\% CI 1.23 to 2.42; P<.001), risk knowledge ($\beta$=.89, 95\% CI 0.55 to 1.24; P<.001), personal control ($\beta$=.22, 95\% CI 0.12 to 0.32; P<.001), worry ($\beta$=.24, 95\% CI 0.10 to 0.39; P=.001), optimism bias ($\beta$=.26, 95\% CI 0.09 to 0.43; P=.003), and supportive behaviors ($\beta$=5.52, 95\% CI 4.03 to 7.01; P<.001). Conclusions: The eHealth family-based intervention improved glucose control and self-care activities among patients with T2DM by aiding the implementation of interventions to improve T2DM risk perceptions among family members. The intervention is generalizable for patients with T2DM using health management systems in community health centers. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020736; https://www.chictr.org.cn/showprojen.aspx?proj=31214 ", doi="10.2196/40420", url="https://mhealth.jmir.org/2023/1/e40420", url="http://www.ncbi.nlm.nih.gov/pubmed/36939825" } @Article{info:doi/10.2196/41804, author="Augustin, Michaela and Licata-Dandel, Maria and Breeman, D. Linda and Harrer, Mathias and Bilgin, Ayten and Wolke, Dieter and Mall, Volker and Ziegler, Margret and Ebert, Daniel David and Friedmann, Anna", title="Effects of a Mobile-Based Intervention for Parents of Children With Crying, Sleeping, and Feeding Problems: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2023", month="Mar", day="10", volume="11", pages="e41804", keywords="children", keywords="crying problems", keywords="sleeping problems", keywords="feeding problems", keywords="feeding", keywords="regulatory problems", keywords="intervention study", keywords="Mobile Health Care", keywords="health app", keywords="mobile app", keywords="patient education", keywords="psychoeducation", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="parenting", keywords="baby", keywords="babies", keywords="sleep", keywords="crying", keywords="newborn", keywords="mobile phone", abstract="Background: Excessive crying, sleeping, and feeding problems in early childhood are major stressors that can result in parents feeling socially isolated and having low self-efficacy. Affected children are a risk group for being maltreated and developing emotional and behavioral problems. Thus, the development of an innovative and interactive psychoeducational app for parents of children with crying, sleeping, and feeding problems may provide low-threshold access to scientifically based information and reduce negative outcomes in parents and children. Objective: We aimed to investigate whether following the use of a newly developed psychoeducational app, the parents of children with crying, sleeping, or feeding problems experienced less parenting stress; gained more knowledge about crying, sleeping, and feeding problems; and perceived themselves as more self-effective and as better socially supported and whether their children's symptoms decreased more than those of the parents who did not use the app. Methods: Our clinical sample consisted of 136 parents of children (aged 0-24 months) who contacted a cry baby outpatient clinic in Bavaria (Southern Germany) for an initial consultation. Using a randomized controlled design, families were randomly allocated to either an intervention group (IG; 73/136, 53.7\%) or a waitlist control group (WCG; 63/136, 46.3\%) during the usual waiting time until consultation. The IG was given a psychoeducational app that included evidence-based information via text and videos, a child behavior diary function, a parent chat forum and experience report, tips on relaxation, an emergency plan, and a regional directory of specialized counseling centers. Outcome variables were assessed using validated questionnaires at baseline test and posttest. Both groups were compared at posttest regarding changes in parenting stress (primary outcome) and secondary outcomes, namely knowledge about crying, sleeping, and feeding problems; perceived self-efficacy; perceived social support; and child symptoms. Results: The mean individual study duration was 23.41 (SD 10.42) days. The IG reported significantly lower levels of parenting stress (mean 83.18, SD 19.94) after app use compared with the WCG (mean 87.46, SD 16.67; P=.03; Cohen d=0.23). Furthermore, parents in the IG reported a higher level of knowledge about crying, sleeping, and feeding (mean 62.91, SD 4.30) than those in the WCG (mean 61.15, SD 4.46; P<.001; Cohen d=0.38). No differences at posttest were found between groups in terms of parental efficacy (P=.34; Cohen d=0.05), perceived social support (P=.66; Cohen d=0.04), and child symptoms (P=.35; Cohen d=0.10). Conclusions: This study provides initial evidence of the efficacy of a psychoeducational app for parents with child crying, sleeping, and feeding problems. By reducing parental stress and increasing knowledge of children's symptoms, the app has the potential to serve as an effective secondary preventive measure. Additional large-scale studies are needed to investigate long-term benefits. Trial Registration: German Clinical Trials Register DRKS00019001; https://drks.de/search/en/trial/DRKS00019001 ", doi="10.2196/41804", url="https://mhealth.jmir.org/2023/1/e41804", url="http://www.ncbi.nlm.nih.gov/pubmed/36897641" } @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/10.2196/43522, author="Yang, Seongwoo and Bui, Nhung Cam and Park, Kyounghoon", title="Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment", journal="JMIR Mhealth Uhealth", year="2023", month="Feb", day="23", volume="11", pages="e43522", keywords="app", keywords="breast cancer", keywords="quality assessment", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="digital health intervention", keywords="cancer management", keywords="tablet", keywords="prevention", keywords="survivor", keywords="peer-support", abstract="Background: The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. Objective: The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. Methods: Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords ``breast cancer'' in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. Results: The initial search identified 1148 apps, 69 (6\%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). Conclusions: The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes. ", doi="10.2196/43522", url="https://mhealth.jmir.org/2023/1/e43522", url="http://www.ncbi.nlm.nih.gov/pubmed/36821352" } @Article{info:doi/10.2196/44468, 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/10.2196/43241, 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/10.2196/41235, author="Salas-Groves, Emily and Galyean, Shannon and Alcorn, Michelle and Childress, Allison", title="Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review", journal="JMIR Mhealth Uhealth", year="2023", month="Jan", day="13", volume="11", pages="e41235", keywords="mobile apps", keywords="apps", keywords="mobile health", keywords="mHealth", keywords="eHealth", keywords="nutrition education", keywords="cancer", keywords="obesity", keywords="diabetes", keywords="cardiovascular disease", keywords="mobile phone", abstract="Background: Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. Objective: The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. Methods: A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. Results: In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41\%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24\%) measured maintenance of health behavior change, of which 7 (64\%) sustained behavior change for approximately 6 to 12 months and 4 (36\%) showed a decline in behavior change or discontinued app use. Conclusions: The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15\%) showed sustained health behavior change, and some (4/46, 9\%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps. ", doi="10.2196/41235", url="https://mhealth.jmir.org/2023/1/e41235", url="http://www.ncbi.nlm.nih.gov/pubmed/36637888" } @Article{info:doi/10.2196/38986, author="Suh, Myung-Whan and Park, Kyun Moo and Kim, Yoonjoong and Kim, Ho Young", title="The Treatment Outcome of Smart Device--Based Tinnitus Retraining Therapy: Prospective Cohort Study", journal="JMIR Mhealth Uhealth", year="2023", month="Jan", day="12", volume="11", pages="e38986", keywords="tinnitus", keywords="tinnitus retraining therapy", keywords="smart device", keywords="sound therapy", keywords="rehabilitation", keywords="therapy", keywords="tablet application", keywords="app-based", keywords="digital therapy", keywords="device-based therapy", abstract="Background: Tinnitus retraining therapy (TRT) is a standard treatment for tinnitus that consists of directive counseling and sound therapy. However, it is based on face-to-face education and a time-consuming protocol. Smart device--based TRT (smart-TRT) seems to have many advantages, but the efficacy of this new treatment has been questioned. Objective: The aim of this study was to compare the efficacy between smart-TRT and conventional TRT (conv-TRT). Methods: We recruited 84 patients with tinnitus. Results were compared between 42 patients who received smart-TRT and 42 control participants who received conv-TRT. An interactive smart pad application was used for directive counseling in the smart-TRT group. The smart pad application included detailed education on ear anatomy, the neurophysiological model of tinnitus, concept of habituation, and sound therapy. The smart-TRT was bidirectional: There were 17 multiple choice questions between each lesson as an interim check. The conv-TRT group underwent traditional person-to-person counseling. The primary outcome measure was the Tinnitus Handicap Inventory (THI), and the secondary outcome measure was assessed using a visual analogue scale (VAS). Results: Both treatments had a significant treatment effect, which comparably improved during the first 2 months. The best improvements in THI were --23.3 (95\% CI --33.1 to --13.4) points at 3 months and --16.8 (95\% CI --30.8 to --2.8) points at 2 months in the smart-TRT group and conv-TRT group, respectively. The improvements on the VAS were also comparable: smart-TRT group: --1.2 to --3.3; conv-TRT: --0.7 to --1.7. Conclusions: TRT based on smart devices can be an effective alternative for tinnitus patients. Considering the amount of time needed for person-to-person counseling, smart-TRT can be a cost-effective solution with similar treatment outcomes as conv-TRT. ", doi="10.2196/38986", url="https://mhealth.jmir.org/2023/1/e38986", url="http://www.ncbi.nlm.nih.gov/pubmed/36633890" } @Article{info:doi/10.2196/38078, 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/10.2196/39678, author="Herrijgers, Corinne and Platteau, Tom and Vandebosch, Heidi and Poels, Karolien and Florence, Eric", title="Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study", journal="JMIR Res Protoc", year="2022", month="Dec", day="21", volume="11", number="12", pages="e39678", keywords="mobile health", keywords="chemsex", keywords="intervention mapping", keywords="harm reduction", keywords="men who have sex with men", keywords="intervention", keywords="mobile phone", abstract="Background: Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex. Objective: The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation. Methods: The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022. Results: Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy). Conclusions: The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions. International Registered Report Identifier (IRRID): RR1-10.2196/39678 ", doi="10.2196/39678", url="https://www.researchprotocols.org/2022/12/e39678", url="http://www.ncbi.nlm.nih.gov/pubmed/36542451" } @Article{info:doi/10.2196/40340, author="Gulec, Hayriye and Smahel, David", title="Individual and Parental Factors of Adolescents' mHealth App Use: Nationally Representative Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="Dec", day="16", volume="10", number="12", pages="e40340", keywords="mobile health", keywords="mHealth", keywords="eHealth literacy", keywords="parental mediation", keywords="health anxiety", keywords="sleep", keywords="body mass index", keywords="digital skills", keywords="phone attitudes", keywords="mobile phone", abstract="Background: Knowledge of the characteristics of adolescents who use mobile health (mHealth) apps to monitor health and how these characteristics differ from those of app nonusers is limited. Objective: We aimed to determine mHealth app use based on adolescent and parental factors, including sociodemographics, digital skills, and health indicators, in a nationally representative sample of Czech adolescents (N=2500). Methods: Adolescents aged 11 to 16 years and one of their parents participated in an online survey in 2021. A professional research agency recruited the participants. Quotas were used to ensure the sample's representativeness. The sociodemographic factors were the adolescents' age, gender, and parental perceived financial security. The adolescents also provided information about their screen time, eHealth literacy, BMI, health anxiety, physical activity, and sleep quality. Parents reported their digital skills, mobile phone attitudes, and the mediation of their children's online health information--seeking behaviors. We evaluated the differences between the users and nonusers of mHealth apps and identified the significant predictors of mHealth app use. Next, we separately examined how these factors were associated with the use of mHealth apps that track calorie intake or expenditure, number of steps, weight, or sports activity (eg, exercise, running, and working out), as well as other mHealth apps (eg, those that track sleep and heart rate). Results: More than half of the adolescents (1429/2455, 58.21\%) reported using mHealth apps. App users were relatively older and, more often, girls. Apps that counted the number of steps were used most frequently, and adolescents whose parents reported higher perceived financial security used them more regularly. Overall, being older and physically active and having higher eHealth literacy skills were associated with using mHealth apps. Adolescents with higher BMI, health anxiety, and lower sleep quality more frequently used mHealth apps to track calorie intake or expenditure, weight, and health indicators. mHealth apps to track physical activity were used more regularly by girls. There was a positive association between parental mediation of online health information--seeking behaviors and adolescents' mHealth app use. Conclusions: These findings demonstrated that older age, physical activity, and eHealth literacy skills were the common underlying factors of adolescents' mHealth app use. We initially showed parents as significant role models for their children's adoption of, and engagement with, mHealth apps when they actively mediate their online health information--seeking behaviors. Improving the eHealth literacy skills of adolescents through parental guidance might enhance health technology use in this population. Tracking eating behaviors, weight, and health were more prevalent for adolescents who reported higher BMI, health anxiety, and lower sleep quality. Future research studies should examine the determinants and health outcomes of adolescents' mHealth app use longitudinally. ", doi="10.2196/40340", url="https://mhealth.jmir.org/2022/12/e40340", url="http://www.ncbi.nlm.nih.gov/pubmed/36525286" } @Article{info:doi/10.2196/40278, author="Edwards, Caitlyn and Orellana, Elisa and Rawlings, Kelly and Rodriguez-Pla, Mirta and Venkatesan, Aarathi", title="Changes in Glycemic Control Following Use of a Spanish-Language, Culturally Adapted Diabetes Program: Retrospective Study", journal="JMIR Form Res", year="2022", month="Dec", day="7", volume="6", number="12", pages="e40278", keywords="type 2 diabetes", keywords="digital health", keywords="diabetes intervention", keywords="diabetes", keywords="mobile health", keywords="mhealth", keywords="app-based", keywords="health coaching", keywords="HbA1c", keywords="glycemic improvements", keywords="localization", keywords="Spanish", keywords="health application", keywords="health education", keywords="patient education", keywords="nutrition", keywords="digital health intervention", keywords="health management", abstract="Background: Several barriers to diabetes treatment and care exist, particularly in underserved medical communities. Objective: This study aimed to evaluate a novel, culturally adapted, Spanish-language mHealth diabetes program for glycemic control. Methods: Professional Spanish translators, linguists, and providers localized the entirety of the Vida Health Diabetes Management Program into a culturally relevant Spanish-language version. The Spanish-language Vida Health Diabetes Management Program was used by 182 (n=119 women) Spanish-speaking adults with diabetes. This app-based program provided access to culturally adapted educational content on diabetes self-management, one-on-one remote counseling and coaching sessions, and on-demand in-app messaging with bilingual (Spanish and English) certified health coaches, registered dietitian nutritionists, and certified diabetes care and education specialists. Hemoglobin A1c (HbA1c) was the primary outcome measure, and a 2-tailed, paired t test was used to evaluate changes in HbA1c before and after program use. To determine the relationship between program engagement and changes in glycemic control, a cluster-robust multiple regression analysis was employed. Results: We observed a significant decrease in HbA1c of --1.23 points between baseline (mean 9.65\%, SD 1.56\%) and follow-up (mean 8.42\%, SD 1.44\%; P<.001). Additionally, we observed a greater decrease in HbA1c among participants with high program engagement (high engagement: --1.59\%, SD 1.97\%; low engagement: --0.84\%, SD 1.64\%; P<.001). Conclusions: This work highlights improvements in glycemic control that were clinically as well as statistically significant among Spanish-preferring adults enrolled in the Vida Health Spanish Diabetes Management Program. Greater improvements in glycemic control were observed among participants with higher program engagement. These results provide needed support for the use of digital health interventions to promote meaningful improvements in glycemic control in a medically underserved community. ", doi="10.2196/40278", url="https://formative.jmir.org/2022/12/e40278", url="http://www.ncbi.nlm.nih.gov/pubmed/36476397" } @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/10.2196/37866, author="Lanssens, Dorien and Thijs, M. Inge and Dreesen, Pauline and Van Hecke, Ann and Coorevits, Pascal and Gaethofs, Gitte and Derycke, Joyce and Tency, Inge", title="Information Resources Among Flemish Pregnant Women: Cross-sectional Study", journal="JMIR Form Res", year="2022", month="Oct", day="11", volume="6", number="10", pages="e37866", keywords="pregnancy app", keywords="mobile app", keywords="questionnaire", keywords="pregnancy", keywords="pregnant", keywords="mHealth", keywords="mobile health", keywords="cross-sectional", keywords="user need", keywords="user expectation", keywords="survey", keywords="maternal", keywords="maternity", keywords="user experience", abstract="Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women's responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2\%) for pregnant women, followed by websites/internet (267/311, 85.9\%) and apps (233/311, 74.9\%). The information that was most searched for was information about the development of the baby (275/311, 88.5\%), discomfort/complaints (251/311, 80.7\%) and health during pregnancy (248/311, 79.7\%), administrative/practical issues (233/311, 74.9\%), and breastfeeding (176/311, 56.6\%). About half of the women (172/311, 55.3\%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0\%). Pregnant women who are single asked their mothers (22/30, 73.3\%) or other family members (13/30, 43.3\%) for significantly more information than did married women (mother [in law]: 82/160, 51.3\%, P=.02; family members: 35/160, 21.9\%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6\% vs 203/237, 85.5\%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1\% vs 55/237, 23.1\%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9\% vs 198/237, 83.5\%; P=.001). They also followed more prenatal sessions (59/73, 80.8\% vs 77/237, 32.5\%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89\% vs 188/237, 79.5\%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4\% vs multigravida 40/199, 20.1\%; P<.001; other pregnant women: primigravida 58/109, 53.2\% vs multigravida 80/199, 40.2\%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. ", doi="10.2196/37866", url="https://formative.jmir.org/2022/10/e37866", url="http://www.ncbi.nlm.nih.gov/pubmed/36222794" } @Article{info:doi/10.2196/38903, author="Huberty, L. Jennifer and Espel-Huynh, M. Hallie and Neher, L. Taylor and Puzia, E. Megan", title="Testing the Pragmatic Effectiveness of a Consumer-Based Mindfulness Mobile App in the Workplace: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Sep", day="28", volume="10", number="9", pages="e38903", keywords="mindfulness", keywords="mobile apps", keywords="workforce", keywords="workplace", keywords="presenteeism", keywords="mental health", abstract="Background: Mental health and sleep problems are prevalent in the workforce, corresponding to costly impairment in productivity and increased health care use. Digital mindfulness interventions are efficacious in improving sleep and mental health in the workplace; however, evidence supporting their pragmatic utility, potential for improving productivity, and ability to reduce employer costs is limited. Objective: This pragmatic, cluster randomized controlled trial aimed to evaluate the experimental effects of implementing a commercially available mindfulness app---Calm---in employees of a large, multisite employer in the United States. Outcomes included mental health (depression, anxiety, and stress), sleep (insomnia and daytime sleepiness), resilience, productivity impairment (absenteeism, presenteeism, overall work impairment, and non--work activity impairment), and health care use (medical visit frequency). Methods: Employees were randomized at the work site to receive either the Calm app intervention or waitlist control. Participants in the Calm intervention group were instructed to use the Calm app for 10 minutes per day for 8 weeks; individuals with elevated baseline insomnia symptoms could opt-in to 6 weeks of sleep coaching. All outcomes were assessed every 2 weeks, with the exception of medical visits (weeks 4 and 8 only). Effects of the Calm intervention on outcomes were evaluated via mixed effects modeling, controlling for relevant baseline characteristics, with fixed effects of the intervention on outcomes assessed at weeks 2, 4, 6, and 8. Models were analyzed via complete-case and intent-to-treat analyses. Results: A total of 1029 employees enrolled (n=585 in the Calm intervention group, including 101 who opted-in to sleep coaching, and n=444 in waitlist control). Of them, 192 (n=88 for the Calm intervention group and n=104 for waitlist) completed all 5 assessments. In the complete-case analysis at week 8, employees at sites randomized to the Calm intervention group experienced significant improvements in depression (P=.02), anxiety (P=.01), stress (P<.001), insomnia (P<.001), sleepiness (P<.001), resilience (P=.02), presenteeism (P=.01), overall work impairment (P=.004), and nonwork impairment (P<.001), and reduced medical care visit frequency (P<.001) and productivity impairment costs (P=.01), relative to the waitlist control. In the intent-to-treat analysis at week 8, significant benefits of the intervention were observed for depression (P=.046), anxiety (P=.01), insomnia (P<.001), sleepiness (P<.001), nonwork impairment (P=.04), and medical visit frequency (P<.001). Conclusions: The results suggest that the Calm app is an effective workplace intervention for improving mental health, sleep, resilience, and productivity and for reducing medical visits and costs owing to work impairment. Future studies should identify optimal implementation strategies that maximize employee uptake and large-scale implementation success across diverse, geographically dispersed employers. Trial Registration: ClinicalTrials.gov NCT05120310; https://clinicaltrials.gov/ct2/show/NCT05120310 ", doi="10.2196/38903", url="https://mhealth.jmir.org/2022/9/e38903", url="http://www.ncbi.nlm.nih.gov/pubmed/36169991" } @Article{info:doi/10.2196/38368, author="Choudhury, Avishek and Choudhury, Murari", title="Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study", journal="JMIR Mhealth Uhealth", year="2022", month="Sep", day="21", volume="10", number="9", pages="e38368", keywords="maternal health", keywords="mHealth", keywords="digital divide", keywords="disparity", keywords="socioeconomic", keywords="India", keywords="health", keywords="awareness", keywords="mobile", keywords="intervention", keywords="adherence", keywords="health behaviors", keywords="tribal", keywords="community", keywords="education", abstract="Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India's socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app---Mobile for Mothers (MfM)---as a supporting tool to improve (1) maternal health awareness and (2) maternal health--related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 ", doi="10.2196/38368", url="https://mhealth.jmir.org/2022/9/e38368", url="http://www.ncbi.nlm.nih.gov/pubmed/36129749" } @Article{info:doi/10.2196/35851, author="B{\'a}ez Guti{\'e}rrez, Nerea and Rodr{\'i}guez Ramallo, H{\'e}ctor and Fern{\'a}ndez Gonz{\'a}lez, Marcos and Abdel-Kader Mart{\'i}n, Laila", title="Smartphone Apps for Patients With Hematologic Malignancies: Systematic Review and Evaluation of Content", journal="JMIR Mhealth Uhealth", year="2022", month="Sep", day="20", volume="10", number="9", pages="e35851", keywords="hematological malignancies", keywords="mobile apps", keywords="smartphone", keywords="eHealth", keywords="mHealth", keywords="cancer", keywords="mobile app", keywords="mobile health", keywords="hematology", abstract="Background: Hematological malignancies (HMs) are a heterogeneous group of cancers representing a significant cause of morbidity and mortality. The chronification of HMs and the increasing use of smartphones may lead patients to seek their current unmet needs through mobile health apps. Objective: The goal of this review was to identify and assess the quality of smartphone apps aimed at patients diagnosed with HMs. Methods: A systematic search of apps that were aimed at patients diagnosed with HMs, accessed from a Spain IP address, and were available on the iOS (App Store) and Android (Google Play) platforms was conducted in November 2021. The search terms used were ``hematology,'' ``blood cancer,'' ``leukemia,'' ``lymphoma,'' and ``myeloma'' apps in English, Spanish, or both languages. The identified apps were downloaded and analyzed independently by 2 reviewers. Information about general app characteristics was collected. The Mobile Application Rating Scale (MARS) was used to assess quality. The resulting parameter of the analyses, the mean score of the apps, was compared by Student t test. Results: Overall, 18 apps were identified; 7 were available on Android, 5 were available on iOS, and 6 were available on both platforms. All included apps were free; 3 were published in 2021, and among the apps published before 2021, only 6 were updated in 2021. Most (16/18, 89\%) of the apps were aimed at patients with leukemia or lymphoma (16). The primary purposes of the apps were to provide general information about the condition (16/18, 89\%) and monitor symptoms and clinical parameters (11/18, 61\%). Health care professionals contributed to the development of 50\% (9/18) of apps; 6 were owned and supported by scientific societies, and 3 were developed with the participation of health care professionals. The mean MARS score for the overall quality of the apps was 3.1 (SD 1.0). The engagement and aesthetics subscales were the lowest rated subscales, with only 44\% (8/18) and 67\% (12/18), respectively, of the apps obtaining acceptable scores. None of the included apps proved clinical efficacy through clinical trials in patients with HMs. Statistically significant differences were found in the MARS scores between operating systems (+1.0, P=.003) in favor of iOS apps. The participation of health care professionals in the development of the apps did not have a statistically significant impact on the MARS scores. Conclusions: This systematic search and evaluation identified few acceptable quality mobile apps for patients with HMs. Current and future apps for patients with HMs should provide evidence-based valuable information, improve user engagement, incorporate functions according to patient preferences, and generate evidence regarding the efficacy of app use by patients with HMs. ", doi="10.2196/35851", url="https://mhealth.jmir.org/2022/9/e35851", url="http://www.ncbi.nlm.nih.gov/pubmed/36125860" } @Article{info:doi/10.2196/30976, author="Catuara-Solarz, Silvina and Skorulski, Bartlomiej and Estella-Aguerri, I{\~n}aki and Avella-Garcia, Bibiana Claudia and Shepherd, Sarah and Stott, Emily and Hemmings, R. Nicola and Ruiz de Villa, Aleix and Schulze, Laura and Dix, Sophie", title="The Efficacy of ``Foundations,'' a Digital Mental Health App to Improve Mental Well-being During COVID-19: Proof-of-Principle Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Jul", day="1", volume="10", number="7", pages="e30976", keywords="mental well-being", keywords="digital health", keywords="cognitive behavioral therapy", keywords="positive psychology", keywords="insomnia", keywords="COVID-19", keywords="mental health", keywords="mobile app", keywords="anxiety", keywords="health app", abstract="Background: Against a long-term trend of increasing demand, the COVID-19 pandemic has led to a global rise in common mental disorders. Now more than ever, there is an urgent need for scalable, evidence-based interventions to support mental well-being. Objective: The aim of this proof-of-principle study was to evaluate the efficacy of a mobile-based app in adults with self-reported symptoms of anxiety and stress in a randomized control trial that took place during the first wave of the COVID-19 pandemic in the United Kingdom. Methods: Adults with mild to severe anxiety and moderate to high levels of perceived stress were randomized to either the intervention or control arm. Participants in the intervention arm were given access to the Foundations app for the duration of the 4-week study. All participants were required to self-report a range of validated measures of mental well-being (10-item Connor-Davidson Resilience scale [CD-RISC-10], 7-item Generalized Anxiety Disorder scale [GAD-7], Office of National Statistics Four Subjective Well-being Questions [ONS-4], World Health Organization-5 Well-Being Index [WHO-5]) and sleep (Minimal Insomnia Scale [MISS]) at baseline and at weeks 2 and 4. The self-reported measures of perceived stress (10-item Perceived Stress Score [PSS-10]) were obtained weekly. Results: A total of 136 participants completed the study and were included in the final analysis. The intervention group (n=62) showed significant improvements compared to the control group (n=74) on measures of anxiety, with a mean GAD-7 score change from baseline of --1.35 (SD 4.43) and --0.23 (SD 3.24), respectively (t134=1.71, P=.04); resilience, with a mean change in CD-RISC score of 1.79 (SD 4.08) and --0.31 (SD 3.16), respectively (t134=--3.37, P<.001); sleep, with a mean MISS score change of --1.16 (SD 2.67) and --0.26 (SD 2.29), respectively (t134=2.13, P=.01); and mental well-being, with a mean WHO-5 score change of 1.53 (SD 5.30) and --0.23 (SD 4.20), respectively (t134=--2.16, P=.02), within 2 weeks of using Foundations, with further improvements emerging at week 4. Perceived stress was also reduced within the intervention group, although the difference did not reach statistical significance relative to the control group, with a PSS score change from baseline to week 2 of --2.94 (SD 6.84) and --2.05 (SD 5.34), respectively (t134= 0.84, P=.20). Conclusions: This study provides a proof of principle that the digital mental health app Foundations can improve measures of mental well-being, anxiety, resilience, and sleep within 2 weeks of use, with greater effects after 4 weeks. Foundations therefore offers potential as a scalable, cost-effective, and accessible solution to enhance mental well-being, even during times of crisis such as the COVID-19 pandemic. Trial Registration: OSF Registries osf.io/f6djb; https://osf.io/vm3xq ", doi="10.2196/30976", url="https://mhealth.jmir.org/2022/7/e30976", url="http://www.ncbi.nlm.nih.gov/pubmed/34978535" } @Article{info:doi/10.2196/32089, author="Mohammad, Zaahirah and Ahmad, Norliza and Baharom, Anisah", title="The Effects of Theory-Based Educational Intervention and WhatsApp Follow-up on Papanicolaou Smear Uptake Among Postnatal Women in Malaysia: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="27", volume="10", number="6", pages="e32089", keywords="uterine cervical neoplasms", keywords="Papanicolaou test", keywords="psychological theory", keywords="self-efficacy", keywords="social media", keywords="health knowledge", keywords="attitude", keywords="practice", keywords="Malaysia", abstract="Background: Despite the availability and accessibility of free Papanicolaou (Pap) smear as a screening tool for cervical cancer, the uptake of Pap smear in Malaysia has not changed in the last 15 years. Previous studies have shown that the high uptake of Pap smear reduces the mortality rate of patients with cervical cancer. The low uptake of Pap smear is multifactorial, and the problem could be minimized through the use of mobile technologies. Nevertheless, most intervention studies focused on individual factors, while other important aspects such as mobile technologies, especially WhatsApp, have not been investigated yet. Objective: This study aims to determine the effects of a theory-based educational intervention and WhatsApp follow-up (Pap smear uptake [PSU] intervention) in improving PSU among postnatal women in Seremban, Negeri Sembilan, Malaysia. Methods: A 2-arm, parallel single-blind cluster randomized controlled trial was conducted among postpartum women from the Seremban district. Twelve health clinics were randomly assigned to the intervention and control groups. At baseline, both groups received a self-administered questionnaire. The intervention group received standard care and PSU intervention delivered by a researcher. This 2-stage intervention module was developed based on Social Cognitive Theory, where the first stage was conducted face-to-face and the second stage included a WhatsApp follow-up. The control group received standard care. Participants were observed immediately and at 4, 8, and 12 weeks after the intervention. The primary endpoint was PSU, whereas the secondary endpoints were knowledge, attitude, and self-efficacy scores for Pap smear screening self-assessed using a Google Forms questionnaire. A generalized mixed model was used to determine the effectiveness of the intervention. All data were analyzed using IBM SPSS (version 25), and P value of .05 was considered statistically significant. Results: We analyzed 401 women, of whom 76 (response rate: 325/401, 81\%) had withdrawn because of the COVID-19 pandemic, with a total of 162 respondents in the intervention group and 163 respondents in the control group. The proportion of Pap smears at the 12-week follow-up was 67.9\% (110/162) in the intervention group versus 39.8\% (65/163) in the control group (P<.001). Significant differences between the intervention and control groups were found for Pap smear use (F4,1178; P<.001), knowledge scores (F4,1172=14.946; P<.001), attitude scores (F4,1172=24.417; P<.001), and self-efficacy scores (F1,1172=10.432; P<.001). Conclusions: This study demonstrated that the PSU intervention is effective in increasing the uptake of Pap smear among postnatal women in Seremban district, Malaysia. This intervention module can be tested in other populations of women. Trial Registration: Thai Clinical Trials Registry TCTR20200205001; https://www.thaiclinicaltrials.org/show/TCTR20200205001 ", doi="10.2196/32089", url="https://mhealth.jmir.org/2022/6/e32089", url="http://www.ncbi.nlm.nih.gov/pubmed/35759319" } @Article{info:doi/10.2196/35500, author="Baertsch, Marc-Andrea and Decker, Sarah and Probst, Leona and Joneleit, Stefan and Salwender, Hans and Frommann, Franziska and Buettner, Hartwig", title="Convenient Access to Expert-Reviewed Health Information via an Alexa Voice Assistant Skill for Patients With Multiple Myeloma: Development Study", journal="JMIR Cancer", year="2022", month="Jun", day="9", volume="8", number="2", pages="e35500", keywords="Alexa voice assistant", keywords="Alexa", keywords="voice assistant", keywords="virtual assistant", keywords="multiple myeloma", keywords="cancer", keywords="oncology", keywords="medical education", keywords="patient support group", keywords="digital health", keywords="patient support", keywords="support group", keywords="Europe", keywords="German", keywords="mobile phone", abstract="Background: Patients with multiple myeloma (MM) have high information needs due to the complexity of the disease and variety of treatments. Digital voice assistants provide support in daily life and can be a convenient tool that even older patients can use to access health information. Voice assistants may therefore be useful in providing digital health services to meet the information needs of patients with MM. Objective: We aim to describe and report on the development, content, and functionality of the first Amazon Alexa voice assistant skill for patients with MM in Germany with the goal of empowering and educating patients. Further, we share data on skill usage and first learnings. Methods: In a cocreation workshop with MM patient organizations and MM medical experts in Germany, Takeda Oncology discussed the development and content of the Alexa skill Multiple Myeloma. Patient information on MM disease, diagnostics, and therapy was presented in a question-and-answer format, reviewed by experts, and programmed into the skill. Additionally, a search function for finding patient support groups within a perimeter of 200 km around the users and a myeloma quiz functionality with multiple-choice questions were integrated into the skill. Aggregated retrospective data on the total number of skill installations and skill usage were retrieved from an Amazon Alexa developer account, and a web-based patient survey was conducted on the Takeda Oncology website. Results: The Alexa skill Multiple Myeloma was launched in September 2019. It was available free of charge on the German Amazon Alexa skill store between September 2019 and March 2022 and could be used with devices featuring the Amazon Alexa voice assistant. Since the launch in September 2019 and up to July 2021, a total of 141 users have installed the skill. Between July 2020 and July 2021, a total of 189 skill sessions with 797 utterances were analyzed. The most popular inquiries were searches for patient support groups near the users (58/797, 7.3\%), followed by inquiries about information on MM disease (53/797, 6.6\%) and the quiz (43/797, 5.4\%). The web-based survey on voice assistant usage and the feedback on the Alexa skill Multiple Myeloma were collected from 24 participants and showed that 46\% (11/24) of participants would recommend the Alexa skill. Nonusers of voice assistants (11/24, 46\%) stated that data protection concerns (7/11, 64\%) and a lack of need (6/11, 55\%) were the most important factors of not using voice assistants. Conclusions: The Alexa skill Multiple Myeloma offers patient-friendly and expert-reviewed answers and explanations for medical terms related to MM disease, diagnostics, and therapy, as well as connections to patient support groups and a quiz functionality. In the future, the skill can be extended with new content and functionalities, such as medication adherence support. ", doi="10.2196/35500", url="https://cancer.jmir.org/2022/2/e35500", url="http://www.ncbi.nlm.nih.gov/pubmed/35679096" } @Article{info:doi/10.2196/35867, author="Itoh, Naohiro and Mishima, Hirokazu and Yoshida, Yuki and Yoshida, Manami and Oka, Hiroyuki and Matsudaira, Ko", title="Evaluation of the Effect of Patient Education and Strengthening Exercise Therapy Using a Mobile Messaging App on Work Productivity in Japanese Patients With Chronic Low Back Pain: Open-Label, Randomized, Parallel-Group Trial", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="16", volume="10", number="5", pages="e35867", keywords="mobile app", keywords="patient education", keywords="chronic low back pain", keywords="exercise regimen", keywords="mobile phone", abstract="Background: Artificial intelligence--assisted interactive health promotion systems are useful tools for the management of musculoskeletal conditions. Objective: This study aimed to explore the effects of web-based video patient education and strengthening exercise therapy, using a mobile messaging app, on work productivity and pain in patients with chronic low back pain (CLBP) receiving pharmacological treatment. Methods: Patients with CLBP were randomly allocated to either the exercise group, who received education and exercise therapy using a mobile messaging app, or the conventional group. For patient education, a web-based video program was used to provide evidence-based thinking regarding the importance of a cognitive behavioral approach for CLBP. The exercise therapy was developed in accordance with the recommendations for alignment, core muscles, and endogenous activation, including improvement of posture and mobility for proper alignment, stimulation and/or strengthening of deep muscles for spinal stability, and operation of intrinsic pain for the activation of endogenous substances by aerobic exercise. Both groups continued to receive the usual medical care with pharmacological treatment. The end points were changes in work productivity, pain intensity, quality of life, fear of movement, and depression. The observation period for this study was 12 weeks. An analysis adjusted for baseline values, age at the time of consent acquisition, sex, and willingness to strengthen the exercise therapy was performed. Results: The exercise and conventional groups included 48 and 51 patients, with a mean age of 47.9 years (SD 10.2 years; n=27, 56.3\% male patients) and 46.9 years (SD 12.3 years; n=28, 54.9\% male patients) in the full analysis set, respectively. No significant impact of these interventions on work productivity was observed in the exercise group compared with the conventional group (primary end point: Quantity and Quality method; 0.062 vs 0.114; difference between groups ?0.053, 95\% CI ?0.184 to 0.079; P=.43). However, the exercise group showed consistently better trends for the other end points than did the conventional group. Compared with the conventional group, the exercise group showed a significant improvement in the symptoms of low back pain (3.2 vs 3.8; difference between groups ?0.5, 95\% CI ?1.1 to 0.0; P=.04), quality of life (EuroQoL 5 Dimensions 5 Level: 0.068 vs 0.006; difference between groups 0.061, 95\% CI 0.008 to 0.114; P=.03), and fear of movement at week 12 (?2.3 vs 0.5; difference between groups ?2.8, 95\% CI ?5.5 to ?0.1; P=.04). Conclusions: This study suggests that patient education and strengthening exercise therapy using a mobile messaging app may be useful for treating CLBP. This study does not reveal the effect of therapeutic interventions on CLBP on work productivity. Thus, further research is required to assess work productivity with therapeutic interventions. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041037; https://center6.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000046866 ", doi="10.2196/35867", url="https://mhealth.jmir.org/2022/5/e35867", url="http://www.ncbi.nlm.nih.gov/pubmed/35576560" } @Article{info:doi/10.2196/36114, author="Morcillo-Mu{\~n}oz, Yolanda and S{\'a}nchez-Guarnido, Jos{\'e} Antonio and Calz{\'o}n-Fern{\'a}ndez, Silvia and Baena-Parejo, Isabel", title="Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial", journal="J Med Internet Res", year="2022", month="May", day="11", volume="24", number="5", pages="e36114", keywords="chronic pain", keywords="eHealth", keywords="multimodal intervention", keywords="catastrophizing", keywords="self-management", keywords="mHealth", keywords="mobile phone", keywords="randomized controlled trials", abstract="Background: Combination therapies delivered remotely via the internet or mobile devices are increasingly being used to improve and promote the self-management of chronic conditions. However, little is known regarding the long-term effects of these interventions. Objective: The aim of this study is to evaluate the effectiveness of a multimodal intervention program that measures associated variables such as catastrophizing, pain acceptance, and quality of life using a mobile device in people with chronic pain in an outpatient setting. Methods: A randomized controlled clinical trial was performed using parallel treatment groups. A total of 209 patients with chronic musculoskeletal pain were randomly assigned to one of the two study arms. The intervention group received a standard web-based psychosocial therapy-type program of activities through a smartphone for 6 weeks. The control group only had access to the Find out more section of the app, which contained audiovisual material for pain management based on a self-help approach. The primary outcome was catastrophizing measured using the Pain Catastrophizing Scale (PCS). Secondary outcomes were pain acceptance measured using the Chronic Pain Acceptance Questionnaire and health-related quality of life measured using the EuroQol Visual Analogue Scale. Assessments were conducted at baseline (T1), after treatment (T2), and at the 3-month follow-up (T3). The variations between the different phases were assessed using the percentage change rescaled with log base 2. The Cohen d was calculated based on the results of the linear mixed model. The investigators of the study who evaluated the results were not involved in patient recruitment and were blinded to the group assignment. Results: Positive effects were found in the intervention group (T2--T1) in catastrophizing between the baseline and posttreatment phases (P<.001) and in helplessness (?0.72 vs 0.1; P=.002), rumination (?1.59 vs ?0.53; P<.001), acceptance (0.38 vs 0.05; P=.001), and quality of life (0.43 vs ?0.01; P=.002), although no significant changes were found for magnification (0.2 vs 0.77; P=.14) and satisfaction with health (0.25 vs ?0.27; P=.13). Three months after treatment, significant differences were observed in the intervention group for the outcome variable of catastrophizing (PCS; ?0.59 vs 0.2; P=.006) and the PCS subscales of helplessness (?0.65 vs 0.01; P=.07), rumination (1.23 vs ?0.59; P=.04), and magnification (0.1 vs 0.86; P=.02). Conclusions: The results of our study suggest that app-based mobile multidimensional treatments for adults with chronic pain improve catastrophizing, quality of life, and psychological flexibility immediately after treatment and that the effects are maintained for the primary outcome of catastrophizing for at least 3 months following treatment. Moreover, they promote self-management and can be used to complement face-to-face pain treatments. Trial Registration: ClinicalTrials.gov NCT04509154; https://clinicaltrials.gov/ct2/show/NCT04509154 ", doi="10.2196/36114", url="https://www.jmir.org/2022/5/e36114", url="http://www.ncbi.nlm.nih.gov/pubmed/35373" } @Article{info:doi/10.2196/36404, author="Maenhout, Laura and Peuters, Carmen and Cardon, Greet and Crombez, Geert and DeSmet, Ann and Compernolle, Sofie", title="Nonusage Attrition of Adolescents in an mHealth Promotion Intervention and the Role of Socioeconomic Status: Secondary Analysis of a 2-Arm Cluster-Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="10", volume="10", number="5", pages="e36404", keywords="mHealth", keywords="nonusage attrition", keywords="adolescents", keywords="socioeconomic status", keywords="mobile phone", abstract="Background: Mobile health (mHealth) interventions may help adolescents adopt healthy lifestyles. However, attrition in these interventions is high. Overall, there is a lack of research on nonusage attrition in adolescents, particularly regarding the role of socioeconomic status (SES). Objective: The aim of this study was to focus on the role of SES in the following three research questions (RQs): When do adolescents stop using an mHealth intervention (RQ1)? Why do they report nonusage attrition (RQ2)? Which intervention components (ie, self-regulation component, narrative, and chatbot) prevent nonusage attrition among adolescents (RQ3)? Methods: A total of 186 Flemish adolescents (aged 12-15 years) participated in a 12-week mHealth program. Log data were monitored to measure nonusage attrition and usage duration for the 3 intervention components. A web-based questionnaire was administered to assess reasons for attrition. A survival analysis was conducted to estimate the time to attrition and determine whether this differed according to SES (RQ1). Descriptive statistics were performed to map the attrition reasons, and Fisher exact tests were used to determine if these reasons differed depending on the educational track (RQ2). Mixed effects Cox proportional hazard regression models were used to estimate the associations between the use duration of the 3 components during the first week and attrition. An interaction term was added to the regression models to determine whether associations differed by the educational track (RQ3). Results: After 12 weeks, 95.7\% (178/186) of the participants stopped using the app. 30.1\% (56/186) of the adolescents only opened the app on the installation day, and 44.1\% (82/186) stopped using the app in the first week. Attrition at any given time during the intervention period was higher for adolescents from the nonacademic educational track compared with those from the academic track. The other SES indicators (family affluence and perceived financial situation) did not explain attrition. The most common reasons for nonusage attrition among participants were perceiving that the app did not lead to behavior change, not liking the app, thinking that they already had a sufficiently healthy lifestyle, using other apps, and not being motivated by the environment. Attrition reasons did not differ depending on the educational track. More time spent in the self-regulation and narrative components during the first week was associated with lower attrition, whereas chatbot use duration was not associated with attrition rates. No moderating effects of SES were observed in the latter association. Conclusions: Nonusage attrition was high, especially among adolescents in the nonacademic educational track. The reported reasons for attrition were diverse, with no statistical differences according to the educational level. The duration of the use of the self-regulation and narrative components during the first week may prevent attrition for both educational tracks. Trial Registration: ClinicalTrials.gov NCT04719858; http://clinicaltrials.gov/ct2/show/NCT04719858 ", doi="10.2196/36404", url="https://mhealth.jmir.org/2022/5/e36404", url="http://www.ncbi.nlm.nih.gov/pubmed/35536640" } @Article{info:doi/10.2196/34531, author="Ju, HyoRim and Kang, EunKyo and Kim, YoungIn and Ko, HyunYoung and Cho, Belong", title="The Effectiveness of a Mobile Health Care App and Human Coaching Program in Primary Care Clinics: Pilot Multicenter Real-World Study", journal="JMIR Mhealth Uhealth", year="2022", month="May", day="6", volume="10", number="5", pages="e34531", keywords="healthcare", keywords="health care", keywords="mobile application", keywords="app", keywords="self-management", keywords="primary care", keywords="chronic conditions", abstract="Background: As the global burden of chronic conditions increases, their effective management is a concern. Although the need for chronic disease management using mobile self-management health care apps is increasing, there are still many barriers to their practical application in the primary care field. Objective: This study evaluated the effectiveness of primary care services combining a mobile self-management health care app with human coaching for patients with chronic diseases in the current primary care system. Methods: A total of 110 patients (mean age 53.2, SD 9.2 years; 64 of 110, 58.2\% female) with hypertension, diabetes, dyslipidemia, or metabolic syndrome who visited one of 17 participating primary care clinics from September to November 2020 were included in this study. All participants recorded data regarding changes in body weight, sleep conditions, quality of life, depression, anxiety, stress, BMI, waist circumference, blood sugar levels, blood pressure, and blood lipids levels. The app user group (n=65) used a mobile self-management health care app with human coaching for 12 weeks, and the control group (n=45) underwent conventional self-managed health care. Results: Patients in the app user group reported significantly more weight loss than those in the control group---the body weight of the app user group decreased by 1.43 kg (95\% CI --2.07 to --0.79) and that of the control group decreased by 0.13 kg (95\% CI --0.67 to 0.41; P=.002). The weight loss was markedly greater after using the app for 9 weeks than that when used for 4 weeks or 5-8 weeks (P=.002). Patients in the app user group reported better sleep quality (P=.04) and duration (P=.004) than those in the control group. Conclusions: The combination of primary care clinics and a mobile self-management health care app with human coaching results in better management of chronic conditions. This study shows that the primary care services combining a mobile self-management health care app with human coaching are effective in the current primary care system. An implication of this study is the possibility that a mobile self-management health care app with human coaching is a treatment option in the current primary care system. ", doi="10.2196/34531", url="https://mhealth.jmir.org/2022/5/e34531", url="http://www.ncbi.nlm.nih.gov/pubmed/35522461" } @Article{info:doi/10.2196/32630, author="Ni{\ss}en, Marcia and R{\"u}egger, Dominik and Stieger, Mirjam and Fl{\"u}ckiger, Christoph and Allemand, Mathias and v Wangenheim, Florian and Kowatsch, Tobias", title="The Effects of Health Care Chatbot Personas With Different Social Roles on the Client-Chatbot Bond and Usage Intentions: Development of a Design Codebook and Web-Based Study", journal="J Med Internet Res", year="2022", month="Apr", day="27", volume="24", number="4", pages="e32630", keywords="chatbot", keywords="conversational agent", keywords="social roles", keywords="interpersonal closeness", keywords="social role theory", keywords="working alliance", keywords="design", keywords="persona", keywords="digital health intervention", keywords="web-based experiment", abstract="Background: The working alliance refers to an important relationship quality between health professionals and clients that robustly links to treatment success. Recent research shows that clients can develop an affective bond with chatbots. However, few research studies have investigated whether this perceived relationship is affected by the social roles of differing closeness a chatbot can impersonate and by allowing users to choose the social role of a chatbot. Objective: This study aimed at understanding how the social role of a chatbot can be expressed using a set of interpersonal closeness cues and examining how these social roles affect clients' experiences and the development of an affective bond with the chatbot, depending on clients' characteristics (ie, age and gender) and whether they can freely choose a chatbot's social role. Methods: Informed by the social role theory and the social response theory, we developed a design codebook for chatbots with different social roles along an interpersonal closeness continuum. Based on this codebook, we manipulated a fictitious health care chatbot to impersonate one of four distinct social roles common in health care settings---institution, expert, peer, and dialogical self---and examined effects on perceived affective bond and usage intentions in a web-based lab study. The study included a total of 251 participants, whose mean age was 41.15 (SD 13.87) years; 57.0\% (143/251) of the participants were female. Participants were either randomly assigned to one of the chatbot conditions (no choice: n=202, 80.5\%) or could freely choose to interact with one of these chatbot personas (free choice: n=49, 19.5\%). Separate multivariate analyses of variance were performed to analyze differences (1) between the chatbot personas within the no-choice group and (2) between the no-choice and the free-choice groups. Results: While the main effect of the chatbot persona on affective bond and usage intentions was insignificant (P=.87), we found differences based on participants' demographic profiles: main effects for gender (P=.04, $\eta$p2=0.115) and age (P<.001, $\eta$p2=0.192) and a significant interaction effect of persona and age (P=.01, $\eta$p2=0.102). Participants younger than 40 years reported higher scores for affective bond and usage intentions for the interpersonally more distant expert and institution chatbots; participants 40 years or older reported higher outcomes for the closer peer and dialogical-self chatbots. The option to freely choose a persona significantly benefited perceptions of the peer chatbot further (eg, free-choice group affective bond: mean 5.28, SD 0.89; no-choice group affective bond: mean 4.54, SD 1.10; P=.003, $\eta$p2=0.117). Conclusions: Manipulating a chatbot's social role is a possible avenue for health care chatbot designers to tailor clients' chatbot experiences using user-specific demographic factors and to improve clients' perceptions and behavioral intentions toward the chatbot. Our results also emphasize the benefits of letting clients freely choose between chatbots. ", doi="10.2196/32630", url="https://www.jmir.org/2022/4/e32630", url="http://www.ncbi.nlm.nih.gov/pubmed/35475761" } @Article{info:doi/10.2196/35120, author="Amagai, Saki and Pila, Sarah and Kaat, J. Aaron and Nowinski, J. Cindy and Gershon, C. Richard", title="Challenges in Participant Engagement and Retention Using Mobile Health Apps: Literature Review", journal="J Med Internet Res", year="2022", month="Apr", day="26", volume="24", number="4", pages="e35120", keywords="mobile phone", keywords="mHealth", keywords="retention", keywords="engagement", abstract="Background: Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps. Objective: This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention. Methods: We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention. Results: Of the 389 identified studies, 62 (15.9\%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained. Conclusions: Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention. ", doi="10.2196/35120", url="https://www.jmir.org/2022/4/e35120", url="http://www.ncbi.nlm.nih.gov/pubmed/35471414" } @Article{info:doi/10.2196/32557, author="Alhussein, Ghada and Hadjileontiadis, Leontios", title="Digital Health Technologies for Long-term Self-management of Osteoporosis: Systematic Review and Meta-analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Apr", day="21", volume="10", number="4", pages="e32557", keywords="mHealth", keywords="digital health", keywords="osteoporosis", keywords="self-management", keywords="systematic review", keywords="meta-analysis", keywords="chronic disease", keywords="bone health", keywords="nutrition", keywords="physical activity", keywords="risk assessment", keywords="mobile phone", abstract="Background: Osteoporosis is the fourth most common chronic disease worldwide. The adoption of preventative measures and effective self-management interventions can help improve bone health. Mobile health (mHealth) technologies can play a key role in the care and self-management of patients with osteoporosis. Objective: This study presents a systematic review and meta-analysis of the currently available mHealth apps targeting osteoporosis self-management, aiming to determine the current status, gaps, and challenges that future research could address, as well as propose appropriate recommendations. Methods: A systematic review of all English articles was conducted, in addition to a survey of all apps available in iOS and Android app stores as of May 2021. A comprehensive literature search (2010 to May 2021) of PubMed, Scopus, EBSCO, Web of Science, and IEEE Xplore was conducted. Articles were included if they described apps dedicated to or useful for osteoporosis (targeting self-management, nutrition, physical activity, and risk assessment) delivered on smartphone devices for adults aged ?18 years. Of the 32 articles, a random effects meta-analysis was performed on 13 (41\%) studies of randomized controlled trials, whereas the 19 (59\%) remaining studies were only included in the narrative synthesis as they did not provide enough data. Results: In total, 3906 unique articles were identified. Of these 3906 articles, 32 (0.81\%) articles met the inclusion criteria and were reviewed in depth. The 32 studies comprised 14,235 participants, of whom, on average, 69.5\% (n=9893) were female, with a mean age of 49.8 (SD 17.8) years. The app search identified 23 relevant apps for osteoporosis self-management. The meta-analysis revealed that mHealth-supported interventions resulted in a significant reduction in pain (Hedges g ?1.09, 95\% CI ?1.68 to ?0.45) and disability (Hedges g ?0.77, 95\% CI ?1.59 to 0.05). The posttreatment effect of the digital intervention was significant for physical function (Hedges g 2.54, 95\% CI ?4.08 to 4.08) but nonsignificant for well-being (Hedges g 0.17, 95\% CI ?1.84 to 2.17), physical activity (Hedges g 0.09, 95\% CI ?0.59 to 0.50), anxiety (Hedges g ?0.29, 95\% CI ?6.11 to 5.53), fatigue (Hedges g ?0.34, 95\% CI ?5.84 to 5.16), calcium (Hedges g ?0.05, 95\% CI ?0.59 to 0.50), vitamin D intake (Hedges g 0.10, 95\% CI ?4.05 to 4.26), and trabecular score (Hedges g 0.06, 95\% CI ?1.00 to 1.12). Conclusions: Osteoporosis apps have the potential to support and improve the management of the disease and its symptoms; they also appear to be valuable tools for patients and health professionals. However, most of the apps that are currently available lack clinically validated evidence of their efficacy and focus on a limited number of symptoms. A more holistic and personalized approach within a cocreation design ecosystem is needed. Trial Registration: PROSPERO 2021 CRD42021269399; https://tinyurl.com/2sw454a9 ", doi="10.2196/32557", url="https://mhealth.jmir.org/2022/4/e32557", url="http://www.ncbi.nlm.nih.gov/pubmed/35451968" } @Article{info:doi/10.2196/31923, author="Powell, Leigh and Nizam, Zayan Mohammed and Nour, Radwa and Zidoun, Youness and Sleibi, Randa and Kaladhara Warrier, Sreelekshmi and Al Suwaidi, Hanan and Zary, Nabil", title="Conversational Agents in Health Education: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Apr", day="19", volume="11", number="4", pages="e31923", keywords="conversational agents", keywords="artificial intelligence chatbots", keywords="chatbots", keywords="health education", keywords="health promotion", keywords="classification", keywords="artificial intelligence assistants", keywords="conversational artificial intelligence", abstract="Background: Conversational agents have the ability to reach people through multiple mediums, including the online space, mobile phones, and hardware devices like Alexa and Google Home. Conversational agents provide an engaging method of interaction while making information easier to access. Their emergence into areas related to public health and health education is perhaps unsurprising. While the building of conversational agents is getting more simplified with time, there are still requirements of time and effort. There is also a lack of clarity and consistent terminology regarding what constitutes a conversational agent, how these agents are developed, and the kinds of resources that are needed to develop and sustain them. This lack of clarity creates a daunting task for those seeking to build conversational agents for health education initiatives. Objective: This scoping review aims to identify literature that reports on the design and implementation of conversational agents to promote and educate the public on matters related to health. We will categorize conversational agents in health education in alignment with current classifications and terminology emerging from the marketplace. We will clearly define the variety levels of conversational agents, categorize currently existing agents within these levels, and describe the development models, tools, and resources being used to build conversational agents for health care education purposes. Methods: This scoping review will be conducted by employing the Arksey and O'Malley framework. We will also be adhering to the enhancements and updates proposed by Levac et al and Peters et al. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews will guide the reporting of this scoping review. A systematic search for published and grey literature will be undertaken from the following databases: (1) PubMed, (2) PsychINFO, (3) Embase, (4) Web of Science, (5) SCOPUS, (6) CINAHL, (7) ERIC, (8) MEDLINE, and (9) Google Scholar. Data charting will be done using a structured format. Results: Initial searches of the databases retrieved 1305 results. The results will be presented in the final scoping review in a narrative and illustrative manner. Conclusions: This scoping review will report on conversational agents being used in health education today, and will include categorization of the levels of the agents and report on the kinds of tools, resources, and design and development methods used. International Registered Report Identifier (IRRID): DERR1-10.2196/31923 ", doi="10.2196/31923", url="https://www.researchprotocols.org/2022/4/e31923", url="http://www.ncbi.nlm.nih.gov/pubmed/35258006" } @Article{info:doi/10.2196/35462, author="Rodr{\'i}guez S{\'a}nchez-Laulh{\'e}, Pablo and Luque-Romero, Gabriel Luis and Barrero-Garc{\'i}a, Jos{\'e} Francisco and Biscarri-Carbonero, {\'A}ngela and Blanquero, Jes{\'u}s and Suero-Pineda, Alejandro and Heredia-Rizo, Marcos Alberto", title="An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Apr", day="7", volume="10", number="4", pages="e35462", keywords="rheumatoid arthritis", keywords="telerehabilitation", keywords="self-management", keywords="mHealth", keywords="primary health care", keywords="physical therapy", keywords="exercise therapy", keywords="mobile applications", keywords="telehealth", keywords="health education", keywords="mobile phone", abstract="Background: Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated. Objective: This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands. Methods: A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61\%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups. Results: In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45\%; control group: 32/58, 55\%), were included in the analysis; 53\% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time{\texttimes}group effect for the total score of the MHQ (F1.62,85.67=9.163; P<.001; $\eta$2=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95\% CI 8.70-25.03) at 3 months and 17.21 points (95\% CI 4.78-29.63) at 6 months. No time{\texttimes}group interaction was observed for the secondary measures (all P>.05). Conclusions: Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes. Trial Registration: ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04713-4 ", doi="10.2196/35462", url="https://mhealth.jmir.org/2022/4/e35462", url="http://www.ncbi.nlm.nih.gov/pubmed/35389367" } @Article{info:doi/10.2196/31831, author="Evans, Kerry and Donelan, Jasper and Rennick-Egglestone, Stefan and Cox, Serena and Kuipers, Yvonne", title="Review of Mobile Apps for Women With Anxiety in Pregnancy: Maternity Care Professionals' Guide to Locating and Assessing Anxiety Apps", journal="J Med Internet Res", year="2022", month="Mar", day="23", volume="24", number="3", pages="e31831", keywords="anxiety", keywords="pregnancy", keywords="antenatal", keywords="mobile applications", keywords="digital interventions", keywords="mHealth", keywords="mobile app", keywords="psychological well-being", keywords="maternity", keywords="evaluation", keywords="quality assessment", abstract="Background: Mental health and pregnancy apps are widely available and have the potential to improve health outcomes and enhance women's experience of pregnancy. Women frequently access digital information throughout their pregnancy. However, health care providers and women have little information to guide them toward potentially helpful or effective apps. Objective: This review aimed to evaluate a methodology for systematically searching and reviewing commercially available apps that support pregnant women with symptoms of anxiety in order to assist maternity care professionals in identifying resources that they could recommend for these women. Methods: A stepwise systematic approach was used to identify, select, describe, and assess the most popular and highly user-rated apps available in the United Kingdom from January to March 2021. This included developing a script-based search strategy and search process, writing evaluation criteria, and conducting a narrative description and evaluation of the selected apps. Results: Useful search terms were identified, which included nonclinical, aspirational, and problem-based phrases. There were 39 apps selected for inclusion in the review. No apps specifically targeted women with anxiety in pregnancy. Of the 39 apps included in the review, 33 (85\%) focused solely on mind-body techniques to promote relaxation, stress reduction, and psychological well-being. Only 8 of the 39 (21\%) apps included in the review reported that health care professionals had contributed to app development and only 1/39 (3\%) provided empirical evidence on the effectiveness and acceptability of the app. The top 12/39 (31\%) apps were evaluated by 2 independent reviewers using the developed criteria and scores. There was a small negative correlation between the reviewers' scores and app user rating scores, with higher user rating scores associated with lower reviewer scores. Conclusions: App developers, publishers, and maternity care professionals should seek advice from women with lived experience of anxiety symptoms in pregnancy to locate, promote, and optimize the visibility of apps for pregnant women. There is a lack of resources that provide coping strategies based on current evidence for the treatment of anxiety in pregnancy. Maternity care providers are limited in their ability to locate and recommend acceptable and trustworthy apps because of the lack of information on the evidence base, development, and testing of apps. Maternity care professionals and women need access to libraries of trusted apps that have been evaluated against relevant and established criteria. ", doi="10.2196/31831", url="https://www.jmir.org/2022/3/e31831", url="http://www.ncbi.nlm.nih.gov/pubmed/35319482" } @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/10.2196/26499, author="Chmiel, P. Francis and Burns, K. Dan and Pickering, Brian John and Blythin, Alison and Wilkinson, MA Thomas and Boniface, J. Michael", title="Prediction of Chronic Obstructive Pulmonary Disease Exacerbation Events by Using Patient Self-reported Data in a Digital Health App: Statistical Evaluation and Machine Learning Approach", journal="JMIR Med Inform", year="2022", month="Mar", day="21", volume="10", number="3", pages="e26499", keywords="COPD", keywords="machine learning", keywords="mHealth", keywords="exacerbation events", keywords="myCOPD", keywords="mobile health", keywords="digital applications", keywords="remote monitoring", keywords="chronic disease", keywords="digital health", keywords="health care applications", abstract="Background: Self-reporting digital apps provide a way of remotely monitoring and managing patients with chronic conditions in the community. Leveraging the data collected by these apps in prognostic models could provide increased personalization of care and reduce the burden of care for people who live with chronic conditions. This study evaluated the predictive ability of prognostic models for the prediction of acute exacerbation events in people with chronic obstructive pulmonary disease by using data self-reported to a digital health app. Objective: The aim of this study was to evaluate if data self-reported to a digital health app can be used to predict acute exacerbation events in the near future. Methods: This is a retrospective study evaluating the use of symptom and chronic obstructive pulmonary disease assessment test data self-reported to a digital health app (myCOPD) in predicting acute exacerbation events. We include data from 2374 patients who made 68,139 self-reports. We evaluated the degree to which the different variables self-reported to the app are predictive of exacerbation events and developed both heuristic and machine learning models to predict whether the patient will report an exacerbation event within 3 days of self-reporting to the app. The model's predictive ability was evaluated based on self-reports from an independent set of patients. Results: Users self-reported symptoms, and standard chronic obstructive pulmonary disease assessment tests displayed correlation with future exacerbation events. Both a baseline model (area under the receiver operating characteristic curve [AUROC] 0.655, 95\% CI 0.689-0.676) and a machine learning model (AUROC 0.727, 95\% CI 0.720-0.735) showed moderate ability in predicting exacerbation events, occurring within 3 days of a given self-report. Although the baseline model obtained a fixed sensitivity and specificity of 0.551 (95\% CI 0.508-0.596) and 0.759 (95\% CI 0.752-0.767) respectively, the sensitivity and specificity of the machine learning model can be tuned by dichotomizing the continuous predictions it provides with different thresholds. Conclusions: Data self-reported to health care apps designed to remotely monitor patients with chronic obstructive pulmonary disease can be used to predict acute exacerbation events with moderate performance. This could increase personalization of care by allowing preemptive action to be taken to mitigate the risk of future exacerbation events. ", doi="10.2196/26499", url="https://medinform.jmir.org/2022/3/e26499", url="http://www.ncbi.nlm.nih.gov/pubmed/35311685" } @Article{info:doi/10.2196/27588, author="Mujcic, Ajla and Blankers, Matthijs and Boon, Brigitte and Verdonck-de Leeuw, M. Irma and Smit, Filip and van Laar, Margriet and Engels, Rutger", title="Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Smoking Cessation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial", journal="J Med Internet Res", year="2022", month="Mar", day="17", volume="24", number="3", pages="e27588", keywords="smoking cessation", keywords="cancer survivors", keywords="effectiveness", keywords="cost-effectiveness", keywords="eHealth", abstract="Background: Smoking cessation (SC) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study aims to evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared with a noninteractive web-based information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months. The study was conducted in the Netherlands over the internet from November 2016 to September 2019. The participants were Dutch adult smoking cancer survivors with the intention to quit smoking. In total, 165 participants were included and analyzed: 83 (50.3\%) in the MyCourse group and 82 (49.7\%) in the control group. In the intervention group, participants had access to a newly developed, digital, minimally guided SC intervention (MyCourse-Quit Smoking). Control group participants received a noninteractive web-based information brochure on SC. Both groups received unrestricted access to usual care. The primary outcome was self-reported 7-day smoking abstinence at the 6-month follow-up. Secondary outcomes were quality-adjusted life years gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction. For the health economic evaluation, intervention costs, health care costs, and costs stemming from productivity losses were assessed over a 12-month horizon. Results: At the 6-month follow-up, the quit rates were 28\% (23/83) and 26\% (21/82) in the MyCourse and control groups, respectively (odds ratio 0.47, 95\% CI 0.03-7.86; P=.60). In both groups, nicotine dependence scores were reduced at 12 months, and the number of smoked cigarettes was reduced by approximately half. The number of cigarettes decreased more over time, and the MyCourse group demonstrated a significantly greater reduction at the 12-month follow-up (incidence rate ratio 0.87; 95\% CI 0.76-1.00; P=.04). Intervention costs were estimated at US \$193 per participant for the MyCourse group and US \$74 for the control group. The mean per-participant societal costs were US \$25,329 (SD US \$29,137) and US \$21,836 (SD US \$25,792), respectively. In the cost-utility analysis, MyCourse was not preferred over the control group from a societal perspective. With smoking behavior as the outcome, the MyCourse group led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio of US \$52,067 (95\% CI US \$32,515-US \$81,346). Conclusions: At 6 months, there was no evidence of a differential effect on cessation rates; in both groups, approximately a quarter of the cancer survivors quit smoking and their number of cigarettes smoked was reduced by half. At 12 months, the MyCourse intervention led to a greater reduction in the number of smoked cigarettes, albeit at higher costs than for the control group. No evidence was found for a differential effect on quality-adjusted life years. Trial Registration: The Netherlands Trial Register NTR6011; https://www.trialregister.nl/trial/5434 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z ", doi="10.2196/27588", url="https://www.jmir.org/2022/3/e27588", url="http://www.ncbi.nlm.nih.gov/pubmed/35297777" } @Article{info:doi/10.2196/26013, author="Gibson, Bryan and Simonsen, Sara and Jensen, D. Jakob and Yingling, Leah and Schaefer, Julia and Sundaresh, Vishnu and Zhang, Yue and Altizer, Roger", title="Mobile Virtual Reality Versus Mobile 360{\textdegree} Video to Promote Enrollment in the Diabetes Prevention Program Among Hispanic Adults: Pilot Study", journal="JMIR Diabetes", year="2022", month="Mar", day="17", volume="7", number="1", pages="e26013", keywords="diabetes prevention", keywords="virtual reality", keywords="risk", keywords="perception", keywords="diabetes", keywords="type 2 diabetes", keywords="mobile phone", keywords="prediabetes", keywords="prevention", keywords="VR", keywords="enrollment", keywords="pilot study", keywords="video", abstract="Background: Hispanic adults are at increased risk of developing type 2 diabetes. The Diabetes Prevention Program (DPP) reduces the risk of developing type 2 diabetes; however, the rate of enrollment is very low. Objective: The goal of this pilot project was to determine whether presenting brief motivational mobile videos in virtual reality vs 360{\textdegree} video has differential effects on risk perceptions and enrollment in the DPP. Methods: Adults with prediabetes were recruited at a clinic serving a low-income Hispanic community. After consenting, the participants completed a baseline survey that collected information about demographics and risk perceptions. All participants then viewed 2 videos. Per random assignment, the videos were presented either using the participant's smartphone alone (360{\textdegree} video) or were viewed with their smartphone in a virtual reality (VR) cardboard headset. Two weeks later, a follow-up survey collected measures of enrollment in the DPP, risk perceptions, health literacy, the importance of contextual factors related to the decision of whether to enroll in the DPP (eg, distance to the class), and qualitative feedback on the interventions. We used logistic regression to determine whether enrollment in the DPP differed by intervention mode, while accounting for health literacy and contextual factors related to the DPP. We used unpaired t tests to examine differences in change in risk perceptions between groups. Paired t tests were used to examine within-subject changes in risk perceptions. Results: A total of 116 participants provided complete data. Most participants were middle-aged (mean age 44.6 years; SD 11.9) Hispanic (114/116), female (79/116), with low health literacy (mean score 12.3/20; SD 3.4). Enrollment in the DPP was 44/116 (37.9\%) overall but did not differ by group (odds ratio for enrolling in VR group 1.78, 95\% CI 0.75-4.3; P=.19). Individuals who rated the distance needed to travel to attend the DPP as more important were less likely to enroll in the DPP (odds ratio 0.56, 95\% CI 0.33-0.92; P=.03). Risk perceptions did not differ by group (mean change in 360{\textdegree} video group -0.07, mean change in VR group 0.03, t=0.6, P=.54) and did not change within subjects (mean 0.02, t=0.21, P=.83). Participant feedback suggested that the videos are emotionally engaging and educational. Conclusions: The videos presented in 360{\textdegree} video and mobile VR had equal efficacy in promoting enrollment in the DPP. Future work to rigorously evaluate this intervention, its mechanism of action, and potential moderators of the efficacy are discussed. ", doi="10.2196/26013", url="https://diabetes.jmir.org/2022/1/e26013", url="http://www.ncbi.nlm.nih.gov/pubmed/35297771" } @Article{info:doi/10.2196/33940, author="Falkenhain, Kaja and Locke, R. Sean and Lowe, A. Dylan and Lee, Terry and Singer, Joel and Weiss, J. Ethan and Little, P. Jonathan", title="Use of an mHealth Ketogenic Diet App Intervention and User Behaviors Associated With Weight Loss in Adults With Overweight or Obesity: Secondary Analysis of a Randomized Clinical Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="14", volume="10", number="3", pages="e33940", keywords="acetone", keywords="biofeedback", keywords="psychology", keywords="diet", keywords="ketogenic", keywords="mobile apps", keywords="overweight", keywords="technology", keywords="telemedicine", keywords="weight loss", keywords="mobile phone", abstract="Background: Low-carbohydrate ketogenic diets are a viable method to lose weight that have regained popularity in recent years. Technology in the form of mobile health (mHealth) apps allows for scalable and remote delivery of such dietary interventions and are increasingly being used by the general population without direct medical supervision. However, it is currently unknown which factors related to app use and user behavior are associated with successful weight loss. Objective: First, to describe and characterize user behavior, we aim to examine characteristics and user behaviors over time of participants who were enrolled in a remotely delivered clinical weight loss trial that tested an mHealth ketogenic diet app paired with a breath acetone biofeedback device. Second, to identify variables of importance to weight loss at 12 weeks that may offer insight for future development of dietary mHealth interventions, we aim to explore which app- and adherence-related user behaviors characterized successful weight loss. Methods: We analyzed app use and self-reported questionnaire data from 75 adults with overweight or obesity who participated in the intervention arm of a previous weight loss study. We examined data patterns over time through linear mixed models and performed correlation, linear regression, and causal mediation analyses to characterize diet-, weight-, and app-related user behavior associated with weight loss. Results: In the context of a low-carbohydrate ketogenic diet intervention delivered remotely through an mHealth app paired with a breath acetone biofeedback device, self-reported dietary adherence seemed to be the most important factor to predict weight loss ($\beta$=--.31; t54=--2.366; P=.02). Furthermore, self-reported adherence mediated the relationship between greater app engagement (from c=--0.008, 95\% CI --0.014 to --0.0019 to c'=--0.0035, 95\% CI --0.0094 to 0.0024) or higher breath acetone levels (from c=--1.34, 95\% CI --2.28 to --0.40 to c'=--0.40, 95\% CI --1.42 to 0.62) and greater weight loss, explaining a total of 27.8\% and 28.8\% of the variance in weight loss, respectively. User behavior (compliance with weight measurements and app engagement) and adherence-related aspects (breath acetone values and self-reported dietary adherence) over time differed between individuals who achieved a clinically significant weight loss of >5\% and those who did not. Conclusions: Our in-depth examination of app- and adherence-related user behaviors offers insight into factors associated with successful weight loss in the context of mHealth interventions. In particular, our finding that self-reported dietary adherence was the most important metric predicting weight loss may aid in the development of future mHealth dietary interventions. Trial Registration: ClinicalTrials.gov NCT04165707; https://clinicaltrials.gov/ct2/show/NCT04165707 International Registered Report Identifier (IRRID): RR2-10.2196/19053 ", doi="10.2196/33940", url="https://mhealth.jmir.org/2022/3/e33940", url="http://www.ncbi.nlm.nih.gov/pubmed/35285809" } @Article{info:doi/10.2196/33038, author="Neale, Joanne and Bowen, May Alice", title="Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users", journal="JMIR Hum Factors", year="2022", month="Mar", day="8", volume="9", number="1", pages="e33038", keywords="apps", keywords="digital literacy", keywords="mHealth", keywords="substance use", keywords="recovery", keywords="qualitative", keywords="mobile phone", abstract="Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non--treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users' views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60\%, men and n=8, 40\%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. ", doi="10.2196/33038", url="https://humanfactors.jmir.org/2022/1/e33038", url="http://www.ncbi.nlm.nih.gov/pubmed/35258474" } @Article{info:doi/10.2196/31016, author="Romero-Jimenez, Rosa and Escudero-Vilaplana, Vicente and Chamorro-De-Vega, Esther and Ais-Larisgoitia, Arantza and Lobato Matilla, Elena Maria and Herranz-Alonso, Ana and Sanjurjo, Maria", title="The Characteristics and Functionalities of Mobile Apps Aimed at Patients Diagnosed With Immune-Mediated Inflammatory Diseases: Systematic App Search", journal="J Med Internet Res", year="2022", month="Mar", day="4", volume="24", number="3", pages="e31016", keywords="immune-mediated inflammatory disease", keywords="mobile app", keywords="mHealth", keywords="mobile health", keywords="chronic disease", keywords="disease management", keywords="outcomes", keywords="functionality", keywords="quality", keywords="patient education", keywords="health outcomes", keywords="reliability", abstract="Background: Immune-mediated inflammatory diseases (IMIDs) are systemic conditions associated with a high social and health impact. New treatments have changed the prognosis of IMIDs and have increased patient autonomy in disease management. Mobile apps have enormous potential to improve health outcomes in patients with IMIDs. Although a large number of IMID apps are available, the app market is not regulated, and functionality and reliability remain uncertain. Objective: Our aims are to review available apps for patients with IMIDs or caregivers and to describe the main characteristics and functionalities of these apps. Methods: We performed an observational, cross-sectional, descriptive study of all apps for patients with IMIDs. Between April 5 and 14, 2021, we conducted a search of the App Store (iOS) and Play Store (Android) platforms. We used the names of the different IMIDs as search terms. The inclusion criteria were as follows: content related to IMIDs, English or Spanish language, and user population consisting of patients and health care consumers, including family and caregivers. The variables analyzed were as follows: app name, type of IMID, platform (Android or iOS), country of origin, language, category of the app, cost, date of the last update, size, downloads, author affiliation, and functionalities. Results: We identified 713 apps in the initial search, and 243 apps met the criteria and were analyzed. Of these, 37\% (n=90) were on Android, 27.2\% (n=66) on iOS, and 35.8\% (n=87) on both platforms. The most frequent categories were health and well-being/fitness apps (n=188, 48.5\%) and medicine (n=82, 37.9\%). A total of 211 (82.3\%) apps were free. The mean time between the date of the analysis and the date of the most recent update was 18.5 (SD 19.3) months. Health care professionals were involved in the development of 100 (41.1\%) apps. We found differences between Android and iOS in the mean time since the last update (16.2, SD 14.7 months vs 30.3, SD 25.7 months) and free apps (85.6\% vs 75.8\%; respectively). The functionalities were as follows: general information about lifestyles, nutrition, or exercises (n=135, 55.6\%); specific information about the disease or treatment (n=102, 42\%); recording of symptoms or adverse events (n=51, 21\%); agenda/calendar (n=44, 18.1\%); reminder medication (n=41, 16.9\%); and recording of patient-reported outcomes (n=41, 16.9\%). A total of 147 (60.5\%) apps had more than one functionality. Conclusions: IMID-related apps are heterogeneous in terms of functionality and reliability. Apps may be a useful complement to IMID care, especially inpatient education (their most frequent functionality). However, more than half of the IMID apps had not been developed by health care professionals or updated in the last year. ", doi="10.2196/31016", url="https://www.jmir.org/2022/3/e31016", url="http://www.ncbi.nlm.nih.gov/pubmed/35254286" } @Article{info:doi/10.2196/28686, author="Sunshine, Jacob", title="Smart Speakers: The Next Frontier in mHealth", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="21", volume="10", number="2", pages="e28686", keywords="digital health", keywords="mobile health", keywords="machine learning", keywords="smart speaker", keywords="smartphone", doi="10.2196/28686", url="https://mhealth.jmir.org/2022/2/e28686", url="http://www.ncbi.nlm.nih.gov/pubmed/35188467" } @Article{info:doi/10.2196/32826, author="Narrillos-Moraza, {\'A}lvaro and G{\'o}mez-Mart{\'i}nez-Sagrera, Patricia and Amor-Garc{\'i}a, {\'A}ngel Miguel and Escudero-Vilaplana, Vicente and Collado-Borrell, Roberto and Villanueva-Bueno, Cristina and G{\'o}mez-Centuri{\'o}n, Ignacio and Herranz-Alonso, Ana and Sanjurjo-S{\'a}ez, Mar{\'i}a", title="Mobile Apps for Hematological Conditions: Review and Content Analysis Using the Mobile App Rating Scale", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="16", volume="10", number="2", pages="e32826", keywords="blood", keywords="hematology", keywords="mHealth", keywords="mobile apps", keywords="quality", keywords="rating tool", keywords="mobile phone", abstract="Background: Hematological conditions are prevalent disorders that are associated with significant comorbidities and have a major impact on patient care. Concerning new tools for the care of these patients, the number of health apps aimed at hematological patients is growing. Currently, there are no quality analyses or classifications of apps for patients diagnosed with hematological conditions. Objective: The aim of this study is to analyze the characteristics and quality of apps designed for patients diagnosed with hematological conditions by using the Mobile App Rating Scale (MARS). Methods: We performed an observational, cross-sectional descriptive study of all smartphone apps for patients diagnosed with hematological conditions. A search was conducted in March 2021 using the following terms: anemia, blood cancer, blood disorder, hematological cancer, hematological malignancy, hematological tumor, hematology, hemophilia, hemorrhage, lymphoma, leukemia, multiple myeloma, thalassemia, thrombocytopenia, and thrombosis. The apps identified were downloaded and evaluated by 2 independent researchers. General characteristics were registered, and quality was analyzed using MARS scores. Interrater reliability was measured by using the Cohen $\kappa$ coefficient. Results: We identified 2100 apps in the initial search, and 4.19\% (88/2100) of apps met the inclusion criteria and were analyzed. Of the 88 apps, 61\% (54/88) were available on Android, 30\% (26/88) were available on iOS, and 9\% (8/88) were available on both platforms. Moreover, 7\% (6/88) required payment, and 49\% (43/88) were updated in the last year. Only 26\% (23/88) of the apps were developed with the participation of health professionals. Most apps were informative (60/88, 68\%), followed by preventive (23/88, 26\%) and diagnostic (5/88, 6\%). Most of the apps were intended for patients with anemia (23/88, 26\%). The mean MARS score for the overall quality of the 88 apps was 3.03 (SD 1.14), ranging from 1.19 (lowest-rated app) to 4.86 (highest-rated app). Only 47\% (41/88) of the apps obtained a MARS score of over 3 points (acceptable quality). Functionality was the best-rated section, followed by aesthetics, engagement, information, and app subjective quality. The five apps with the highest MARS score were the following: Multiple Myeloma Manager, Hodgkin Lymphoma Manager, Focus On Lymphoma, ALL Manager, and CLL Manager. The analysis by operating system, developer, and cost revealed statistically significant differences in MARS scores (P<.001, P<.001, and P=.049, respectively). The interrater agreement between the 2 reviewers was substantial (k=0.78). Conclusions: There is great heterogeneity in the quality of apps for patients with hematological conditions. More than half of the apps do not meet acceptable criteria for quality and content. Most of them only provide information about the pathology, lacking interactivity and personalization options. The participation of health professionals in the development of these apps is low, although it is narrowly related to better quality. ", doi="10.2196/32826", url="https://mhealth.jmir.org/2022/2/e32826", url="http://www.ncbi.nlm.nih.gov/pubmed/35171109" } @Article{info:doi/10.2196/31537, author="Brown, Marie Jacqueline and Franco-Arellano, Beatriz and Froome, Hannah and Siddiqi, Amina and Mahmood, Amina and Arcand, JoAnne", title="The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="16", volume="10", number="2", pages="e31537", keywords="mHealth", keywords="children", keywords="app quality", keywords="behavior change techniques", keywords="child nutrition", keywords="mobile apps", keywords="Canada", keywords="mobile phone", abstract="Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (?12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50\%) and as not recommended (8/16, 50\%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9\%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5\% (162/259) of apps were classified as food games, 27.4\% (71/259) as didactic nutrition guides, 6.6\% (17/259) as habit trackers, and 3.5\% (9/259) as other. Most apps (198/259, 76.4\%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps ($\beta$=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7\%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. ", doi="10.2196/31537", url="https://mhealth.jmir.org/2022/2/e31537", url="http://www.ncbi.nlm.nih.gov/pubmed/35171100" } @Article{info:doi/10.2196/28886, author="Gonzalez-Plaza, Elena and Bellart, Jordi and Arranz, {\'A}ngela and Luj{\'a}n-Barroso, Leila and Crespo Mirasol, Esther and Seguranyes, Gloria", title="Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="15", volume="10", number="2", pages="e28886", keywords="obesity", keywords="maternal", keywords="pregnancy", keywords="mHealth", keywords="mobile apps", keywords="telemedicine", keywords="telenursing", keywords="physical activity", keywords="gestational weight gain", keywords="lifestyle", keywords="mobile phone", abstract="Background: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. Objective: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. Methods: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire--Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. Results: We analyzed 120 women, of whom 30 (25\%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95\% CI 0.4-0.6) kg per week in the control group and 0.3 (95\% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95\% CI ?0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks--minutes per week vs 1386 metabolic equivalents of tasks--minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61\% (36/59) of the women who were pregnant used the smartband daily, and 75\% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. Conclusions: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. Trial Registration: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872 ", doi="10.2196/28886", url="https://mhealth.jmir.org/2022/2/e28886", url="http://www.ncbi.nlm.nih.gov/pubmed/35166684" } @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/10.2196/22093, author="Sowon, Karen and Maliwichi, Priscilla and Chigona, Wallace", title="The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="27", volume="10", number="1", pages="e22093", keywords="human-technology interaction", keywords="maternal health", keywords="mHealth", keywords="mobile phone", keywords="utilization", keywords="Kenya", abstract="Background: The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective: This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods: Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results: A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions: In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness. ", doi="10.2196/22093", url="https://mhealth.jmir.org/2022/1/e22093", url="http://www.ncbi.nlm.nih.gov/pubmed/35084356" } @Article{info:doi/10.2196/31607, author="Hayman, J. Melanie and Alfrey, Kristie-Lee and Waters, Kim and Cannon, Summer and Mielke, I. Gregore and Keating, E. Shelley and Mena, P. Gabriela and Mottola, F. Michelle and Evenson, R. Kelly and Davenport, H. Margie and Barlow, Ariel S. and Budzynski-Seymour, Emily and Comardelle, Natalie and Dickey, Madison and Harrison, L. Cheryce and Kebbe, Maryam and Moholdt, Trine and Moran, J. Lisa and Nagpal, S. Taniya and Schoeppe, Stephanie and Alley, Stephanie and Brown, J. Wendy and Williams, Susan and Vincze, Lisa", title="Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="19", volume="10", number="1", pages="e31607", keywords="apps", keywords="exercise", keywords="mobile health", keywords="mHealth", keywords="mobile phone", keywords="physical activity", keywords="pregnancy", keywords="exercise prescription", keywords="evidence-based guidelines", keywords="app development", keywords="systematic review", abstract="Background: Guidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear. Objective: This study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers. Methods: Systematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ?4 out of 5). Apps were then independently reviewed using an author-designed extraction tool. Results: Overall, 27 apps were included in this review (Google Play Store: 16/27, 59\%, and App Store: 11/27, 41\%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11\% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15\% (4/27) of the apps collected information about the user's current exercise behaviors, 11\% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials. Conclusions: Few exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual's characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps. ", doi="10.2196/31607", url="https://mhealth.jmir.org/2022/1/e31607", url="http://www.ncbi.nlm.nih.gov/pubmed/35044318" } @Article{info:doi/10.2196/30724, author="Spadaro, Benedetta and Martin-Key, A. Nayra and Funnell, Erin and Bahn, Sabine", title="mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="17", volume="10", number="1", pages="e30724", keywords="digital mental health", keywords="perinatal mental health", keywords="pregnancy", keywords="MIND", keywords="mobile phone", abstract="Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. ", doi="10.2196/30724", url="https://mhealth.jmir.org/2022/1/e30724", url="http://www.ncbi.nlm.nih.gov/pubmed/35037894" } @Article{info:doi/10.2196/31567, author="Poduval, Shoba and Ross, Jamie and Pal, Kingshuk and Newhouse, Nikki and Hamilton, Fiona and Murray, Elizabeth", title="Web-Based Structured Education for Type 2 Diabetes: Interdisciplinary User-Centered Design Approach", journal="JMIR Hum Factors", year="2022", month="Jan", day="14", volume="9", number="1", pages="e31567", keywords="type 2 diabetes", keywords="patient self-management", keywords="diabetes education", keywords="primary care", keywords="digital health", abstract="Background: Digital health research encompasses methods from human-computer interaction and health research. Objective: This paper aims to describe how these methods were combined to develop HeLP-Diabetes: Starting Out, a web-based structured education program for people newly diagnosed with type 2 diabetes. Methods: The development process consisted of three phases: initial design for effectiveness, optimization for usability, and in the wild testing in the National Health Service with people newly diagnosed with type 2 diabetes, and further revisions. We adopted an iterative user-centered approach and followed steps from the human-computer interaction design life cycle and the Medical Research Council guidelines on developing and evaluating complex interventions. Results: The initial design process resulted in an 8-session program containing information and behavior change techniques targeting weight loss, being more active, and taking medication. The usability testing was highlighted at an early stage, where changes needed to be made to the language and layout of the program. The in the wild testing provided data on uptake of and barriers to use. The study suggested low uptake and completion of the program, but those who used it seemed to benefit from it. The qualitative findings suggested that barriers to use included an expectation that the program would take too long. This informed refinements to the program. Conclusions: The use of interdisciplinary methods resulted in an iterative development process and refinements to the program that were based on user needs and data on uptake. The final intervention was more suitable for a definitive evaluation than the initial version. The description of our approach informs other digital health researchers on how to make interventions more sensitive to user needs. ", doi="10.2196/31567", url="https://humanfactors.jmir.org/2022/1/e31567", url="http://www.ncbi.nlm.nih.gov/pubmed/35029531" } @Article{info:doi/10.2196/31381, author="Decker, J. Martha and Harrison, Salish and Price, Melisa and Gutmann-Gonzalez, Abigail and Yarger, Jennifer and Tenney, Rachel", title="Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study", journal="JMIR Hum Factors", year="2022", month="Jan", day="12", volume="9", number="1", pages="e31381", keywords="adolescent", keywords="sex education", keywords="technology", keywords="mobile app", keywords="implementation", keywords="California", keywords="health educator", abstract="Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths' sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators' experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators' experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87\% of the time in the first year, which decreased to 47\% in the third year as health educators' familiarity with the app increased and functionality improved. Technology issues were also more common in non--school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents' use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 ", doi="10.2196/31381", url="https://humanfactors.jmir.org/2022/1/e31381", url="http://www.ncbi.nlm.nih.gov/pubmed/35019842" } @Article{info:doi/10.2196/31698, author="Kumar, Shefali and Rudie, Emma and Dorsey, Cynthia and Blase, Amy and Benjafield, V. Adam and Sullivan, S. Shannon", title="Assessment of Patient Journey Metrics for Users of a Digital Obstructive Sleep Apnea Program: Single-Arm Feasibility Pilot Study", journal="JMIR Form Res", year="2022", month="Jan", day="12", volume="6", number="1", pages="e31698", keywords="obstructive sleep apnea", keywords="virtual care", keywords="remote care", keywords="OSA diagnosis", keywords="sleep apnea", keywords="OSA", keywords="underdiagnosed", keywords="feasibility", keywords="patient-centered", keywords="treatment pathway", keywords="diagnostic", keywords="eHealth", abstract="Background: Despite the importance of diagnosis and treatment, obstructive sleep apnea (OSA) remains a vastly underdiagnosed condition; this is partially due to current OSA identification methods and a complex and fragmented diagnostic pathway. Objective: This prospective, single-arm, multistate feasibility pilot study aimed to understand the journey in a nonreferred sample of participants through the fully remote OSA screening and diagnostic and treatment pathway, using the Primasun Sleep Apnea Program (formally, Verily Sleep Apnea Program). Methods: Participants were recruited online from North Carolina and Texas to participate in the study entirely virtually. Eligible participants were invited to schedule a video telemedicine appointment with a board-certified sleep physician who could order a home sleep apnea test (HSAT) to be delivered to the participant's home. The results were interpreted by the sleep physician and communicated to the participant during a second video telemedicine appointment. The participants who were diagnosed with OSA during the study and prescribed a positive airway pressure (PAP) device were instructed to download an app that provides educational and support-related content and access to personalized coaching support during the study's 90-day PAP usage period. Surveys were deployed throughout the study to assess baseline characteristics, prior knowledge of sleep apnea, and satisfaction with the program. Results: For the 157 individuals who were ordered an HSAT, it took a mean of 7.4 (SD 2.6) days and median 7.1 days (IQR 2.0) to receive their HSAT after they completed their first televisit appointment. For the 114 individuals who were diagnosed with OSA, it took a mean of 13.9 (SD 9.6) days and median 11.7 days (IQR 10.1) from receiving their HSAT to being diagnosed with OSA during their follow-up televisit appointment. Overall, the mean and median time from the first televisit appointment to receiving an OSA diagnosis was 21.4 (SD 9.6) days and 18.9 days (IQR 9.2), respectively. For those who were prescribed PAP therapy, it took a mean of 8.1 (SD 9.3) days and median 6.0 days (IQR 4.0) from OSA diagnosis to PAP therapy initiation. Conclusions: These results demonstrate the possibility of a highly efficient, patient-centered pathway for OSA workup and treatment. Such findings support pathways that could increase access to care, reduce loss to follow-up, and reduce health burden and overall cost. The program's ability to efficiently diagnose patients who otherwise may have not been diagnosed with OSA is important, especially during a pandemic, as the United States shifted to remote care models and may sustain this direction. The potential economic and clinical impact of the program's short and efficient journey time and low attrition rate should be further examined in future analyses. Future research also should examine how a fast and positive diagnosis experience impacts success rates for PAP therapy initiation and adherence. Trial Registration: ClinicalTrials.gov NCT04599803; https://clinicaltrials.gov/ct2/show/NCT04599803 ", doi="10.2196/31698", url="https://formative.jmir.org/2022/1/e31698", url="http://www.ncbi.nlm.nih.gov/pubmed/34792470" } @Article{info:doi/10.2196/30807, author="Senoo, Keitaro and Miki, Tomonori and Ohkura, Takashi and Iwakoshi, Hibiki and Nishimura, Tetsuro and Shiraishi, Hirokazu and Teramukai, Satoshi and Matoba, Satoaki", title="A Smartphone App to Improve Oral Anticoagulation Adherence in Patients With Atrial Fibrillation: Prospective Observational Study", journal="JMIR Mhealth Uhealth", year="2022", month="Jan", day="7", volume="10", number="1", pages="e30807", keywords="atrial fibrillation", keywords="smartphone app", keywords="anticoagulants", keywords="drug adherence", keywords="education", keywords="patient involvement", abstract="Background: Poor adherence to oral anticoagulation in elderly patients with atrial fibrillation (AF) has been shown to negatively impact health care costs, morbidity, and mortality. Although various methods such as automated reminders, counseling, telephone support, and patient education have been effective in improving medication adherence, the burden on health care providers has been considerable. Recently, an attempt has been made to improve medication adherence without burdening health care providers by using smartphone apps; however, the use of the app for elderly patients with AF is still limited. Objective: The purpose of this study was to determine whether the newly developed smartphone app for patients with AF (the Smart AF), which integrates education, automatic reminder, and patient engagement strategies with a simple user interface, can improve medication adherence in elderly patients with AF. Methods: Patient enrollment was carried out by obtaining informed consent from patients with AF attending Kyoto Prefectural University of Medicine hospital between May 2019 and September 2020. Follow-up was planned at 1, 3, and 6 months after enrollment, and questionnaire reminders were automatically sent to patient apps at designated follow-up time points. A questionnaire-based survey of medication adherence was performed electronically using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8) as the survey tool. Results: A total of 136 patients with AF were enrolled in this study. During the follow-up period, 112 (82\%) patients underwent follow-up at 1 month, 107 (79\%) at 3 months, and 96 (71\%) at 6 months. The mean age of the enrolled patients was 64.3 years (SD 9.6), and male participants accounted for 79.4\% (108/136) of the study population. The mean CHADS2 (congestive heart failure, hypertension, age, diabetes, previous stroke, or transient ischemic attack) score was 1.2, with hypertension being the most common comorbidity. At the time of enrollment, 126 (93\%) and 10 (7\%) patients were taking direct oral anticoagulants and warfarin, respectively. For medication adherence as measured according to the MMAS-8, MMAS scores at 1 month, 3 months, and 6 months were significantly improved compared with baseline MMAS scores (all P values less than .01). The overall improvement in medication adherence achieved by the 6-month intervention was as follows: 77.8\% (14/18) of the patients in the high adherence group (score=8) at baseline remained in the same state, 45.3\% (24/53) of the patients in the medium adherence group (score=6 to <8) at baseline moved to the high adherence group, and 72\% (18/25) of the patients in the low adherence group (score <6) moved to either the medium or high adherence group. Conclusions: The Smart AF app improved medication adherence among elderly patients with AF. In the realm of medication management, an approach using a mobile health technology that emphasizes education, automatic reminder, and patient engagement may be helpful. ", doi="10.2196/30807", url="https://mhealth.jmir.org/2022/1/e30807", url="http://www.ncbi.nlm.nih.gov/pubmed/34894626" } @Article{info:doi/10.2196/29969, author="Wang, Hua and Gupta, Sneha and Singhal, Arvind and Muttreja, Poonam and Singh, Sanghamitra and Sharma, Poorva and Piterova, Alice", title="An Artificial Intelligence Chatbot for Young People's Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study", journal="J Med Internet Res", year="2022", month="Jan", day="3", volume="24", number="1", pages="e29969", keywords="artificial intelligence", keywords="chatbot", keywords="Facebook", keywords="affordance", keywords="sex education", keywords="sexual and reproductive health", keywords="contraception", keywords="case study", keywords="young people", keywords="India", keywords="transmedia", keywords="mobile apps", keywords="mobile health", keywords="technology design", keywords="user engagement", keywords="digital health", keywords="mobile phone", abstract="Background: Leveraging artificial intelligence (AI)--driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources. Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India. Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings. Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience. Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. ", doi="10.2196/29969", url="https://www.jmir.org/2022/1/e29969", url="http://www.ncbi.nlm.nih.gov/pubmed/34982034" } @Article{info:doi/10.2196/22557, author="Ghorbani, Banafsheh and Jackson, C. Alun and Noorchenarboo, Mohammad and Mandegar, H. Mohammad and Sharifi, Farshad and Mirmoghtadaie, Zohrehsadat and Bahramnezhad, Fatemeh", title="Comparing the Effects of Gamification and Teach-Back Training Methods on Adherence to a Therapeutic Regimen in Patients After Coronary Artery Bypass Graft Surgery: Randomized Clinical Trial", journal="J Med Internet Res", year="2021", month="Dec", day="10", volume="23", number="12", pages="e22557", keywords="teach back", keywords="gamification", keywords="treatment regimen", keywords="coronary artery bypass graft", keywords="patient training", abstract="Background: Patients undergoing coronary artery bypass graft surgery (CABGS) may fail to adhere to their treatment regimen for many reasons. Among these, one of the most important reasons for nonadherence is the inadequate training of such patients or training using inappropriate methods. Objective: This study aimed to compare the effect of gamification and teach-back training methods on adherence to a therapeutic regimen in patients after CABGS. Methods: This randomized clinical trial was conducted on 123 patients undergoing CABGS in Tehran, Iran, in 2019. Training was provided to the teach-back group individually. In the gamification group, an app developed for the purpose was installed on each patient's smartphone, with training given via this device. The control group received usual care, or routine training. Adherence to the therapeutic regimen was assessed using a questionnaire on adherence to a therapeutic regimen (physical activity and dietary regimen) and an adherence scale as a pretest and a 1-month posttest. Results: One-way analysis of variance (ANOVA) for comparing the mean scores of teach-back and gamification training methods showed that the mean normalized scores for the dietary regimen (P<.001, F=71.80), movement regimen (P<.001, F=124.53), and medication regimen (P<.001, F=9.66) before and after intervention were significantly different between the teach-back, gamification, and control groups. In addition, the results of the Dunnett test showed that the teach-back and gamification groups were significantly different from the control group in all three treatment regimen methods. There was no statistically significant difference in adherence to the therapeutic regimen between the teach-back and control groups. Conclusions: Based on the results of this study, the use of teach-back and gamification training approaches may be suggested for patients after CABGS to facilitate adherence to the therapeutic regimen. Trial Registration: Iranian Registry of Clinical Trials IRCT20111203008286N8; https://en.irct.ir/trial/41507 ", doi="10.2196/22557", url="https://www.jmir.org/2021/12/e22557", url="http://www.ncbi.nlm.nih.gov/pubmed/34890346" } @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/10.2196/31307, author="Hopkins, M. Christina and Miller, N. Hailey and Brooks, L. Taylor and Mo-Hunter, Lihua and Steinberg, M. Dori and Bennett, G. Gary", title="Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias", journal="JMIR Res Protoc", year="2021", month="Nov", day="25", volume="10", number="11", pages="e31307", keywords="obesity", keywords="stigma", keywords="mHealth", keywords="mindfulness", keywords="self-compassion", keywords="mobile phone", abstract="Background: Weight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. Objective: Ruby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. Methods: Adults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. Results: The protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. Conclusions: Ruby will be the first digital standalone, self-compassion--based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial Registration: ClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID): DERR1-10.2196/31307 ", doi="10.2196/31307", url="https://www.researchprotocols.org/2021/11/e31307", url="http://www.ncbi.nlm.nih.gov/pubmed/34842549" } @Article{info:doi/10.2196/26252, author="Pant, Ichhya and Rimal, Rajiv and Yilma, Hagere and Bingenheimer, Jeffrey and Sedlander, Erica and Behera, Sibabrata", title="mHealth for Anemia Reduction: Protocol for an Entertainment Education--Based Dual Intervention", journal="JMIR Res Protoc", year="2021", month="Nov", day="22", volume="10", number="11", pages="e26252", keywords="mHealth", keywords="interactive", keywords="voice response", keywords="entertainment", keywords="education", keywords="rural", keywords="anemia", keywords="bystander", keywords="violence against women", abstract="Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India's burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education--based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women--related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study's primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms--based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women--related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 ", doi="10.2196/26252", url="https://www.researchprotocols.org/2021/11/e26252", url="http://www.ncbi.nlm.nih.gov/pubmed/34812735" } @Article{info:doi/10.2196/26612, author="Lewkowicz, Daniel and Slosarek, Tamara and Wernicke, Sarah and Winne, Antonia and Wohlbrandt, M. Attila and Bottinger, Erwin", title="Digital Therapeutic Care and Decision Support Interventions for People With Low Back Pain: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2021", month="Nov", day="19", volume="8", number="4", pages="e26612", keywords="digital therapeutic care", keywords="decision support interventions", keywords="low back pain", keywords="behavior change techniques", keywords="back", keywords="orthopedic", keywords="systematic review", keywords="digital therapy", keywords="decision support", keywords="mobile phone", abstract="Background: Low back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change. Objective: This systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates. Methods: We searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates. Results: We retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50\%) were RCTs and 6 (50\%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67\% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials. Conclusions: This systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants' ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs. ", doi="10.2196/26612", url="https://rehab.jmir.org/2021/4/e26612", url="http://www.ncbi.nlm.nih.gov/pubmed/34807837" } @Article{info:doi/10.2196/30191, author="Sarker, Rahman Mohammad Habibur and Moriyama, Michiko and Rashid, Ur Harun and Rahman, Moshiur Md and Chisti, Jobayer Mohammod and Das, Kumar Sumon and Jahan, Yasmin and Saha, Kumar Samir and Arifeen, El Shams and Ahmed, Tahmeed and Faruque, G. A. S.", title="Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="19", volume="10", number="11", pages="e30191", keywords="chronic kidney disease", keywords="campaign", keywords="mHealth", keywords="knowledge", keywords="Bangladesh", abstract="Background: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients' increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients' mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71\%) females in the control group and 38 out of 63 (60\%) females in the intervention group. In addition, there were 38 out of 63 (60\%) literate patients in the control group and 33 out of 63 (52\%) literate patients in the intervention group. Conclusions: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID): DERR1-10.2196/30191 ", doi="10.2196/30191", url="https://www.researchprotocols.org/2021/11/e30191", url="http://www.ncbi.nlm.nih.gov/pubmed/34806998" } @Article{info:doi/10.2196/29447, author="Chavez-Yenter, Daniel and Kimball, E. Kadyn and Kohlmann, Wendy and Lorenz Chambers, Rachelle and Bradshaw, L. Richard and Espinel, F. Whitney and Flynn, Michael and Gammon, Amanda and Goldberg, Eric and Hagerty, J. Kelsi and Hess, Rachel and Kessler, Cecilia and Monahan, Rachel and Temares, Danielle and Tobik, Katie and Mann, M. Devin and Kawamoto, Kensaku and Del Fiol, Guilherme and Buys, S. Saundra and Ginsburg, Ophira and Kaphingst, A. Kimberly", title="Patient Interactions With an Automated Conversational Agent Delivering Pretest Genetics Education: Descriptive Study", journal="J Med Internet Res", year="2021", month="Nov", day="18", volume="23", number="11", pages="e29447", keywords="cancer", keywords="genetic testing", keywords="virtual conversational agent", keywords="user interaction", keywords="smartphone", keywords="mobile phone", abstract="Background: Cancer genetic testing to assess an individual's cancer risk and to enable genomics-informed cancer treatment has grown exponentially in the past decade. Because of this continued growth and a shortage of health care workers, there is a need for automated strategies that provide high-quality genetics services to patients to reduce the clinical demand for genetics providers. Conversational agents have shown promise in managing mental health, pain, and other chronic conditions and are increasingly being used in cancer genetic services. However, research on how patients interact with these agents to satisfy their information needs is limited. Objective: Our primary aim is to assess user interactions with a conversational agent for pretest genetics education. Methods: We conducted a feasibility study of user interactions with a conversational agent who delivers pretest genetics education to primary care patients without cancer who are eligible for cancer genetic evaluation. The conversational agent provided scripted content similar to that delivered in a pretest genetic counseling visit for cancer genetic testing. Outside of a core set of information delivered to all patients, users were able to navigate within the chat to request additional content in their areas of interest. An artificial intelligence--based preprogrammed library was also established to allow users to ask open-ended questions to the conversational agent. Transcripts of the interactions were recorded. Here, we describe the information selected, time spent to complete the chat, and use of the open-ended question feature. Descriptive statistics were used for quantitative measures, and thematic analyses were used for qualitative responses. Results: We invited 103 patients to participate, of which 88.3\% (91/103) were offered access to the conversational agent, 39\% (36/91) started the chat, and 32\% (30/91) completed the chat. Most users who completed the chat indicated that they wanted to continue with genetic testing (21/30, 70\%), few were unsure (9/30, 30\%), and no patient declined to move forward with testing. Those who decided to test spent an average of 10 (SD 2.57) minutes on the chat, selected an average of 1.87 (SD 1.2) additional pieces of information, and generally did not ask open-ended questions. Those who were unsure spent 4 more minutes on average (mean 14.1, SD 7.41; P=.03) on the chat, selected an average of 3.67 (SD 2.9) additional pieces of information, and asked at least one open-ended question. Conclusions: The pretest chat provided enough information for most patients to decide on cancer genetic testing, as indicated by the small number of open-ended questions. A subset of participants were still unsure about receiving genetic testing and may require additional education or interpersonal support before making a testing decision. Conversational agents have the potential to become a scalable alternative for pretest genetics education, reducing the clinical demand on genetics providers. ", doi="10.2196/29447", url="https://www.jmir.org/2021/11/e29447", url="http://www.ncbi.nlm.nih.gov/pubmed/34792472" } @Article{info:doi/10.2196/27995, author="Mu{\~n}oz-Mancisidor, Aranzazu and Martin-Payo, Ruben and Gonzalez-Mendez, Xana and Fern{\'a}ndez-{\'A}lvarez, Mar Mar{\'i}a Del", title="Content, Behavior Change Techniques, and Quality of Pregnancy Apps in Spain: Systematic Search on App Stores", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="17", volume="9", number="11", pages="e27995", keywords="pregnancy", keywords="mobile apps", keywords="behavior", keywords="technology assessment, biomedical", keywords="telemedicine", abstract="Background: Women consult information in mobile apps (apps) during pregnancy, and even obstetrics specialists highlight that pregnancy is the ideal moment for the use of apps as consultation sources. However, the high number of apps designed for pregnancy requires a careful assessment to determine their suitability before recommendation. Objective: The aim of this study is to identify the apps available in Spanish that can be recommended based on their content, behavior change techniques (BCTs), and quality as a complementary tool during pregnancy. Methods: A systematic search on app stores to identify apps was performed in the Apple App Store and Google Play with the subject term ``pregnancy.'' The apps meeting the following criteria were chosen: pregnancy-related content, free, and available in Spanish. An app was excluded if it was classified as a game or entertainment and thus lacking an educational or health aim and if it did not target the population under study. The selected apps were downloaded, and their quality was assessed using the Mobile Application Rating Scale (MARS), with the BCTs included evaluated using the BCT taxonomy version 1 and its content. Results: A total of 457 apps were identified, 25 of which were downloaded for assessment (5.6\%). The median for objective and subjective quality was 2.94 (IQR 2.71-3.46) and 1.75 (IQR 1.25-2.25), respectively. Regarding content, the median of topics included in the apps was 23 (IQR 16-23), with weight gain, nutrition, fetal development, and physical activity being the most common. The median number of BCTs was 12 (IQR 0.5-3.5). The most frequently identified BCTs in the apps were ``Self-Monitoring of Outcomes,'' followed by ``Goal Behavior'' and ``Instructions.'' Statistically significant correlations were observed between objective quality and content ($\rho$=0.624; P=.001), subjective quality and content ($\rho$=0.638; P=.001), objective quality and BCTs ($\rho$=0.672; P<.001), subjective quality and BCTs ($\rho$=0.623; P<.001), and BCTs and content ($\rho$=0.580; P=.002). Conclusions: The results of this study suggest that only a small percentage of free pregnancy apps available in Spanish should be recommended. The apps with the best MARS scores were those that addressed a higher number of topics and included a higher number of BCTs. Those with the best content and quality, and a higher number of BCTs included could be recommended by health professionals. ", doi="10.2196/27995", url="https://mhealth.jmir.org/2021/11/e27995", url="http://www.ncbi.nlm.nih.gov/pubmed/34787587" } @Article{info:doi/10.2196/28024, author="Cyriac, Jissy and Jenkins, Sarah and Patten, A. Christi and Hayes, N. Sharonne and Jones, Clarence and Cooper, A. Lisa and Brewer, C. LaPrincess", title="Improvements in Diet and Physical Activity--Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="12", volume="9", number="11", pages="e28024", keywords="African Americans", keywords="cardiovascular health disparities", keywords="mHealth lifestyle intervention", keywords="diet", keywords="physical activity", keywords="mobile phone", abstract="Background: African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective: This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods: This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73\% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory--informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results: Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=?0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions: Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans. ", doi="10.2196/28024", url="https://mhealth.jmir.org/2021/11/e28024", url="http://www.ncbi.nlm.nih.gov/pubmed/34766917" } @Article{info:doi/10.2196/23874, author="Chukwu, Emeka and Gilroy, Sonia and Addaquay, Kojo and Jones, Nafisa Nki and Karimu, Gbadia Victor and Garg, Lalit and Dickson, Eva Kim", title="Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey", journal="JMIR Form Res", year="2021", month="Nov", day="12", volume="5", number="11", pages="e23874", keywords="young people", keywords="short message service", keywords="SMS", keywords="chatbot", keywords="text message", keywords="interactive voice response", keywords="IVR", keywords="WhatsApp", keywords="Facebook", keywords="family planning", keywords="contraceptives", keywords="Sierra Leone", abstract="Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media--only internet bundle, with the cost ranging from 1000 leones (US \$0.11) to 1500 leones (US \$0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US \$0.11) and 5000 leones (US \$0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. ", doi="10.2196/23874", url="https://formative.jmir.org/2021/11/e23874", url="http://www.ncbi.nlm.nih.gov/pubmed/34766908" } @Article{info:doi/10.2196/27897, author="Li, Yiran and Guo, Yan and Hong, Alicia Y. and Zeng, Chengbo and Zeng, Yu and Zhang, Hanxi and Zhu, Mengting and Qiao, Jiaying and Cai, Weiping and Li, Linghua and Liu, Cong", title="Mediating Effects of Stigma and Depressive Symptoms in a Social Media--Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Nov", day="9", volume="23", number="11", pages="e27897", keywords="mHealth", keywords="HIV", keywords="depressive symptoms", keywords="quality of life", keywords="structural equation model", abstract="Background: Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective: This study aims to explore the intervention mechanisms of a social media--based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods: We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL. Results: About 91.3\% (274/300), 88.3\% (265/300), and 86.7\% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions: These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media--based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 ", doi="10.2196/27897", url="https://www.jmir.org/2021/11/e27897", url="http://www.ncbi.nlm.nih.gov/pubmed/34751654" } @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/10.2196/25453, author="Jain, Deeptee and Norman, Kevin and Werner, Zachary and Makovoz, Bar and Baker, Turner and Huber, Stephan", title="Using Postmarket Surveillance to Assess Safety-Related Events in a Digital Rehabilitation App (Kaia App): Observational Study", journal="JMIR Hum Factors", year="2021", month="Nov", day="9", volume="8", number="4", pages="e25453", keywords="lower back pain", keywords="digital therapeutics", keywords="adverse event", keywords="pain", keywords="safety", keywords="digital health", keywords="multidisciplinary pain treatment", abstract="Background: Low back pain (LBP) affects nearly 4 out of 5 individuals during their lifetime and is the leading cause of disability globally. Digital therapeutics are emerging as effective treatment options for individuals experiencing LBP. Despite the growth of evidence demonstrating the benefits of these therapeutics in reducing LBP and improving functional outcomes, little data has been systematically collected on their safety profiles. Objective: This study aims to evaluate the safety profile of a multidisciplinary digital therapeutic for LBP, the Kaia App, by performing a comprehensive assessment of reported adverse events (AEs) by users as captured by a standardized process for postmarket surveillance. Methods: All users of a multidisciplinary digital app that includes physiotherapy, mindfulness techniques, and education for LBP (Kaia App) from 2018 to 2019 were included. Relevant messages sent by users via the app were collected according to a standard operating procedure regulating postmarket surveillance of the device. These messages were then analyzed to determine if they described an adverse event (AE). Messages describing an AE were then categorized based on the type of AE, its seriousness, and its relatedness to the app, and they were described by numerical counts. User demographics, including age and gender, and data on app use were collected and evaluated to determine if they were risk factors for increased AE reporting. Results: Of the 138,337 active users of the Kaia App, 125 (0.09\%) reported at least one AE. Users reported 0.00014 AEs per active day on the app. The most common nonserious AE reported was increased pain. Other nonserious AEs reported included muscle issues, unpleasant sensations, headache, dizziness, and sleep disturbances. One serious AE, a surgery, was reported. Details of the event and its connection to the intervention were not obtainable, as the user did not provide more information when asked to do so; therefore, it was considered to be possibly related to the intervention. There was no relationship between gender and AE reporting (P>.99). Users aged 25 to 34 years had reduced odds (odds ratio [OR] 0.31, 95\% CI 0.08-0.95; P=.03) of reporting AEs, while users aged 55 to 65 years (OR 2.53, 95\% CI 1.36-4.84, P=.002) and ?75 years (OR 4.36, 95\% CI 1.07-13.26; P=.02) had increased odds. AEs were most frequently reported by users who had 0 to 99 active days on the app, and less frequently reported by users with more active days on the app. Conclusions: This study on the Kaia App provides the first comprehensive assessment of reported AEs associated with real-world use of digital therapeutics for lower back pain. The overall rate of reported AEs was very low, but significant reporting bias is likely to be present. The AEs reported were generally consistent with those described for in-person therapies for LBP. ", doi="10.2196/25453", url="https://humanfactors.jmir.org/2021/4/e25453", url="http://www.ncbi.nlm.nih.gov/pubmed/34751664" } @Article{info:doi/10.2196/29386, author="Woodcock, Claire and Mittelstadt, Brent and Busbridge, Dan and Blank, Grant", title="The Impact of Explanations on Layperson Trust in Artificial Intelligence--Driven Symptom Checker Apps: Experimental Study", journal="J Med Internet Res", year="2021", month="Nov", day="3", volume="23", number="11", pages="e29386", keywords="symptom checker", keywords="chatbot", keywords="artificial intelligence", keywords="explanations", keywords="trust", keywords="knowledge", keywords="clinical communication", keywords="mHealth", keywords="digital health", keywords="eHealth", keywords="conversational agent", keywords="virtual health care", keywords="symptoms", keywords="diagnostics", keywords="mobile phone", abstract="Background: Artificial intelligence (AI)--driven symptom checkers are available to millions of users globally and are advocated as a tool to deliver health care more efficiently. To achieve the promoted benefits of a symptom checker, laypeople must trust and subsequently follow its instructions. In AI, explanations are seen as a tool to communicate the rationale behind black-box decisions to encourage trust and adoption. However, the effectiveness of the types of explanations used in AI-driven symptom checkers has not yet been studied. Explanations can follow many forms, including why-explanations and how-explanations. Social theories suggest that why-explanations are better at communicating knowledge and cultivating trust among laypeople. Objective: The aim of this study is to ascertain whether explanations provided by a symptom checker affect explanatory trust among laypeople and whether this trust is impacted by their existing knowledge of disease. Methods: A cross-sectional survey of 750 healthy participants was conducted. The participants were shown a video of a chatbot simulation that resulted in the diagnosis of either a migraine or temporal arteritis, chosen for their differing levels of epidemiological prevalence. These diagnoses were accompanied by one of four types of explanations. Each explanation type was selected either because of its current use in symptom checkers or because it was informed by theories of contrastive explanation. Exploratory factor analysis of participants' responses followed by comparison-of-means tests were used to evaluate group differences in trust. Results: Depending on the treatment group, two or three variables were generated, reflecting the prior knowledge and subsequent mental model that the participants held. When varying explanation type by disease, migraine was found to be nonsignificant (P=.65) and temporal arteritis, marginally significant (P=.09). Varying disease by explanation type resulted in statistical significance for input influence (P=.001), social proof (P=.049), and no explanation (P=.006), with counterfactual explanation (P=.053). The results suggest that trust in explanations is significantly affected by the disease being explained. When laypeople have existing knowledge of a disease, explanations have little impact on trust. Where the need for information is greater, different explanation types engender significantly different levels of trust. These results indicate that to be successful, symptom checkers need to tailor explanations to each user's specific question and discount the diseases that they may also be aware of. Conclusions: System builders developing explanations for symptom-checking apps should consider the recipient's knowledge of a disease and tailor explanations to each user's specific need. Effort should be placed on generating explanations that are personalized to each user of a symptom checker to fully discount the diseases that they may be aware of and to close their information gap. ", doi="10.2196/29386", url="https://www.jmir.org/2021/11/e29386", url="http://www.ncbi.nlm.nih.gov/pubmed/34730544" } @Article{info:doi/10.2196/32921, author="Xiao, Jin and Luo, Jiebo and Ly-Mapes, Oriana and Wu, Tong Tong and Dye, Timothy and Al Jallad, Nisreen and Hao, Peirong and Ruan, Jinlong and Bullock, Sherita and Fiscella, Kevin", title="Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study", journal="JMIR Res Protoc", year="2021", month="Oct", day="22", volume="10", number="10", pages="e32921", keywords="artificial intelligence", keywords="smartphone app", keywords="mDentistry", keywords="dental caries", keywords="underserved population", keywords="mobile dentistry", abstract="Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55\% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85\% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence--powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence--powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 ", doi="10.2196/32921", url="https://www.researchprotocols.org/2021/10/e32921", url="http://www.ncbi.nlm.nih.gov/pubmed/34529582" } @Article{info:doi/10.2196/25667, author="Frid, Gabriela and Bogaert, Kelly and Chen, T. Katherine", title="Mobile Health Apps for Pregnant Women: Systematic Search, Evaluation, and Analysis of Features", journal="J Med Internet Res", year="2021", month="Oct", day="18", volume="23", number="10", pages="e25667", keywords="app", keywords="app store", keywords="mHealth", keywords="mobile health", keywords="prenatal", keywords="pregnancy", keywords="women's health", abstract="Background: Many pregnant women use the internet to obtain information about pregnancy and childbirth. Over 50\% of pregnant women use pregnancy apps and must search through thousands of pregnancy or women's health--related apps available on app stores. The COVID-19 pandemic is changing how women receive prenatal care. Mobile health apps may help maintain women's satisfaction with their prenatal care. Objective: Our objective is to identify pregnancy mobile apps and to evaluate the apps using a modified APPLICATIONS (app comprehensiveness, price, privacy, literature used, in-app purchases, connectivity, advertisements, text search field, images/videos, other special features, navigation ease, subjective presentation) scoring system. Methods: A list of pregnancy apps was identified in the first 20 Google search results using the search term ``pregnancy app.'' After excluding irrelevant, inaccurate, malfunctioning, or no longer available apps, all unique apps were downloaded and evaluated with the modified APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features. Results: A list of 57 unique pregnancy apps was generated. After 28 apps were excluded, the remaining 29 apps were evaluated, with a mean score of 9.4 points out of a maximum of 16. The highest scoring app scored 15 points. Over 60\% (18/29) of apps did not have comprehensive information for every stage of pregnancy or did not contain all four desired components of pregnancy apps: health promotion/patient education, communication, health tracking, and notifications and reminders. Only 24\% (7/29) of apps included a text search field, and only 28\% (8/29) of apps cited literature. Conclusions: Our search yielded many high-scoring apps, but few contained all desired components and features. This list of identified and rated apps can lessen the burden on pregnant women and providers to find available apps on their own. Although health care providers should continue to vet apps before recommending them to patients, these findings also highlight that a Google search is a successful way for patients and providers to find useful and comprehensive pregnancy apps. ", doi="10.2196/25667", url="https://www.jmir.org/2021/10/e25667", url="http://www.ncbi.nlm.nih.gov/pubmed/34524100" } @Article{info:doi/10.2196/29739, author="Shetty, B. Vinutha and Soon, K. Wayne H. and Roberts, G. Alison and Fried, Leanne and Roby, C. Heather and Smith, J. Grant and Fournier, A. Paul and Jones, W. Timothy and Davis, A. Elizabeth", title="A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study", journal="JMIR Diabetes", year="2021", month="Oct", day="14", volume="6", number="4", pages="e29739", keywords="mobile health app", keywords="exercise", keywords="acT1ve", keywords="type 1 diabetes", keywords="young people", keywords="blood glucose level", abstract="Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1\%, SD 0.5\%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were ``increased knowledge,'' ``increased confidence to exercise,'' and ``suitability'' for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 ", doi="10.2196/29739", url="https://diabetes.jmir.org/2021/4/e29739", url="http://www.ncbi.nlm.nih.gov/pubmed/34647896" } @Article{info:doi/10.2196/28136, 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/10.2196/26732, author="Kovoor, G. Joshua and McIntyre, Daniel and Chik, B. William W. and Chow, K. Clara and Thiagalingam, Aravinda", title="Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study", journal="J Med Internet Res", year="2021", month="Oct", day="11", volume="23", number="10", pages="e26732", keywords="Shared decision-making", keywords="chronic disease", keywords="outpatients", keywords="audiovisual aids", keywords="atrial fibrillation", keywords="educational technology", keywords="teaching materials", keywords="referral and consultation", keywords="physician-patient relations", keywords="physicians", abstract="Background: The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner. Objective: The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation. Methods: We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module's utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient's value for clinician narration and the module's utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales. Results: This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were ``very satisfied'' with the educational video content across the 4 videos ranged from 93\% (86/92) to 96.3\% (104/108) and this was between 98\% (90/92) and 99.1\% (107/108) for ``satisfied'' or ``very satisfied.'' There were no reports of dissatisfaction for the first 3 videos, and only 1\% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician's narration adding benefit to the patient experience. Conclusions: Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input. ", doi="10.2196/26732", url="https://www.jmir.org/2021/10/e26732", url="http://www.ncbi.nlm.nih.gov/pubmed/34633292" } @Article{info:doi/10.2196/22653, author="Maliwichi, Priscilla and Chigona, Wallace and Sowon, Karen", title="Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="6", volume="9", number="10", pages="e22653", keywords="mHealth", keywords="appropriation", keywords="mobile phones", keywords="model of technology appropriation", keywords="maternal health", keywords="community of purpose", keywords="hermeneutic literature review", abstract="Background: Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care--seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective: This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods: This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results: This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions: The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions. ", doi="10.2196/22653", url="https://mhealth.jmir.org/2021/10/e22653", url="http://www.ncbi.nlm.nih.gov/pubmed/34612835" } @Article{info:doi/10.2196/25630, author="Wu, Dan and An, Jiye and Yu, Ping and Lin, Hui and Ma, Li and Duan, Huilong and Deng, Ning", title="Patterns for Patient Engagement with the Hypertension Management and Effects of Electronic Health Care Provider Follow-up on These Patterns: Cluster Analysis", journal="J Med Internet Res", year="2021", month="Sep", day="28", volume="23", number="9", pages="e25630", keywords="hypertension", keywords="health care services", keywords="mHealth", keywords="patient engagement", keywords="electronic follow-up", keywords="cluster analysis", abstract="Background: Hypertension is a long-term medical condition. Electronic and mobile health care services can help patients to self-manage this condition. However, not all management is effective, possibly due to different levels of patient engagement (PE) with health care services. Health care provider follow-up is an intervention to promote PE and blood pressure (BP) control. Objective: This study aimed to discover and characterize patterns of PE with a hypertension self-management app, investigate the effects of health care provider follow-up on PE, and identify the follow-up effects on BP in each PE pattern. Methods: PE was represented as the number of days that a patient recorded self-measured BP per week. The study period was the first 4 weeks for a patient to engage in the hypertension management service. K-means algorithm was used to group patients by PE. There was compliance follow-up, regular follow-up, and abnormal follow-up in management. The follow-up effect was calculated by the change in PE (CPE) and the change in systolic blood pressure (CSBP, SBP) before and after each follow-up. Chi-square tests and z scores were used to ascertain the distribution of gender, age, education level, SBP, and the number of follow-ups in each cluster. The follow-up effect was identified by analysis of variances. Once a significant effect was detected, Bonferroni multiple comparisons were further conducted to identify the difference between 2 clusters. Results: Patients were grouped into 4 clusters according to PE: (1) PE started low and dropped even lower (PELL), (2) PE started high and remained high (PEHH), (3) PE started high and dropped to low (PEHL), and (4) PE started low and rose to high (PELH). Significantly more patients over 60 years old were found in the PEHH cluster (P?.05). Abnormal follow-up was significantly less frequent (P?.05) in the PELL cluster. Compliance follow-up and regular follow-up can improve PE. In the clusters of PEHH and PELH, the improvement in PE in the first 3 weeks and the decrease in SBP in all 4 weeks were significant after follow-up. The SBP of the clusters of PELL and PELH decreased more (--6.1 mmHg and --8.4 mmHg) after follow-up in the first week. Conclusions: Four distinct PE patterns were identified for patients engaging in the hypertension self-management app. Patients aged over 60 years had higher PE in terms of recording self-measured BP using the app. Once SBP reduced, patients with low PE tended to stop using the app, and a continued decline in PE occurred simultaneously with the increase in SBP. The duration and depth of the effect of health care provider follow-up were more significant in patients with high or increased engagement after follow-up. ", doi="10.2196/25630", url="https://www.jmir.org/2021/9/e25630", url="http://www.ncbi.nlm.nih.gov/pubmed/34581680" } @Article{info:doi/10.2196/20520, author="Chew, Elaine Chu Shan and Davis, Courtney and Lim, Ethel Jie Kai and Lim, Micheal Chee Meng and Tan, Henny Yi Zhen and Oh, Yin Jean and Rajasegaran, Kumudhini and Chia, Michael Yong Hwa and Finkelstein, Andrew Eric", title="Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study", journal="J Med Internet Res", year="2021", month="Sep", day="28", volume="23", number="9", pages="e20520", keywords="pediatric obesity", keywords="mobile health", keywords="apps", keywords="health behavior", keywords="mHealth", keywords="obesity", keywords="adolescent", keywords="lifestyle", keywords="well-being", keywords="mobile phone", abstract="Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app--based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo's health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55\%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83\% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83\% (33/40) of participants completing at least 7 coaching sessions. In total, 78\% (18/23) of participants rated the app as good to excellent and 70\% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. ", doi="10.2196/20520", url="https://www.jmir.org/2021/9/e20520", url="http://www.ncbi.nlm.nih.gov/pubmed/34581672" } @Article{info:doi/10.2196/26545, author="Weinstein, S. Ronald and Holcomb, J. Michael and Mo, Julia and Yonsetto, Peter and Bojorquez, Octavio and Grant, Marcia and Wendel, S. Christopher and Tallman, J. Nancy and Ercolano, Elizabeth and Cidav, Zuleyha and Hornbrook, C. Mark and Sun, Virginia and McCorkle, Ruth and Krouse, S. Robert", title="An Ostomy Self-management Telehealth Intervention for Cancer Survivors: Technology-Related Findings From a Randomized Controlled Trial", journal="J Med Internet Res", year="2021", month="Sep", day="27", volume="23", number="9", pages="e26545", keywords="telehealth", keywords="telemedicine", keywords="cloud computing", keywords="ostomy", keywords="cancer survivors", keywords="family caregivers", keywords="self-management", keywords="patient education", keywords="videoconferencing", keywords="mobile phone", abstract="Background: An Ostomy Self-management Telehealth (OSMT) intervention by nurse educators and peer ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology--related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud-based videoconferencing service, Zoom for Healthcare. Objective: This paper examines technology-related challenges, issues, and opportunities encountered in the use of telehealth in a randomized controlled trial intervention for cancer survivors living with a permanent ostomy. Methods: The Arizona Telemedicine Program provided telehealth engineering support for 105 OSMT sessions, scheduled for 90 to 120 minutes each, over a 2-year period. The OSMT groups included up to 15 participants, comprising 4-6 ostomates, 4-6 peer ostomates, 2 nurse educators, and 1 telehealth engineer. OSMT-session TTR incidents were recorded contemporaneously in detailed notes by the research staff. TTR incidents were categorized and tallied. Results: A total of 97.1\% (102/105) OSMT sessions were completed as scheduled. In total, 3 OSMT sessions were not held owing to non--technology-related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86\%) completed their OSMT curriculum. TTR incidents occurred in 36.3\% (37/102) of the completed sessions with varying disruptive impacts. No sessions were canceled or rescheduled because of TTR incidents. Disruptions from TTR incidents were minimized by following the TTR incident prevention and incident response plans. Conclusions: Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. Potentially, OSMT greatly expands the availability of ostomy self-management education for new ostomates. Trial Registration: ClinicalTrials.gov NCT02974634; https://clinicaltrials.gov/ct2/show/NCT02974634 ", doi="10.2196/26545", url="https://www.jmir.org/2021/9/e26545", url="http://www.ncbi.nlm.nih.gov/pubmed/34086595" } @Article{info:doi/10.2196/29928, author="Bae, Jang-Whan and Woo, Seoung-Il and Lee, Joongyub and Park, Sang-Don and Kwon, Woo Sung and Choi, Huan Seong and Yoon, Gwang-Seok and Kim, Mi-Sook and Hwang, Seung-Sik and Lee, Kyung Won", title="mHealth Interventions for Lifestyle and Risk Factor Modification in Coronary Heart Disease: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Sep", day="24", volume="9", number="9", pages="e29928", keywords="coronary heart disease", keywords="prevention", keywords="lifestyle modification", keywords="mobile health", keywords="text message", keywords="mHealth", abstract="Background: Self-management of lifestyle and cardiovascular disease risk factors is challenging in older patients with coronary heart disease (CHD). SMS text messaging could be a potential support tool for self-management and the most affordable and accessible method through a mobile phone. High-quality evidence had been lacking, and previous studies evaluated the effects of SMS text messaging on the subjective measures of short-term outcomes. Recently, a large-sized randomized controlled trial in Australia reported promising findings on the objective measures upon 6-month follow-up. However, an examination of the effectiveness of such interventions in an Asian population with unique demographic characteristics would be worthwhile. Objective: This study examined the effectiveness of a 1-way SMS text messaging program to modify the lifestyle and cardiovascular disease risk factors of patients who underwent the first percutaneous coronary intervention (PCI). Methods: A parallel, single-blinded, 1:1 random allocation clinical trial was conducted with 879 patients treated through PCI. They were recruited during hospital admission from April 2017 to May 2020 at 2 university hospitals in the Republic of Korea. In addition to standard care, the intervention group received access to a supporting website and 4 SMS text messages per week for 6 months regarding a healthy diet, physical activity, smoking cessation, and cardiovascular health. Random allocation upon study enrollment and SMS text messaging after hospital discharge were performed automatically using a computer program. The coprimary outcomes were low-density-lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), and BMI. The secondary outcomes were change in lifestyle and adherence to the recommended health behaviors. Results: Of the eligible population, 440 and 439 patients who underwent PCI were assigned to the intervention and control groups, respectively. The 1-way SMS text messaging program significantly enhanced physical activity (P=.02), healthy diet (P<.01), and medication adherence (P<.04) among patients with CHD. Hence, more people were likely to control their cardiovascular disease risk factors per the recommendations. The intervention group was more likely to control all 5 risk factors by 62\% (relative risk 1.62, 95\% CI 1.05-2.50) per the recommendations. On the other hand, physiological measures of the primary outcomes, including LDL-C levels, SBP, and BMI, were not significant. Most participants found the SMS text messaging program useful and helpful in motivating lifestyle changes. Conclusions: Lifestyle-focused SMS text messages were effective in the self-management of a healthy diet, exercise, and medication adherence, but their influence on the physiological measures was not significant. One-way SMS text messages can be used as an affordable adjuvant method for lifestyle modification to help prevent the recurrence of cardiovascular disease. Trial Registration: Clinical Research Information Service (CRiS) KCT0005087; https://cris.nih.go.kr/cris/search/detailSearch.do/19282 ", doi="10.2196/29928", url="https://mhealth.jmir.org/2021/9/e29928", url="http://www.ncbi.nlm.nih.gov/pubmed/34559058" } @Article{info:doi/10.2196/25558, 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/10.2196/21088, author="Keum, Jiyoung and Chung, Jae Moon and Kim, Youngin and Ko, Hyunyoung and Sung, Je Min and Jo, Hyun Jung and Park, Youp Jeong and Bang, Seungmin and Park, Woo Seung and Song, Young Si and Lee, Seung Hee", title="Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="31", volume="9", number="8", pages="e21088", keywords="pancreatic ductal adenocarcinoma", keywords="mobile app", keywords="nutritional support", keywords="quality of life", keywords="chemotherapy", abstract="Background: Approximately 80\% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective: We aimed to evaluate the efficacy of a mobile app--based program, Noom, in patients receiving chemotherapy for PDAC. Methods: We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results: Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08{\textpm}12.27 cm2/m2 to 46.08{\textpm}10.55 cm2/m2; non-Noom users, 50.60{\textpm}9.05 cm2/m2 to 42.97{\textpm}8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96\% vs. -3.27\%; P=.11). Conclusions: This pilot study demonstrates that a mobile app--based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration: ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495. ", doi="10.2196/21088", url="https://mhealth.jmir.org/2021/8/e21088", url="http://www.ncbi.nlm.nih.gov/pubmed/34463630" } @Article{info:doi/10.2196/28104, author="Timmers, Thomas and Keijsers, Manouk and Kremer, M. Jan A. and Janssen, Loes and Smeenk, Jesper", title="Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="27", volume="9", number="8", pages="e28104", keywords="patient education", keywords="fertilization in vitro", keywords="mobile health", keywords="health literacy", keywords="gynecology", abstract="Background: Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. Objective: This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients' level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. Methods: This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. Results: In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. Conclusions: Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app's usage statistics demonstrate patients' informational needs and their willingness to use an electronic health application as part of their treatment. Trial Registration: Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959 ", doi="10.2196/28104", url="https://mhealth.jmir.org/2021/8/e28104", url="http://www.ncbi.nlm.nih.gov/pubmed/34448725" } @Article{info:doi/10.2196/27455, author="Baek, Younghwa and Jeong, Kyoungsik and Lee, Siwoo and Kim, Hoseok and Seo, Bok-Nam and Jin, Hee-Jeong", title="Feasibility and Effectiveness of Assessing Subhealth Using a Mobile Health Management App (MibyeongBogam) in Early Middle-Aged Koreans: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="19", volume="9", number="8", pages="e27455", keywords="mobile health", keywords="health status", keywords="mobile app", keywords="middle-aged group", keywords="subhealth", keywords="Korean medicine", abstract="Background: Mobile health (mHealth) is a major source of health management systems. Moreover, the demand for mHealth, which is in need of change due to the COVID-19 pandemic, is increasing worldwide. Accordingly, interest in health care in everyday life and the importance of mHealth are growing. Objective: We developed the MibyeongBogam (MBBG) app that evaluates the user's subhealth status via a smartphone and provides a health management method based on that user's subhealth status for use in everyday life. Subhealth is defined as a state in which the capacity to recover to a healthy state is diminished, but without the presence of clinical disease. The objective of this study was to compare the awareness and status of subhealth after the use of the MBBG app between intervention and control groups, and to evaluate the app's practicality. Methods: This study was a prospective, open-label, parallel group, randomized controlled trial. The study was conducted at two hospitals in Korea with 150 healthy people in their 30s and 40s, at a 1:1 allocation ratio. Participants visited the hospital three times as follows: preintervention, intermediate visit 6 weeks after the intervention, and final visit 12 weeks after the intervention. Key endpoints were measured at the first visit before the intervention and at 12 weeks after the intervention. The primary outcome was the awareness of subhealth, and the secondary outcomes were subhealth status, health-promoting behaviors, and motivation to engage in healthy behaviors. Results: The primary outcome, subhealth awareness, tended to slightly increase for both groups after the uncompensated intervention, but there was no significant difference in the score between the two groups (intervention group: mean 23.69, SD 0.25 vs control group: mean 23.1, SD 0.25; P=.09). In the case of secondary outcomes, only some variables of the subhealth status showed significant differences between the two groups after the intervention, and the intervention group showed an improvement in the total scores of subhealth (P=.03), sleep disturbance (P=.02), depression (P=.003), anger (P=.01), and anxiety symptoms (P=.009) compared with the control group. Conclusions: In this study, the MBBG app showed potential for improving the health, especially with regard to sleep disturbance and depression, of individuals without particular health problems. However, the effects of the app on subhealth awareness and health-promoting behaviors were not clearly evaluated. Therefore, further studies to assess improvements in health after the use of personalized health management programs provided by the MBBG app are needed. The MBBG app may be useful for members of the general public, who are not diagnosed with a disease but are unable to lead an optimal daily life due to discomfort, to seek strategies that can improve their health. Trial Registration: Clinical Research Information Service KCT0003488; https://cris.nih.go.kr/cris/search/search\_result\_st01.jsp?seq=14379 ", doi="10.2196/27455", url="https://mhealth.jmir.org/2021/8/e27455/", url="http://www.ncbi.nlm.nih.gov/pubmed/34420922" } @Article{info:doi/10.2196/26703, author="van der Zander, W. Quirine E. and Reumkens, Ankie and van de Valk, Bas and Winkens, Bjorn and Masclee, M. Ad A. and de Ridder, J. Rogier J.", title="Effects of a Personalized Smartphone App on Bowel Preparation Quality: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="19", volume="9", number="8", pages="e26703", keywords="colonoscopy", keywords="laxatives", keywords="bowel preparation", keywords="smartphone application", keywords="smartphone", keywords="patient satisfaction", keywords="randomized controlled trial", keywords="mobile phone", keywords="mHealth", abstract="Background: Adequate bowel preparation is essential for the visualization of the colonic mucosa during colonoscopy. However, the rate of inadequate bowel preparation is still high, ranging from 18\% to 35\%; this may lead to a higher risk of missing clinically relevant lesions, procedural difficulties, prolonged procedural time, an increased number of interval colorectal carcinomas, and additional health care costs. Objective: The aims of this study are to compare bowel preparation instructions provided via a personalized smartphone app (Prepit, Ferring B V) with regular written instructions for bowel preparation to improve bowel preparation quality and to evaluate patient satisfaction with the bowel preparation procedure. Methods: Eligible patients scheduled for an outpatient colonoscopy were randomized to a smartphone app group or a control group. Both the groups received identical face-to-face education from a research physician, including instructions about the colonoscopy procedure, diet restrictions, and laxative intake. In addition, the control group received written information, whereas the smartphone app group was instructed to use the smartphone app instead of the written information for the actual steps of the bowel preparation schedule. All patients used bisacodyl and sodium picosulfate with magnesium citrate as laxatives. The quality of bowel preparation was scored using the Boston Bowel Preparation Scale (BBPS) by blinded endoscopists. Patient satisfaction was measured using the Patient Satisfaction Questionnaire-18. Results: A total of 87 patients were included in the smartphone app group and 86 in the control group. The mean total BBPS score was significantly higher in the smartphone app group (mean 8.3, SD 0.9) than in the control group (mean 7.9, SD 1.2; P=.03). The right colon showed a significantly higher bowel preparation score in the smartphone app group (mean 2.7, SD 0.5 vs mean 2.5, SD 0.6; P=.04). No significant differences were observed in segment scores for the mean transverse colon (mean 2.8, SD 0.4 vs mean 2.8, SD 0.4; P=.34) and left colon (mean 2.8, SD 0.4 vs mean 2.6, SD 0.5; P=.07). General patient satisfaction was high for the smartphone app group (mean 4.4, SD 0.7) but showed no significant difference when compared with the control group (mean 4.3, SD 0.8; P=.32). Conclusions: Our personalized smartphone app significantly improved bowel preparation quality compared with regular written instructions for bowel preparation. In particular, in the right colon, the BBPS score improved, which is of clinical relevance because the right colon is considered more difficult to clean and the polyp detection rate in the right colon improves with improvement of bowel cleansing of the right colon. No further improvement in patient satisfaction was observed compared with patients receiving regular written instructions. Trial Registration: ClinicalTrials.gov NCT03677050; https://clinicaltrials.gov/ct2/show/NCT03677050 ", doi="10.2196/26703", url="https://mhealth.jmir.org/2021/8/e26703", url="http://www.ncbi.nlm.nih.gov/pubmed/34420924" } @Article{info:doi/10.2196/25425, author="Mackert, Michael and Mandell, Dorothy and Donovan, Erin and Walker, Lorraine and Henson-Garc{\'i}a, Mike and Bouchacourt, Lindsay", title="Mobile Apps as Audience-Centered Health Communication Platforms", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="17", volume="9", number="8", pages="e25425", keywords="health communication", keywords="mHealth", keywords="mobile apps", keywords="mobile health", keywords="prenatal health", keywords="pregnancy", keywords="audience-centered", doi="10.2196/25425", url="https://mhealth.jmir.org/2021/8/e25425", url="http://www.ncbi.nlm.nih.gov/pubmed/34402797" } @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/10.2196/18830, author="Pavuluri, Haritha and Grant, Alicia and Hartman, Alexander and Fowler, Lauren and Hudson, Jennifer and Springhart, Patrick and Kennedy, Blair Ann", title="Implementation of iPads to Increase Compliance With Delivery of New Parent Education in the Mother--Baby Unit: Retrospective Study", journal="JMIR Pediatr Parent", year="2021", month="Jun", day="15", volume="4", number="2", pages="e18830", keywords="technology", keywords="handheld computers", keywords="workflow", keywords="education", keywords="newborn", keywords="head trauma", abstract="Background: Abusive head trauma (AHT) is a serious health problem affecting more than 3000 infants annually in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) recommend that health care providers counsel new parents about the dangers of AHT. Previous studies demonstrate that parental education is effective at reducing AHT events. South Carolina law requires hospitals to offer all new parents with the opportunity to watch an educational video about AHT. This mandate is addressed in different ways at the several delivery centers within a large South Carolina health care system with a range of viewing methods utilized, from DVD players to mobile workstations to personal devices. Frequent technical barriers and workflow inefficiencies resulted in low rates of compliance with this mandate at several campuses. To improve compliance of parent viewing of this educational video, the health care system standardized video viewing protocol across all campuses by implementing the use of iPads for parental education. Existing literature suggests that patient education can be improved in the hospital setting by utilizing tablet computers, but our literature search identified a gap in research around the education of parents and caregivers during hospitalization for childbirth. We used the implementation of an iPad-based parental education delivery protocol to evaluate whether tablet computers can improve compliance with delivering new parent education in the hospital setting. Objective: The objective of this study was to evaluate whether the standardized use of iPads to deliver education in the mother--baby unit resulted in improved rates of parents' acceptance of the opportunity to view an educational video about AHT. Methods: We interviewed physicians and nurses to determine what previous protocols were in place to educate new parents before a standardized iPad-based protocol was implemented across 6 campuses of a large South Carolina health care system. A retrospective study was conducted by review of 5231 records from across the 6 campuses to determine the pre- and postintervention compliance rates of viewing the AHT educational video by parents in the mother--baby unit. Results: Compliance increased overall (P<.001) across sites from an average of 41.93\% (SD 46.24) to 99.73\% (SD 0.26) ($\phi$=0.510). As much as 4 of 6 locations saw a significant increase in compliance rates after introducing the iPad intervention (P<.001). The remaining 2 locations that showed no significant difference (P>.05) had very high rates of preintervention compliance. Conclusions: Following the implementation of a standardized iPad-based protocol to deliver new parent education, there was a significant improvement in the percentage of new parents who viewed an educational video about AHT in the mother--baby unit. Based on these results, other health care providers should consider iPads to be a feasible and effective method for delivering hospital-based education to families in the mother--baby unit. ", doi="10.2196/18830", url="https://pediatrics.jmir.org/2021/2/e18830", url="http://www.ncbi.nlm.nih.gov/pubmed/34128809" } @Article{info:doi/10.2196/25021, author="Willems, H. Sofie and Rao, Jyotsna and Bhambere, Sailee and Patel, Dipu and Biggins, Yvonne and Guite, W. Jessica", title="Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity", journal="JMIR Mhealth Uhealth", year="2021", month="Jun", day="11", volume="9", number="6", pages="e25021", keywords="coronavirus", keywords="digital health", keywords="multiplatform", keywords="chat", keywords="symptom tracking", keywords="well-being", keywords="COVID-19", keywords="online platform", keywords="symptom", keywords="monitoring", keywords="follow-up", doi="10.2196/25021", url="https://mhealth.jmir.org/2021/6/e25021", url="http://www.ncbi.nlm.nih.gov/pubmed/34033575" } @Article{info:doi/10.2196/29750, author="Boumparis, Nikolaos and Schulte, H. Mieke and Kleiboer, Annet and Huizink, Anja and Riper, Heleen", title="A Mobile Intervention to Promote Low-Risk Drinking Habits in Young Adults: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jun", day="7", volume="10", number="6", pages="e29750", keywords="alcohol", keywords="lifestyle", keywords="drinking", keywords="young adults", keywords="digital", keywords="mobile app", keywords="COVID-19", abstract="Background: Young adults' drinking habits commonly exceed recommendations for low-risk drinking, which may have a negative effect on their mental, social, and physical health. As smartphones are highly accessible to young adults, mobile apps could be used to support young adults to develop low-risk drinking habits and improve their general health. Objective: The objective of this study is to evaluate the effectiveness of Boozebuster, a self-guided mobile app based on healthy lifestyle--related components that aim to develop and maintain low-risk drinking habits among young adults. Methods: This two-arm, parallel-group randomized controlled trial will investigate whether a 6-week self-guided mobile intervention (Boozebuster) targeting drinking behavior is more effective than a minimal intervention consisting of an educational website on alcohol use and its consequences for young adults. We will recruit 506 young adults (aged 18-30 years) from the Netherlands via an open recruitment strategy by using an open access website. All outcomes will be self-assessed through questionnaires. The primary outcome is the quantity and frequency of alcohol consumption in standard drinks (10 g ethanol per standard drink) per month (timeline follow-back [TLFB]). Secondary outcomes include binge-drinking sessions per month, alcohol-related problem severity (Rutgers Alcohol Problem Index), cannabis use frequency and quantity in grams (TLFB), depressive symptoms (Center for Epidemiological Studies Depression Scale), perceived stress (Perceived Stress Scale), engagement (Twente Engagement with eHealth Technologies Scale), readiness to change (Readiness to Change Questionnaire), mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), trauma and COVID-19--related trauma (Short-Form Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), impulsivity (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale), study or work performance (Individual Work Performance Questionnaire), and treatment adherence. Baseline (T0), 6-week postbaseline (T1), and 3-month postbaseline (T2) assessments will be conducted and analyzed on the basis of the intention-to-treat principle using multilevel mixed modeling analyses. Results: Recruitment began in September 2020. We received 933 registrations via our study information website; 506 participants have completed the T0 assessment, 336 participants have completed the T1 assessment, and 308 participants have completed the T2 assessment as of May 2021. The study is still in progress, and results will be reported in 2021 and 2022. Conclusions: Self-guided mobile interventions based on a lifestyle approach might be an attractive approach for young adults due to their preference on self-reliance, healthy living, and increased perceived anonymity. Such interventions are yet understudied, and it is known that interventions addressing solely problem drinking are less appealing to young adults. We hypothesize that the Boozebuster mobile app will effectively reduce drinking levels compared to an alcohol educational website (control condition). If effective, our intervention could be an inexpensive and scalable public health intervention to improve drinking habits in young adults. Trial Registration: Netherlands Trial Register NL8828; https://www.trialregister.nl/trial/8828 International Registered Report Identifier (IRRID): DERR1-10.2196/29750 ", doi="10.2196/29750", url="https://www.researchprotocols.org/2021/6/e29750", url="http://www.ncbi.nlm.nih.gov/pubmed/34033583" } @Article{info:doi/10.2196/25006, author="Ruggiano, Nicole and Brown, L. Ellen and Roberts, Lisa and Framil Suarez, Victoria C. and Luo, Yan and Hao, Zhichao and Hristidis, Vagelis", title="Chatbots to Support People With Dementia and Their Caregivers: Systematic Review of Functions and Quality", journal="J Med Internet Res", year="2021", month="Jun", day="3", volume="23", number="6", pages="e25006", keywords="dementia", keywords="caregivers", keywords="chatbots", keywords="conversation agents", keywords="mobile apps", keywords="mobile phone", abstract="Background: Over the past decade, there has been an increase in the use of information technologies to educate and support people with dementia and their family caregivers. At the same time, chatbot technologies have become increasingly popular for use by the public and have been identified as having benefits for health care delivery. However, little is known about how chatbot technologies may benefit people with dementia and their caregivers. Objective: This study aims to identify the types of current commercially available chatbots that are designed for use by people with dementia and their caregivers and to assess their quality in terms of features and content. Methods: Chatbots were identified through a systematic search on Google Play Store, Apple App Store, Alexa Skills, and the internet. An evidence-based assessment tool was used to evaluate the features and content of the identified apps. The assessment was conducted through interrater agreement among 4 separate reviewers. Results: Of the 505 initial chatbots identified, 6 were included in the review. The chatbots assessed varied significantly in terms of content and scope. Although the chatbots were generally found to be easy to use, some limitations were noted regarding their performance and programmed content for dialog. Conclusions: Although chatbot technologies are well established and commonly used by the public, their development for people with dementia and their caregivers is in its infancy. Given the successful use of chatbots in other health care settings and for other applications, there are opportunities to integrate this technology into dementia care. However, more evidence-based chatbots that have undergone end user evaluation are needed to evaluate their potential to adequately educate and support these populations. ", doi="10.2196/25006", url="https://www.jmir.org/2021/6/e25006", url="http://www.ncbi.nlm.nih.gov/pubmed/34081019" } @Article{info:doi/10.2196/19262, author="Ghanbari, Elaheh and Yektatalab, Shahrzad and Mehrabi, Manoosh", title="Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="May", day="18", volume="9", number="5", pages="e19262", keywords="anxiety", keywords="breast cancer", keywords="education", keywords="mobile app", keywords="self-esteem", abstract="Background: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. Objective: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. Methods: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. Results: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95\% CI --17.44 to --8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95\% CI --9.20 to --4.21, P<.001, d=0.88 and trait anxiety: 95\% CI --8.50 to --4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95\% CI 1.28 to 2.82, P<.001). Conclusions: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Trial Registration: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882 ", doi="10.2196/19262", url="https://mhealth.jmir.org/2021/5/e19262", url="http://www.ncbi.nlm.nih.gov/pubmed/34003138" } @Article{info:doi/10.2196/23671, author="Richards, Rebecca and Kinnersley, Paul and Brain, Kate and Wood, Fiona", title="Cancer Clinicians' Views Regarding an App That Helps Patients With Cancer Meet Their Information Needs: Qualitative Interview Study", journal="JMIR Cancer", year="2021", month="May", day="6", volume="7", number="2", pages="e23671", keywords="education, medical", keywords="medical information exchange", keywords="smartphone", keywords="mobile apps", keywords="mobile phone", abstract="Background: Many patients with cancer have unmet information needs during the course of the illness. Smart devices, such as smartphones and tablet computers, provide an opportunity to deliver information to patients remotely. We aim to develop an app intervention to help patients with cancer meet their illness-related information needs in noninpatient settings. In addition to the in-depth exploration of the issues faced by the target users of a potential intervention, it is important to gain an understanding of the context in which the intervention will be used and the potential influences on its adoption. As such, understanding the views of clinicians is key to the successful implementation of this type of app in practice. Additionally, clinicians have an awareness of their patients' needs and can provide further insight into the type of app and features that might be most beneficial. Objective: This study aims to explore cancer clinicians' views on this type of intervention and whether they would support the use of an app in cancer care. Specifically, the perceived acceptability of an app used in consultations, useful app features, the potential benefits and disadvantages of an app, and barriers to app use were explored. Methods: A total of 20 qualitative, semistructured interviews were conducted with 22 clinicians from urological, colorectal, breast, or gynecological cancer clinics across 2 hospitals in South Wales. The interviews were audio recorded, transcribed, and analyzed using thematic analysis. Results: Clinicians felt that it would be acceptable for patients to use such an app in noninpatient settings, including during consultations. The benefits of this type of app were anticipated to be a more informed patient, an increased sense of control for patients, better doctor-patient communication, and a more efficient and effective consultation. In contrast, an increase in clinicians' workload and poorer communication in consultations, which depended on the included app features, were identified as potential disadvantages. The anticipated barriers to app use included patients' age and prior experience with smart technology, their access to smart devices, the confidentiality of information, and an avoidant coping approach to their condition. Conclusions: This study suggests that clinicians should support their patients in using an app to help them meet their information needs both at home and during consultations. This study highlights some of the potential barriers for this type of intervention in practice, which could be minimized during the intervention design process. ", doi="10.2196/23671", url="https://cancer.jmir.org/2021/2/e23671", url="http://www.ncbi.nlm.nih.gov/pubmed/33955836" } @Article{info:doi/10.2196/19511, author="Yun, Ke and Chu, Zhenxing and Zhang, Jing and Geng, Wenqing and Jiang, Yongjun and Dong, Willa and Shang, Hong and Xu, Junjie", title="Mobile Phone Intervention Based on an HIV Risk Prediction Tool for HIV Prevention Among Men Who Have Sex With Men in China: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="13", volume="9", number="4", pages="e19511", keywords="eHealth intervention", keywords="high-risk behavior intervention", keywords="HIV risk prediction", keywords="men who have sex with men", abstract="Background: eHealth interventions based on risk stratification have not been extensively applied for HIV behavioral interventions among HIV-negative men who have sex with men (MSM). Objective: This study aimed to evaluate the efficacy of a mobile phone intervention based on an HIV risk prediction tool in promoting HIV testing and reducing high-risk behavior among HIV-negative MSM in China. Methods: We performed a mobile phone--based randomized controlled clinical trial for 12 weeks. A comprehensive intervention package deployed on Jinshuju---an online survey platform---was developed and consisted of 4 components: (1) a validated HIV risk prediction tool that provides information on personalized risk reduction interventions; (2) a map of individualized HIV testing facilities based on their geographic location; (3) a QR code for free resources on HIV prevention, including condoms and HIV self-testing kits; and (4) general resources for HIV health education. MSM participants recruited from WeChat/QQ groups were randomly assigned to the intervention or control group at a 1:1 ratio. The staff sent the QR code for the comprehensive intervention package to MSM in the intervention group over WeChat and sent the QR code only for the resources on HIV health education to those in the control group. At baseline and 12-week follow-up, data on HIV-related risk behavior and HIV testing behavior were collected through the Jinshuju online survey platform. Results: In total, 192 MSM were recruited and assigned to the intervention or control group (n=96 each). At week 12, the total clinical trial retention rate was 87.5\%. The number of male sexual partners of the MSM in the past 3 months was significantly lower in the intervention group than in the control group (3.51, SD 4.1 vs 6.01, SD 11.4, respectively; mean difference ?2.5; 95\% CI ?5.12 to 0.12; P=.05); the rate of condom use with casual sexual partners was higher in the intervention group than in the control group (87\%, n=66/76 vs 70\%, n=54/77 respectively; odds ratio 2.81, 95\% CI 1.23-6.39; P=.01). The proportion of individuals intending to undergo HIV testing after in the following 30 days was marginally higher in the intervention group than in the control group (90\%, n=77/86 vs 79\%, n=65/82 respectively; odds ratio 2.20, 95\% CI 0.90-5.35; P=.07). The incremental cost-effectiveness ratio of eHealth intervention was US \$131.60 on reducing 1 sexual partner and US \$19.70 for a 1\% increment in condom usage with casual partners. Conclusions: A comprehensive intervention based on an HIV risk prediction tool can reduce the number of male sexual partners among MSM and increase the rate of condom use with casual partners. Hence, this intervention is a very promising preventive strategy for HIV among MSM, especially in areas with a prominent HIV epidemic. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017268; http://www.chictr.org.cn/showprojen.aspx?proj=29271 ", doi="10.2196/19511", url="https://mhealth.jmir.org/2021/4/e19511", url="http://www.ncbi.nlm.nih.gov/pubmed/33847597" } @Article{info:doi/10.2196/24065, author="Russ, Stephanie and Sevdalis, Nick and Ocloo, Josephine", title="A Smartphone App Designed to Empower Patients to Contribute Toward Safer Surgical Care: Qualitative Evaluation of Diverse Public and Patient Perceptions Using Focus Groups", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="8", volume="9", number="4", pages="e24065", keywords="patient safety", keywords="mobile health", keywords="patient involvement", keywords="perioperative care", keywords="smartphone app", keywords="mobile phone", abstract="Background: MySurgery is a smartphone app designed to empower patients and their caregivers to contribute toward safer surgical care by following practical advice to help reduce susceptibility to errors and complications. Objective: The aim of this study is to evaluate service users' perceptions of MySurgery, including its perceived acceptability, the potential barriers and facilitators to accessing and using its content, and ideas about how to facilitate its effective implementation. The secondary aim is to analyze how the intended use of the app might differ for diverse patients, including seldom-heard groups. Methods: We implemented a diversity approach to recruit participants from a range of backgrounds with previous experience of surgery. We aimed to achieve representation from seldom-heard groups, including those from a Black, Asian, and minority ethnic (BAME) background; those with a disability; and those from the lesbian, gay, bisexual, transgender, queer (LGBT+) community. A total of 3 focus groups were conducted across a 2-month period, during which a semistructured protocol was followed to elicit a rich discussion around the app. The focus groups were audio recorded, and thematic analysis was carried out. Results: In total, 22 individuals participated in the focus groups. A total of 50\% (n=11) of the participants were from a BAME background, 59\% (n=13) had a disability, and 36\% (n=8) were from the LGBT+ community. There was a strong degree of support for the MySurgery app. The majority of participants agreed that it was acceptable and appropriate in terms of content and usability, and that it would help to educate patients about how to become involved in improving safety. The checklist-like format was popular. There was rich discussion around the accessibility and inclusivity of MySurgery. Specific user groups were identified who might face barriers in accessing the app or acting on its advice, such as those with visual impairments or learning difficulties and those who preferred to take a more passive role (eg, some individuals because of their cultural background or personality type). The app could be improved by signposting further specialty-specific information and incorporating a calendar and notes section. With regard to implementation, it was agreed that use of the app should be signposted before the preoperative appointment and that training and education should be provided for clinicians to increase awareness and buy-in. Communication about the app should clarify its scientific basis in plain English and should stress that its use is optional. Conclusions: MySurgery was endorsed as a powerful tool for enhancing patient empowerment and facilitating the direct involvement of patients and their caregivers in maintaining patient safety. The diversity approach allowed for a better understanding of the needs of different population groups and highlighted opportunities for increasing accessibility and involvement in the app. ", doi="10.2196/24065", url="https://mhealth.jmir.org/2021/4/e24065", url="http://www.ncbi.nlm.nih.gov/pubmed/33830062" } @Article{info:doi/10.2196/23649, author="Hayman, Melanie and Alfrey, Kristie-Lee and Cannon, Summer and Alley, Stephanie and Rebar, L. Amanda and Williams, Susan and Short, E. Camille and Altazan, Abby and Comardelle, Natalie and Currie, Sinead and Denton, Caitlin and Harrison, L. Cheryce and Lamerton, Tayla and Mena, P. Gabriela and Moran, Lisa and Mottola, Michelle and Nagpal, S. Taniya and Vincze, Lisa and Schoeppe, Stephanie", title="Quality, Features, and Presence of Behavior Change Techniques in Mobile Apps Designed to Improve Physical Activity in Pregnant Women: Systematic Search and Content Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="7", volume="9", number="4", pages="e23649", keywords="pregnancy", keywords="exercise", keywords="physical activity", keywords="mobile health (mHealth)", keywords="applications", keywords="MARS", keywords="behavior change techniques", keywords="mobile phone", abstract="Background: Physical activity during pregnancy is associated with several health benefits for the mother and child. However, very few women participate in regular physical activity during pregnancy. eHealth platforms (internet and mobile apps) have become an important information source for pregnant women. Although the use of pregnancy-related apps has significantly increased among pregnant women, very little is known about their theoretical underpinnings, including their utilization of behavior change techniques (BCTs). This is despite research suggesting that inclusion of BCTs in eHealth interventions are important for promoting healthy behaviors, including physical activity. Objective: The aim of this study was to conduct a systematic search and content analysis of app quality, features, and the presence of BCTs in apps designed to promote physical activity among pregnant women. Methods: A systematic search in the Australian App Store and Google Play store using search terms relating to exercise and pregnancy was performed. App quality and features were assessed using the 19-item Mobile App Rating Scale (MARS), and a taxonomy of BCTs was used to determine the presence of BCTs (26 items). BCTs previously demonstrating efficacy in behavior changes during pregnancy were also identified from a literature review. Spearman correlations were used to investigate the relationships between app quality, app features, and number of BCTs identified. Results: Nineteen exercise apps were deemed eligible for this review and they were accessed via Google Play (n=13) or App Store (n=6). The MARS overall quality scores indicated moderate app quality (mean 3.5 [SD 0.52]). Functionality was the highest scoring MARS domain (mean 4.2 [SD 0.5]), followed by aesthetics (mean 3.7 [SD 0.6]) and information quality (mean 3.16 [SD 0.42]). Subjective app quality (mean 2.54 [SD 0.64]) and likelihood for behavioral impact (mean 2.5 [SD 0.6]) were the lowest scoring MARS domains. All 19 apps were found to incorporate at least two BCTs (mean 4.74, SD 2.51; range 2-10). However, only 11 apps included BCTs that previously demonstrated efficacy for behavior change during pregnancy, the most common being provide opportunities for social comparison (n=8) and prompt self-monitoring of behavior (n=7). There was a significant positive correlation between the number of BCTs with engagement and aesthetics scores, but the number of BCTs was not significantly correlated with functionality, information quality, total MARS quality, or subjective quality. Conclusions: Our findings showed that apps designed to promote physical activity among pregnant women were functional and aesthetically pleasing, with overall moderate quality. However, the incorporation of BCTs was low, with limited prevalence of BCTs previously demonstrating efficacy in behavior change during pregnancy. Future app development should identify and adopt factors that enhance and encourage user engagement, including the use of BCTs, especially those that have demonstrated efficacy for promoting physical activity behavior change among pregnant women. ", doi="10.2196/23649", url="https://mhealth.jmir.org/2021/4/e23649", url="http://www.ncbi.nlm.nih.gov/pubmed/33825693" } @Article{info:doi/10.2196/22960, author="Liu, Ting and Xie, Sumei and Wang, Yingmin and Tang, Jie and He, Xiaokuo and Yan, Tiebin and Li, Kun", title="Effects of App-Based Transitional Care on the Self-Efficacy and Quality of Life of Patients With Spinal Cord Injury in China: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="1", volume="9", number="4", pages="e22960", keywords="spinal cord injury", keywords="mobile app", keywords="transitional care", keywords="self-efficacy", keywords="quality of life", abstract="Background: Spinal cord injury (SCI) severely impairs the physical and mental health of patients, decreasing their self-efficacy in coping with daily life and quality of life (QOL). In China, a large gap remains between the complex long-term health needs of SCI patients and the current community care system. With the prevalence of mobile terminals, the usage of mobile health apps has the potential to fill this gap by extending qualified medical resources to the families of SCI patients. Our team developed the app Together for the transitional care of home-dwelling SCI patients in China. Objective: This study aimed to evaluate the effects of app-based transitional care on the self-efficacy and QOL of SCI patients. Methods: Through a three-round Delphi process, an Android app was designed. Both medical staff and patients could access the app. Medical staff used it for providing remote transitional care to SCI patients. Patients used it to view transitional care time and send messages to medical staff. Thereafter, a multicenter and assessor-blinded randomized controlled trial was conducted. Participants (n=98) who had SCI and lived at home following discharge were recruited and randomly assigned to a study group (n=49) and control group (n=49) using a randomized number list in four research centers. Patients in both groups received systematic discharge education before discharge. The study group received five follow-ups conducted by trained nurses through the app, which had four core functions, namely remote assessment, health education, interdisciplinary referral, and patient interaction, at weeks 2, 4, 6, 8, and 12 following discharge. The control group received a routine telephone follow-up conducted by nurses at week 12 following discharge. The outcome measures were the Moorong Self-Efficacy Scale (MSES) and 36-item Short-Form Health Survey (SF-36) scores. Data were collected before discharge (T0) and at weeks 12 (T1) and 24 following discharge (T2). Differences between the groups were tested by repeated measures analysis of variance and simple effect analysis. Results: After the follow-up, the total MSES scores in the study group improved over time (T0=67.80, T1=71.90, and T2=76.29) and were higher than those in the control group (T2=64.49) at 24 weeks following discharge (simple effect analysis: F1=8.506, P=.004). Regarding the total SF-36 score, although it was higher in patients from the study group (T2=65.36) than those from the control group (T2=58.77) at 24 weeks following discharge, only time effects were significant (F2,95=6.671, P=.002) and neither the group effects nor the interaction effects influenced the change in QOL (group effects: F1,96=0.082, P=.78; interaction effects: F2,95=3.059, P=.052). Conclusions: This study confirmed that app-based transitional care improves the self-efficacy of SCI patients. Nevertheless, QOL improvement is not yet evident. Future investigations with larger sample sizes and longer observation periods are warranted to further verify the effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012317; http://www.chictr.org.cn/showproj.aspx?proj=19828 ", doi="10.2196/22960", url="https://mhealth.jmir.org/2021/4/e22960", url="http://www.ncbi.nlm.nih.gov/pubmed/33792555" } @Article{info:doi/10.2196/21128, author="Harshbarger, Camilla and Burrus, Olivia and Rangarajan, Sivakumar and Bollenbacher, John and Zulkiewicz, Brittany and Verma, Rohit and Galindo, A. Carla and Lewis, A. Megan", title="Challenges of and Solutions for Developing Tailored Video Interventions That Integrate Multiple Digital Assets to Promote Engagement and Improve Health Outcomes: Tutorial", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="23", volume="9", number="3", pages="e21128", keywords="HIV video intervention", keywords="patient-provider communication", keywords="ART adherence", keywords="digital interventions", keywords="mobile interventions", keywords="computer based interventions", keywords="interactive technologies", abstract="Background: Video is a versatile and popular medium for digital health interventions. As mobile device and app technology advances, it is likely that video-based interventions will become increasingly common. Although clinic waiting rooms are complex and busy environments, they offer the opportunity to facilitate engagement with video-based digital interventions as patients wait to see their providers. However, to increase efficiency in public health, leverage the scalability and low cost of implementing digital interventions, and keep up with rapidly advancing technology and user needs, more design and development guidance is needed for video-based tailored interventions. Objective: We provide a tutorial for digital intervention researchers and developers to efficiently design and develop video-based tailored digital health interventions. We describe the challenges and solutions encountered with Positive Health Check (PHC), a hybrid app used to deliver a brief, interactive, individually tailored video-based HIV behavioral counseling intervention. PHC uses video clips and multimedia digital assets to deliver intervention content, including interactive tailored messages and graphics, a repurposed animated video, and patient and provider handouts generated in real time by PHC. Methods: We chronicle multiple challenges and solutions for the following: (1) using video as a medium to enhance user engagement, (2) navigating the complexity of linking a database of video clips with other digital assets, and (3) identifying the main steps involved in building an app that will seamlessly deliver to users individually tailored messages, graphics, and handouts. Results: We leveraged video to enhance user engagement by featuring ``video doctors,'' full-screen video, storyboards, and streamlined scripts. We developed an approach to link the database of video clips with other digital assets through script coding and flow diagrams of algorithms to deliver a tailored user experience. We identified the steps to app development by using keyframes to design the integration of video and digital assets, using agile development methods to gather iterative feedback from multidisciplinary teams, and creating an intelligent data-driven back-end solution to tailor message delivery to individual users. Conclusions: Video-based digital health interventions will continue to play an important role in the future of HIV prevention and treatment, as well as other clinical health practices. However, facilitating the adoption of an HIV video intervention in HIV clinical settings is a work in progress. Our experience in designing and developing PHC presented unique challenges due to the extensive use of a large database of videos tailored individually to each user. Although PHC focuses on promoting the health and well-being of persons with HIV, the challenges and solutions presented in this tutorial are transferable to the design and development of video-based digital health interventions focused on other areas of health. ", doi="10.2196/21128", url="https://mhealth.jmir.org/2021/3/e21128", url="http://www.ncbi.nlm.nih.gov/pubmed/33755025" } @Article{info:doi/10.2196/18763, author="Zhang, Xianzuo and Chen, Xiaoxuan and Kourkoumelis, Nikolaos and Gao, Ran and Li, Guoyuan and Zhu, Chen", title="A Social Media--Promoted Educational Community of Joint Replacement Patients Using the WeChat App: Survey Study", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="18", volume="9", number="3", pages="e18763", keywords="WeChat", keywords="social media", keywords="arthroplasty", keywords="perioperative education", keywords="patient satisfaction", abstract="Background: Much effort has been made to optimize the results of total hip arthroplasty and total knee arthroplasty. With the rapid growth of social media use, mobile apps, such as WeChat, have been considered for improving outcomes and patient satisfaction after total hip arthroplasty and total knee arthroplasty. Objective: We aimed to evaluate the effectiveness of a WeChat-based community as an intervention for overall patient satisfaction. Methods: The study was conducted among discharged in-hospital patients who received hip or knee procedures in the First Affiliated Hospital of the University of Science and Technology of China from April 2019 to January 2020. An educational online social community was constructed with the WeChat app. Participants willing to join the community were enrolled in a WeChat group and received 3 months of intervention and follow-up. Those who were not willing to use the account were included in a control group and received routine publicity via telephone, mail, and brochures. The Danish Health and Medicine Authority patient satisfaction questionnaire was used to score perioperative patient education and overall satisfaction. The contents in the group chat were analyzed using natural language processing tools. Results: A total of 3428 patients were enrolled in the study, including 2292 in the WeChat group and 1236 in the control group. Participants in the WeChat group had higher overall satisfaction scores than those in the control group (mean 8.48, SD 1.12 vs mean 6.66, SD 1.80, P<.001). The difference between the two groups was significant for primary surgery based on subgroup stratification. To control confounding factors and explore the effects of WeChat participation as a mediating variable between perioperative patient education and overall satisfaction, hierarchical regression was utilized. An interpatient interaction model was found in the community group chat, and it contributed to overall satisfaction. Patients in the group with more interpatient interactions were more likely to have better overall satisfaction. Conclusions: The social media--promoted educational community using WeChat was effective among joint replacement patients. Provision of more perioperative education is associated with more active patient participation in the community and therefore more patient satisfaction in terms of the overall joint procedure. Community group chat could facilitate interactions among patients and contribute to overall satisfaction. ", doi="10.2196/18763", url="https://mhealth.jmir.org/2021/3/e18763", url="http://www.ncbi.nlm.nih.gov/pubmed/33734094" } @Article{info:doi/10.2196/22147, author="Lim, Karen and Chan, Shiao-Yng and Lim, Lin Su and Tai, Choo Bee and Tsai, Cammy and Wong, Ren Su and Ang, Min Siew and Yew, Wei Tong and Tai, Shyong E. and Yong, Leong Eu", title="A Smartphone App to Restore Optimal Weight (SPAROW) in Women With Recent Gestational Diabetes Mellitus: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="16", volume="9", number="3", pages="e22147", keywords="randomized controlled trial", keywords="gestational diabetes mellitus", keywords="prevention", keywords="weight loss", keywords="mobile phone", abstract="Background: Women with a history of gestational diabetes mellitus (GDM) are at an increased risk of developing type 2 diabetes mellitus (T2DM). Lifestyle interventions aimed at postpartum weight loss to reduce T2DM risk have been reported, but poor compliance remains a barrier. Smartphone-based interventions may improve compliance, but data on its use in women with recent GDM are limited. Objective: This trial aimed to investigate the efficacy of a smartphone app in restoring optimal weight following delivery in women with GDM, in the setting of a population with high rates of GDM and type 2 diabetes. Methods: In this unblinded randomized controlled trial, 200 women with GDM were randomized to receive the intervention or standard care following delivery. The intervention enabled logging of weight, meals, and activity, with web-based interaction with a team comprising dieticians, a physiotherapist, and an occupational therapist. The primary outcome was an achievement of optimal weight (defined as the restoration of first trimester weight if first trimester BMI?23 kg/m2 or weight loss of at least 5\% from first trimester weight if first trimester BMI>23 kg/m2) at 4 months post partum. Secondary outcome measures included absolute weight loss, serum metabolic markers, self-reported nutritional intake, health education, and quality of life via questionnaires and user engagement in the intervention group. Results: In total, 40\% (38/96) of women in the intervention group achieved optimal weight at 4 months post delivery compared with 32\% (28/93) in the control group (P=.27). Compared with the control group, women in the intervention group reported significantly reduced caloric intake at 4 months after delivery (P<.001) and higher health-directed behavior scores (P=.045). The intervention group also reported increased emotional distress scores (P=.01). At 4 months, participant engagement with the intervention was maintained at 60.8\% (SD 33.9\%). Conclusions: Although a statistically significant increase in women achieving healthy weight was not observed, this app remains promising, as women in the intervention group reported improved health behaviors and lower caloric intake. Importantly, the high retention rates suggest that a larger study with a longer follow-up period might confirm the effectiveness of this app for weight management. Trial Registration: ClinicalTrials.gov NCT03324737; https://clinicaltrials.gov/ct2/show/NCT03324737 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7691-3 ", doi="10.2196/22147", url="https://mhealth.jmir.org/2021/3/e22147", url="http://www.ncbi.nlm.nih.gov/pubmed/33724204" } @Article{info:doi/10.2196/26159, author="Sandborg, Johanna and Henriksson, Pontus and Larsen, Erica and Lindqvist, Anna-Karin and Rutberg, Stina and S{\"o}derstr{\"o}m, Emmie and Maddison, Ralph and L{\"o}f, Marie", title="Participants' Engagement and Satisfaction With a Smartphone App Intended to Support Healthy Weight Gain, Diet, and Physical Activity During Pregnancy: Qualitative Study Within the HealthyMoms Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="5", volume="9", number="3", pages="e26159", keywords="pregnancy", keywords="gestational weight gain", keywords="mHealth", keywords="telemedicine", keywords="digital health", keywords="mobile health", keywords="eHealth", keywords="smartphone intervention", keywords="mobile application", keywords="smartphone application", keywords="engagement", keywords="physical activity", keywords="exercise", keywords="nutrition", keywords="diet", keywords="qualitative", keywords="thematic analysis", abstract="Background: Excessive gestational weight gain (GWG) is common and associated with negative health outcomes for both mother and child. Mobile health--delivered lifestyle interventions offer the potential to mitigate excessive GWG. The effectiveness of a smartphone app (HealthyMoms) was recently evaluated in a randomized controlled trial. To explore the users' experiences of using the app, a qualitative study within the HealthyMoms trial was performed. Objective: This qualitative study explored participants' engagement and satisfaction with the 6-month usage of the HealthyMoms app. Methods: A total of 19 women (mean age: 31.7, SD 4.4 years; mean BMI: 24.6, SD 3.4 kg/m2; university degree attainment: 13/19, 68\%; primiparous: 11/19, 58\%) who received the HealthyMoms app in a randomized controlled trial completed semistructured exit interviews. The interviews were audiorecorded and fully transcribed, coded, and analyzed using thematic analysis with an inductive approach. Results: Thematic analysis revealed a main theme and 2 subthemes. The main theme, ``One could suit many: a multifunctional tool to strengthen women's health during pregnancy,'' and the 2 subthemes, ``Factors within and beyond the app influence app engagement'' and ``Trust, knowledge, and awareness: aspects that can motivate healthy habits,'' illustrated that a trustworthy and appreciated health and pregnancy app that is easy to use can inspire a healthy lifestyle during pregnancy. The first subtheme discussed how factors within the app (eg, regular updates and feedback) were perceived to motivate both healthy habits and app engagement. Additionally, factors beyond the app were described to both motivate (eg, interest, motivation, and curiosity) and limit (eg, pregnancy-related complications, lack of time) app engagement. The second subtheme reflected important aspects, such as high trustworthiness of the app, increased knowledge, and awareness from using the app, which motivated participants to improve or maintain healthy habits during pregnancy. Conclusions: The HealthyMoms app was considered a valuable and trustworthy tool to mitigate excessive GWG, with useful features and relevant information to initiate and maintain healthy habits during pregnancy. Trial Registration: ClinicalTrials.gov NCT03298555; https://clinicaltrials.gov/ct2/show/NCT03298555 International Registered Report Identifier (IRRID): RR2-10.2196/13011 ", doi="10.2196/26159", url="https://mhealth.jmir.org/2021/3/e26159", url="http://www.ncbi.nlm.nih.gov/pubmed/33666554" } @Article{info:doi/10.2196/22229, author="Byonanebye, Mirembe Dathan and Nabaggala, S. Maria and Naggirinya, Bwanika Agnes and Lamorde, Mohammed and Oseku, Elizabeth and King, Rachel and Owarwo, Noela and Laker, Eva and Orama, Richard and Castelnuovo, Barbara and Kiragga, Agnes and Parkes-Ratanshi, Rosalind", title="An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="11", volume="9", number="2", pages="e22229", keywords="mHealth", keywords="HIV", keywords="quality of life", keywords="interactive voice response", keywords="mobile health", keywords="digital health", abstract="Background: Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings. Objective: The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively. Methods: Within the Call for Life study, ART-experienced and ART-na{\"i}ve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4. Results: Overall, 600 participants (413 female, 68.8\%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3\%) opted for IVR and 2 (0.7\%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4\%) active participants had picked up at least 50\% of the calls. In the active intervention participants, high users (received >75\% of reminders) had overall higher QoL compared to low users (received <25\% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51\%-75\%) had better viral suppression at 12 months (80/94, 85\% versus 11/19, 58\%, P=.006). Conclusions: Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 ", doi="10.2196/22229", url="https://mhealth.jmir.org/2021/2/e22229", url="http://www.ncbi.nlm.nih.gov/pubmed/33570497" } @Article{info:doi/10.2196/23917, author="Liu, Guihua and Wang, Shuo and Liao, Jinhua and Ou, Ping and Huang, Longsheng and Xie, Namei and He, Yingshuang and Lin, Jinling and He, Hong-Gu and Hu, Rongfang", title="The Efficacy of WeChat-Based Parenting Training on the Psychological Well-being of Mothers With Children With Autism During the COVID-19 Pandemic: Quasi-Experimental Study", journal="JMIR Ment Health", year="2021", month="Feb", day="10", volume="8", number="2", pages="e23917", keywords="coronavirus disease 2019", keywords="autism spectrum disorder", keywords="parenting training", keywords="psychological well-being", keywords="social media", keywords="WeChat", keywords="COVID-19", keywords="autism", keywords="parenting", keywords="mental health", keywords="well-being", keywords="anxiety", keywords="depression", keywords="stress", abstract="Background: During the COVID-19 pandemic, special education schools for children in most areas of China were closed between the end of January and the beginning of June in 2020. The sudden interruption in schooling and the pandemic itself caused parents to be anxious and even to panic. Mobile-based parenting skills education has been demonstrated to be an effective method for improving the psychological well-being of mothers with children with autism. However, whether it can improve the psychological states of mothers in the context of the COVID-19 pandemic is a subject that should be urgently investigated. Objective: The aim of this study is to evaluate the efficacy of WeChat-based parenting training on anxiety, depression, parenting stress, and hope in mothers with children with autism, as well as the feasibility of the program during the COVID-19 pandemic. Methods: This was a quasi-experimental trial. A total of 125 mothers with preschool children with autism were recruited in January 2020. The participants were assigned to the control group (n=60), in which they received routine care, or the intervention group (n=65), in which they received the 12-week WeChat-based parenting training plus routine care, according to their preferences. Anxiety, depression, parenting stress, hope, satisfaction, and adherence to the intervention were measured at three timepoints: baseline (T0), postintervention (T1), and a 20-week follow-up (T2). Results: In total, 109 mothers completed the T1 assessment and 104 mothers completed the T2 assessment. The results of the linear mixed model analysis showed statistically significant group {\texttimes} time interaction effects for the intervention on anxiety (F=14.219, P<.001), depression (F=26.563, P<.001), parenting stress (F=68.572, P<.001), and hope (F=197.608, P<.001). Of all mothers in the intervention group, 90.4\% (48.8/54) reported that they were extremely satisfied with the WeChat-based parenting training. In total, 40.0\% (26/65) logged their progress in home training each week and 61.5\% (40/65) logged their progress more than 80\% of the time for all 20 weeks. Conclusions: The WeChat-based parenting training is acceptable and appears to be an effective approach for reducing anxiety, depression, and parenting stress, as well as increasing hope in mothers with children with autism during the global COVID-19 pandemic. Future studies with rigorous designs and longer follow-up periods are needed to further detect the effectiveness of the WeChat-based parenting training. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000031772; http://www.chictr.org.cn/showproj.aspx?proj=52165 ", doi="10.2196/23917", url="https://mental.jmir.org/2021/2/e23917", url="http://www.ncbi.nlm.nih.gov/pubmed/33481751" } @Article{info:doi/10.2196/20694, author="Willems, J. Stijn and Coppieters, W. Michel and Pronk, Yvette and Diks, F. Miranda J. and van der Heijden, P. Klaas W. A. and Rooker, Servan and Scholten-Peeters, M. Gwendolyne G.", title="A Clinical Journey Mobile Health App for Perioperative Patients: Cross-sectional Study", journal="JMIR Hum Factors", year="2021", month="Feb", day="8", volume="8", number="1", pages="e20694", keywords="eHealth", keywords="mHealth", keywords="applications", keywords="musculoskeletal", keywords="user-friendliness", keywords="rehabilitation", keywords="usability", keywords="patient education", keywords="technology", keywords="disability", keywords="feasibility", keywords="adherence", abstract="Background: Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps. Objective: The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences. Methods: A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses. Results: Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users' confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians. Conclusions: The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app. ", doi="10.2196/20694", url="http://humanfactors.jmir.org/2021/1/e20694/", url="http://www.ncbi.nlm.nih.gov/pubmed/33555262" } @Article{info:doi/10.2196/26192, author="Logie, Carmen and Okumu, Moses and Hakiza, Robert and Kibuuka Musoke, Daniel and Berry, Isha and Mwima, Simon and Kyambadde, Peter and Kiera, Mimy Uwase and Loutet, Miranda and Neema, Stella and Newby, Katie and McNamee, Clara and Baral, D. Stefan and Lester, Richard and Musinguzi, Joshua and Mbuagbaw, Lawrence", title="Mobile Health--Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other)", journal="JMIR Res Protoc", year="2021", month="Feb", day="2", volume="10", number="2", pages="e26192", keywords="adolescents and youth", keywords="implementation research", keywords="HIV testing", keywords="mobile health", keywords="refugee", keywords="Uganda", abstract="Background: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. Trial Registration: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. International Registered Report Identifier (IRRID): DERR1-10.2196/26192 ", doi="10.2196/26192", url="https://www.researchprotocols.org/2021/2/e26192", url="http://www.ncbi.nlm.nih.gov/pubmed/33528378" } @Article{info:doi/10.2196/22061, author="Kabukye, K. Johnblack and Ilozumba, Onaedo and Broerse, W. Jacqueline E. and de Keizer, Nicolette and Cornet, Ronald", title="Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="26", volume="9", number="1", pages="e22061", keywords="telemedicine", keywords="medical oncology", keywords="health promotion", keywords="low-and-middle-income countries", keywords="participatory research", keywords="mobile phone", abstract="Background: Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective: This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods: A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results: The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8\%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6\%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions: IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general. ", doi="10.2196/22061", url="http://mhealth.jmir.org/2021/1/e22061/", url="http://www.ncbi.nlm.nih.gov/pubmed/33496672" } @Article{info:doi/10.2196/17537, author="Batch, C. Bryan and Spratt, E. Susan and Blalock, V. Dan and Benditz, Chad and Weiss, Andi and Dolor, J. Rowena and Cho, H. Alex", title="General Behavioral Engagement and Changes in Clinical and Cognitive Outcomes of Patients with Type 2 Diabetes Using the Time2Focus Mobile App for Diabetes Education: Pilot Evaluation", journal="J Med Internet Res", year="2021", month="Jan", day="20", volume="23", number="1", pages="e17537", keywords="mobile technology", keywords="diabetes", keywords="self management support", keywords="self efficacy", keywords="illness perception", abstract="Background: Type 2 diabetes affects 30 million Americans, representing a significant cause of morbidity and mortality. Self-management support is an important component of chronic illness care and is a key pillar of the chronic care model. Face-to-face teaching and patient education materials suffer from being static or incompatible with mobile lifestyles. Digital apps provide a self-management support alternative that is convenient and scalable. Objective: This pilot study tested the real-world deployment of a self-guided mobile app for diabetes education (Time2Focus app; MicroMass Communications Inc, Cary, NC), which utilizes evidence-based content and gamification to deliver an interactive learning experience. Methods: Primary care providers were approached for permission to invite their patients to participate. Eligible patients were 18 to 89 years of age, had a diagnosis of type 2 diabetes, hemoglobin A1c (HbA1c) ?8\% and <12\% in the past 3 months, an active online patient portal account (tied to the electronic health record), and access to an iOS or Android smartphone. Interested patients were emailed a baseline survey, and once this was completed, were sent instructions for downloading the Time2Focus app. After completing all 12 levels, participants were sent a follow-up survey. The primary outcome was the change in HbA1c. Secondary outcomes included medication adherence, self-care activities, self-reporting of physical activities, diabetes self-efficacy, illness perceptions, diabetes distress scale, and users' engagement with and rating of the app. Results: Of 1355 potentially eligible patients screened, 201 were consented. Of these 201 patients, 101 (50.2\%) did not download the app. Of the 100 participants (49.8\%) who downloaded the app, 16 (16.0\%) completed 0 levels, 26 (26.0\%) completed 1 to 4 levels, 10 (10.0\%) completed 5 to 11 levels, and 48 (48.0\%) completed all 12 levels of the app and the follow-up survey. Those completing one or more levels had a mean pre/post-HbA1c change of --0.41\% (compared to --0.32\% among those who completed zero levels); however, the unadjusted two-tailed t test indicated no significant difference between the two groups (P=.73). Diabetes self-efficacy showed a large and significant increase during app usage for completers (mean change 1.28, P<.001, d=.83). Severity of illness perceptions showed a small but significant decrease during app usage for completers (mean change --0.51, P=.004, d=.43). Diabetes distress showed a small but significant decrease during app usage for completers (mean change --0.45, P=.006, d=.41). The net promoter score was 62.5, indicating that those who completed all levels of the app rated it highly and would recommend it to others. Conclusions: Participants who engaged in all 12 levels of the Time2Focus mobile app showed an improvement in diabetes self-efficacy and a decrease in severity of illness perceptions. The decrease in HbA1c observed in app users relative to nonusers during this limited pilot study was not statistically significant. However, uptake and application of lessons learned from self-management support may be delayed. Further research is needed to address how to increase engagement through self-management support and to investigate if follow up over a longer period demonstrates a significant change in outcomes such as HbA1c. ", doi="10.2196/17537", url="http://www.jmir.org/2021/1/e17537/", url="http://www.ncbi.nlm.nih.gov/pubmed/33470947" } @Article{info:doi/10.2196/24045, author="Yang, Samuel and Lee, Jennifer and Sezgin, Emre and Bridge, Jeffrey and Lin, Simon", title="Clinical Advice by Voice Assistants on Postpartum Depression: Cross-Sectional Investigation Using Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="11", volume="9", number="1", pages="e24045", keywords="voice assistant", keywords="virtual assistant", keywords="conversational agent", keywords="postpartum depression", keywords="mobile health", keywords="mental health", abstract="Background: A voice assistant (VA) is inanimate audio-interfaced software augmented with artificial intelligence, capable of 2-way dialogue, and increasingly used to access health care advice. Postpartum depression (PPD) is a common perinatal mood disorder with an annual estimated cost of \$14.2 billion. Only a small percentage of PPD patients seek care due to lack of screening and insufficient knowledge of the disease, and this is, therefore, a prime candidate for a VA-based digital health intervention. Objective: In order to understand the capability of VAs, our aim was to assess VA responses to PPD questions in terms of accuracy, verbal response, and clinically appropriate advice given. Methods: This cross-sectional study examined four VAs (Apple Siri, Amazon Alexa, Google Assistant, and Microsoft Cortana) installed on two mobile devices in early 2020. We posed 14 questions to each VA that were retrieved from the American College of Obstetricians and Gynecologists (ACOG) patient-focused Frequently Asked Questions (FAQ) on PPD. We scored the VA responses according to accuracy of speech recognition, presence of a verbal response, and clinically appropriate advice in accordance with ACOG FAQ, which were assessed by two board-certified physicians. Results: Accurate recognition of the query ranged from 79\% to 100\%. Verbal response ranged from 36\% to 79\%. If no verbal response was given, queries were treated like a web search between 33\% and 89\% of the time. Clinically appropriate advice given by VA ranged from 14\% to 29\%. We compared the category proportions using the Fisher exact test. No single VA statistically outperformed other VAs in the three performance categories. Additional observations showed that two VAs (Google Assistant and Microsoft Cortana) included advertisements in their responses. Conclusions: While the best performing VA gave clinically appropriate advice to 29\% of the PPD questions, all four VAs taken together achieved 64\% clinically appropriate advice. All four VAs performed well in accurately recognizing a PPD query, but no VA achieved even a 30\% threshold for providing clinically appropriate PPD information. Technology companies and clinical organizations should partner to improve guidance, screen patients for mental health disorders, and educate patients on potential treatment. ", doi="10.2196/24045", url="http://mhealth.jmir.org/2021/1/e24045/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427680" } @Article{info:doi/10.2196/22947, author="Schooley, Benjamin and Singh, Akanksha and Hikmet, Ne?et and Brookshire, Robert and Patel, Nitin", title="Integrated Digital Patient Education at the Bedside for Patients with Chronic Conditions: Observational Study", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="22", volume="8", number="12", pages="e22947", keywords="patient education", keywords="patient understanding", keywords="blended learning", keywords="adherence", keywords="digital patient education", keywords="chronic condition", keywords="understanding", keywords="outcome", keywords="mHealth", keywords="education", keywords="digital health", abstract="Background: Patient education delivered by a health care provider increases patients' understanding and adherence to medical instructions, which helps to improve patient health. Multiple challenges exist to delivering effective patient education to patients with multiple chronic conditions, including giving the necessary time, range, and types of learning materials, and assessing the level of understanding. To help overcome these challenges, it is important to study new electronic means to assist in patient education, such as the use of mobile devices, interactive media, 3-dimensional images, and multimedia educational content at the bedside. Objective: The goal of this study was to address the need for blended learning strategies combining technical and workflow integration of digital patient education systems for patients with chronic conditions within and across the regular process of care. Studies are needed to evaluate the utility and benefits of these technologies for providers and patients alike. Methods: A mixed-methods approach was employed including survey administration to 178 patients after they received digital patient education in person with a health care provider, and qualitative interviews with 16 nurse educators who used the mobile digital health education technology to deliver instruction to patients. Patient survey data were analyzed using chi-square statistical tests. Qualitative interviews were analyzed for user acceptance and perceived value themes. Results: Patients who were counseled using a blended digital health education approach reported improved understanding of educational content (P=.034) and chronic health conditions (P<.001), were more motivated to care for themselves at home (P<.001), were more likely to say that they felt capable of making health care decisions with their doctors (P<.001) and on their own (P=.001), and were more likely to report their intention to follow their doctor's instructions (P<.001) than were patients whose education was not computer-based. Nurse educators felt that the digital education system and content enhanced their education efforts and could be easily integrated into the outpatient clinical workflow. Conclusions: Patient education for individuals with chronic conditions may be more effective than traditional formats when provided in blended digital formats supervised by a health care provider. ", doi="10.2196/22947", url="http://mhealth.jmir.org/2020/12/e22947/", url="http://www.ncbi.nlm.nih.gov/pubmed/33350961" } @Article{info:doi/10.2196/17542, author="Bashi, Nazli and Varnfield, Marlien and Karunanithi, Mohanraj", title="A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach", journal="JMIR Form Res", year="2020", month="Dec", day="18", volume="4", number="12", pages="e17542", keywords="mobile health", keywords="mHealth", keywords="mobile health apps", keywords="smartphone", keywords="mobile phone", keywords="self-management", keywords="patient education", keywords="cardiovascular disease", keywords="acute coronary syndrome", abstract="Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology--Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists' survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients' data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. ", doi="10.2196/17542", url="http://formative.jmir.org/2020/12/e17542/", url="http://www.ncbi.nlm.nih.gov/pubmed/33337339" } @Article{info:doi/10.2196/18316, author="Aida, Azusa and Svensson, Thomas and Svensson, Kishi Akiko and Chung, Ung-Il and Yamauchi, Toshimasa", title="eHealth Delivery of Educational Content Using Selected Visual Methods to Improve Health Literacy on Lifestyle-Related Diseases: Literature Review", journal="JMIR Mhealth Uhealth", year="2020", month="Dec", day="9", volume="8", number="12", pages="e18316", keywords="application", keywords="educational", keywords="eHealth", keywords="health literacy", keywords="lifestyle-related disease", keywords="mHealth", keywords="review", abstract="Background: Lifestyle-related diseases, such as stroke, heart disease, and diabetes, are examples of noncommunicable diseases. Noncommunicable diseases are now the leading cause of death in the world, and their major causes are lifestyle related. The number of eHealth interventions is increasing, which is expected to improve individuals' health literacy on lifestyle-related diseases. Objective: This literature review aims to identify existing literature published in the past decade on eHealth interventions aimed at improving health literacy on lifestyle-related diseases among the general population using selected visual methods, such as educational videos, films, and movies. Methods: A systematic literature search of the PubMed database was conducted in April 2019 for papers written in English and published from April 2, 2009, through April 2, 2019. A total of 538 papers were identified and screened in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. Finally, 23 papers were included in this review. Results: The 23 papers were characterized according to study characteristics (author and year of publication, study design and region where the study was conducted, study objective, service platform, target disease and participant age, research period, outcomes, and research method); the playback time of the educational videos, films, and movies; and the evaluation of the study's impacts on health literacy. A total of 7 studies compared results using statistical methods. Of these, 5 studies reported significant positive effects of the intervention on health literacy and health-related measures (eg, physical activity, body weight). Although most of the studies included educational content aimed at improving health literacy, only 7 studies measured health literacy. In addition, only 5 studies assessed literacy using health literacy measurement tools. Conclusions: This review found that the provision of educational content was satisfactory in most eHealth studies using selected visual methods, such as videos, films, and movies. These findings suggest that eHealth interventions influence people's health behaviors and that the need for this intervention is expected to increase. Despite the need to develop eHealth interventions, standardized measurement tools to evaluate health literacy are lacking. Further research is required to clarify acceptable health literacy measurements. ", doi="10.2196/18316", url="http://mhealth.jmir.org/2020/12/e18316/", url="http://www.ncbi.nlm.nih.gov/pubmed/33295296" } @Article{info:doi/10.2196/18174, author="Brief, James and Chawla, Anupama and Lerner, Diana and Vitola, Bernadette and Woroniecki, Robert and Morganstern, Jeffrey", title="The Impact of a Smartphone App on the Quality of Pediatric Colonoscopy Preparations: Randomized Controlled Trial", journal="JMIR Pediatr Parent", year="2020", month="Nov", day="10", volume="3", number="2", pages="e18174", keywords="colonoscopy", keywords="app", keywords="pediatrics", keywords="prep", keywords="smartphone", keywords="mobile phone", keywords="mHealth", abstract="Background: Smartphone apps have been successfully used to help adults prepare for colonoscopies. However, no study to date has investigated the effect of a smartphone app on pediatric colonoscopy preparation. Objective: The aim of this study is to determine if an app (SB Colonoscopy Prep) designed to educate and guide patients through their colonoscopy preparation will yield benefits over paper-based instructions and information. Methods: In total, 46 patients aged 5-18 years received either app-based or written material with instructions on how to take their prep medications as well as information about the colonoscopy procedure. Prep quality, the number of calls to the gastroenterology service, and patient arrival time were recorded. After the procedure, a questionnaire was given to each patient through which they graded their knowledge of the procedure both before and after receiving the app or written material. Results: App users had higher mean Boston scores versus control subjects receiving written instructions (7.2 vs 5.9, P=.02), indicating better colonoscopy preps. In total, 75\% (15/20) of app users and 41\% (9/22) of written instruction users had preps categorized as ``excellent'' on the Boston scale. We found no significant differences in knowledge about the procedure (app users: 10/20 [50\%], written instruction users 8/22 [36\%]; P=.37), phone calls to the gastroenterology clinic (n=6 vs n=2; P=.27), or arrival times at the endoscopy suite (44 min vs 46 min before the scheduled procedure time; P=.56). Conclusions: Smartphone app use was associated with an increased number of colonoscopy preps classified as ``excellent'' on the Boston scale. There was no significant difference between app users and the control group regarding the number of calls to the gastroenterology clinic, patient arrival time, or patient knowledge about the procedure. Trial Registration: ClinicalTrials.gov NCT04590105; https://clinicaltrials.gov/ct2/show/NCT04590105 ", doi="10.2196/18174", url="https://pediatrics.jmir.org/2020/2/e18174", url="http://www.ncbi.nlm.nih.gov/pubmed/33170131" } @Article{info:doi/10.2196/19953, author="Su, Yanfang and Heitner, Jesse and Yuan, Changzheng and Si, Yafei and Wang, Dan and Zhou, Zhiying and Zhou, Zhongliang", title="Effect of a Text Messaging--Based Educational Intervention on Cesarean Section Rates Among Pregnant Women in China: Quasirandomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Nov", day="3", volume="8", number="11", pages="e19953", keywords="cesarean section", keywords="short message service", keywords="SMS text messaging", keywords="quasirandomized controlled trial", keywords="mobile health", abstract="Background: Consensus exists that appropriate regional cesarean rates should not exceed 15\% of births, but China's cesarean rate exceeds 50\% in some areas, prompting numerous calls for its reduction. At present, China's 2016 two-child policy has heightened the implications of national cesarean section trends. Objective: This study leveraged pervasive cellular phone access amongst Chinese citizens to test the effect of a low-cost and scalable prenatal advice program on cesarean section rates. Methods: Participants were pregnant women presenting for antenatal care at a clinic in Xi'an, China. Assignment was quasirandomized and utilized factorial assignment based on the expecting mother's birthday. Participants were assigned to one of the following four groups, with each receiving a different set of messages: (1) a comparison group that received only a few ``basic'' messages, (2) a group receiving messages primarily regarding care seeking, (3) a group receiving messages primarily regarding good home prenatal practices, and (4) a group receiving text messages of all groups. Messages were delivered throughout pregnancy and were tailored to each woman's gestational week. The main outcome was the rates of cesarean delivery reported in the intervention arms. Data analysts were blinded to treatment assignment. Results: In total, 2115 women completed the trial and corresponding follow-up surveys. In the unadjusted analysis, the group receiving all texts was associated with an odds ratio of 0.77 (P=.06), though neither the care seeking nor good home prenatal practice set yielded a relevant impact. Adjusting for potentially confounding covariates showed that the group with all texts sent together was associated with an odds ratio of 0.67 (P=.01). Notably, previous cesarean section evoked an odds ratio of 11.78 (P<.001), highlighting that having a cesarean section predicts future cesarean section in a subsequent pregnancy. Conclusions: Sending pregnant women in rural China short informational messages with integrated advice regarding both care-seeking and good home prenatal practices appears to reduce women's likelihood of undergoing cesarean section. Reducing clear medical indications for cesarean section seems to be the strongest potential pathway of the effect. Cesarean section based on only maternal request did not seem to occur regularly in our study population. Preventing unnecessary cesarean section at present may have a long-term impact on future cesarean section rates. Trial Registration: ClinicalTrials.gov NCT02037087; https://clinicaltrials.gov/ct2/show/NCT02037087. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-011016 ", doi="10.2196/19953", url="https://mhealth.jmir.org/2020/11/e19953", url="http://www.ncbi.nlm.nih.gov/pubmed/33141099" } @Article{info:doi/10.2196/21704, author="Biebl, Theresia Johanna and Huber, Stephan and Rykala, Marzena and Kraft, Eduard and Lorenz, Andreas", title="Attitudes and Expectations of Health Care Professionals Toward App-Based Therapy in Patients with Osteoarthritis of the Hip or Knee: Questionnaire Study", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="28", volume="8", number="10", pages="e21704", keywords="mobile health", keywords="digital health", keywords="self-management", keywords="osteoarthritis", keywords="smartphone", keywords="patient education", keywords="exercise therapy", abstract="Background: The use of mobile health (mHealth) apps is becoming increasingly widespread. However, little is known about the attitudes, expectations, and basic acceptance of health care professionals toward such treatment options. As physical activity and behavior modification are crucial in osteoarthritis management, app-based therapy could be particularly useful for the self-management of this condition. Objective: The objective of the study was to determine the expectations and attitudes of medical professionals toward app-based therapy for osteoarthritis of the hip or knee. Methods: Health care professionals attending a rehabilitation congress and employees of a university hospital were asked to fill out a questionnaire consisting of 16 items. A total of 240 questionnaires were distributed. Results: A total of 127 participants completed the questionnaire. At 95.3\% (121/127), the approval rate for app-based therapy for patients with osteoarthritis of the hip or knee was very high. Regarding possible concerns, aspects related to data protection and privacy were primarily mentioned (41/127, 32.3\%). Regarding potential content, educational units, physiotherapeutic exercise modules, and practices based on motivation psychology were all met with broad approval. Conclusions: The study showed a high acceptance of app-based therapy for osteoarthritis, indicating a huge potential of this form of treatment to be applied, prescribed, and recommended by medical professionals. It was widely accepted that the content should reflect a multimodal therapy approach. ", doi="10.2196/21704", url="http://mhealth.jmir.org/2020/10/e21704/", url="http://www.ncbi.nlm.nih.gov/pubmed/33112255" } @Article{info:doi/10.2196/20982, author="Aida, Azusa and Svensson, Thomas and Svensson, Kishi Akiko and Urushiyama, Hirokazu and Okushin, Kazuya and Oguri, Gaku and Kubota, Naoto and Koike, Kazuhiko and Nangaku, Masaomi and Kadowaki, Takashi and Yamauchi, Toshimasa and Chung, Ung-Il", title="Using mHealth to Provide Mobile App Users With Visualization of Health Checkup Data and Educational Videos on Lifestyle-Related Diseases: Methodological Framework for Content Development", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="21", volume="8", number="10", pages="e20982", keywords="apps", keywords="educational videos", keywords="health checkup", keywords="lifestyle-related disease", keywords="mHealth, prevention", keywords="telehealth", keywords="visualization", abstract="Background: The number of people with lifestyle-related diseases continues to increase worldwide. Improving lifestyle behavior with health literacy may be the key to address lifestyle-related diseases. The delivery of educational videos using mobile health (mHealth) services can replace the conventional way of educating individuals, and visualization can replace the provision of health checkup data. Objective: This paper aimed to describe the development of educational content for MIRAMED, a mobile app aimed at improving users' lifestyle behaviors and health literacy for lifestyle-related diseases. Methods: All videos were based on a single unified framework to provide users with a consistent flow of information. The framework was later turned into a storyboard. The final video contents were created based on this storyboard and further discussions with leading experts and specialist physicians on effective communication with app users about lifestyle-related diseases. Results: The app uses visualization of personal health checkup data and educational videos on lifestyle-related diseases based on the current health guidelines, scientific evidence, and expert opinions of leading specialist physicians in the respective fields. A total of 8 videos were created for specific lifestyle-related diseases affecting 8 organs: (1) brain--cerebrovascular disorder, (2) eyes--diabetic retinopathy, (3) lungs--chronic obstructive pulmonary disease, (4) heart--ischemic heart disease, (5) liver--fatty liver, (6) kidneys--chronic kidney disease (diabetic kidney disease), (7) blood vessels--peripheral arterial disease, and (8) nerves--diabetic neuropathy. Conclusions: Providing enhanced mHealth education using novel digital technologies to visualize conventional health checkup data and lifestyle-related diseases is an innovative strategy. Future studies to evaluate the efficacy of the developed content are planned. ", doi="10.2196/20982", url="http://mhealth.jmir.org/2020/10/e20982/", url="http://www.ncbi.nlm.nih.gov/pubmed/33084586" } @Article{info:doi/10.2196/19153, author="Lee, Young Da and Yoo, Seung-Hyun and Min, Pil Kyong and Park, Cheol-Young", title="Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="18", volume="8", number="9", pages="e19153", keywords="diabetes mellitus", keywords="health services research", keywords="mobile applications", keywords="diabetes", keywords="mHealth", keywords="app", keywords="lifestyle", keywords="self-management", keywords="volunteer", keywords="participation", abstract="Background: The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective: We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods: This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results: A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions: mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration: ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283 ", doi="10.2196/19153", url="http://mhealth.jmir.org/2020/9/e19153/", url="http://www.ncbi.nlm.nih.gov/pubmed/32945775" } @Article{info:doi/10.2196/17083, author="Alenazi, A. Hanan and Jamal, Amr and Batais, A. Mohammed", title="Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="11", volume="8", number="9", pages="e17083", keywords="diabetes", keywords="mobile features", keywords="engagement strategies", keywords="mobile app", keywords="Delphi consensus", abstract="Background: Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6\% of the general population, and the prevalence of T2DM is predicted to rise to 45.36\% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. Objective: The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. Methods: In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. Results: In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user's goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients' app use compliance during clinical visits (6.91), and flexibility and customization (7.91). Conclusions: This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts' opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic. ", doi="10.2196/17083", url="http://mhealth.jmir.org/2020/9/e17083/", url="http://www.ncbi.nlm.nih.gov/pubmed/32678798" } @Article{info:doi/10.2196/14346, author="Peuchot, Jeremy and Allard, Etienne and Dureuil, Bertrand and Veber, Benoit and Comp{\`e}re, Vincent", title="Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="10", volume="8", number="9", pages="e14346", keywords="outpatient surgery", keywords="short message service (SMS)", keywords="patient information", keywords="organizational", keywords="cost", keywords="unanticipated admission", keywords="preoperative instructions", abstract="Background: Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective: The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods: We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results: A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77\%) with a difference between SMS group (8/2228, 0.36\%) and telephone group (26/2160, 1.20\%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions: In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting. ", doi="10.2196/14346", url="https://mhealth.jmir.org/2020/9/e14346", url="http://www.ncbi.nlm.nih.gov/pubmed/32909948" } @Article{info:doi/10.2196/17646, author="Garg, Rani Priyanka and Uppal, Leena and Mehra, Sunil and Mehra, Devika", title="Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="8", volume="8", number="9", pages="e17646", keywords="mHealth", keywords="Indonesia", keywords="HIV", keywords="key populations", abstract="Background: Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. Objective: The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. Methods: A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98\% and 70\%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. Results: From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20\% (10/49) to 60\% (29/49), 22\% (11/49) to 57\% (28/49), and 49\% (34/70) to 74\% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22\% (11/49) to 19\% (9/49), 18\% (9/49) to 12\% (6/49), and 21\% (15/70) to 10\% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31\% (15/49) for men who have sex with men, 49\% (24/49) for transgender women, and 26\% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78\%) to 15/70 (26\%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27\% (7/24) of men who have sex with men, 25\% (4/15) of transgender women, and 11\% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80\% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. Conclusions: This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV. ", doi="10.2196/17646", url="https://mhealth.jmir.org/2020/9/e17646", url="http://www.ncbi.nlm.nih.gov/pubmed/32896831" } @Article{info:doi/10.2196/13179, author="Jansen, Ronelle and Reid, Marianne", title="Communication Technology Use by Caregivers of Adolescents With Mental Health Issues: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="19", volume="8", number="8", pages="e13179", keywords="caregiver", keywords="communication technology", keywords="adolescent", keywords="mental health issues", keywords="systematic review", keywords="self-efficacy, knowledge", keywords="parental skills", keywords="IMBP", abstract="Background: Caregivers of adolescents with mental health issues experience challenges that may result in the caregivers having a variety of unmet needs. There is a growing need to support these caregivers. Effective support to strengthen positive caregiving behavior in caregivers may address their challenges. Communication technologies offer novel opportunities to assist these caregivers and may contribute to strengthening caregiver behavior. However, little is known about the use of communication technologies among caregivers of adolescents with mental health issues. Objective: The study aimed to answer the question: ``What is the best evidence available to strengthen positive behavior of caregivers of adolescents with mental health issues using communication technology.'' Methods: A systematic review of articles published between January 2007 and August 2018 was conducted. Searches included articles of multiple study designs from EBSCO Host and Scopus platforms with prespecified eligibility criteria. Methodological quality was evaluated using the applicable Critical Appraisal Skills Programme and Joanna Briggs Institute assessment tools. Results: The search yielded 1746 articles. Altogether, 5 articles met the eligibility criteria and were included in the review for data synthesis. Data analysis and synthesis identified three thematic conclusions reflecting the types of communication technologies used, caregivers as the target population, and strengthening of positive behavior through determinants of the Integrated Model of Behavior Prediction. Conclusions: The review reported the usefulness of communication technology by caregivers. Caregivers also demonstrated improvement in self-efficacy, knowledge, parent-child communication, and parental skills reflecting positive behavior. Although the use of communication technology is expanding as a supportive intervention to address caregivers' needs, the evidence for usefulness among caregivers of adolescents with mental health issues is still scarce. More research and information related to preferred methods of communication delivery among caregivers of adolescents is still needed. ", doi="10.2196/13179", url="http://mhealth.jmir.org/2020/8/e13179/", url="http://www.ncbi.nlm.nih.gov/pubmed/32663143" } @Article{info:doi/10.2196/19531, author="Langford, Aisha and Orellana, Kerli and Kalinowski, Jolaade and Aird, Carolyn and Buderer, Nancy", title="Use of Tablets and Smartphones to Support Medical Decision Making in US Adults: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="12", volume="8", number="8", pages="e19531", keywords="smartphone", keywords="mHealth", keywords="eHealth", keywords="mobile phone", keywords="cell phone", keywords="tablets", keywords="ownership", keywords="decision making", keywords="health communication", keywords="telemedicine", keywords="monitoring", keywords="physiologic", keywords="surveys and questionnaires", abstract="Background: Tablet and smartphone ownership have increased among US adults over the past decade. However, the degree to which people use mobile devices to help them make medical decisions remains unclear. Objective: The objective of this study is to explore factors associated with self-reported use of tablets or smartphones to support medical decision making in a nationally representative sample of US adults. Methods: Cross-sectional data from participants in the 2018 Health Information National Trends Survey (HINTS 5, Cycle 2) were evaluated. There were 3504 responses in the full HINTS 5 Cycle 2 data set; 2321 remained after eliminating respondents who did not have complete data for all the variables of interest. The primary outcome was use of a tablet or smartphone to help make a decision about how to treat an illness or condition. Sociodemographic factors including gender, race/ethnicity, and education were evaluated. Additionally, mobile health (mHealth)- and electronic health (eHealth)-related factors were evaluated including (1) the presence of health and wellness apps on a tablet or smartphone, (2) use of electronic devices other than tablets and smartphones to monitor health (eg, Fitbit, blood glucose monitor, and blood pressure monitor), and (3) whether people shared health information from an electronic monitoring device or smartphone with a health professional within the last 12 months. Descriptive and inferential statistics were conducted using SAS version 9.4. Weighted population estimates and standard errors, univariate odds ratios, and 95\% CIs were calculated, comparing respondents who used tablets or smartphones to help make medical decisions (n=944) with those who did not (n=1377), separately for each factor. Factors of interest with a P value of <.10 were included in a subsequent multivariable logistic regression model. Results: Compared with women, men had lower odds of reporting that a tablet or smartphone helped them make a medical decision. Respondents aged 75 and older also had lower odds of using a tablet or smartphone compared with younger respondents aged 18-34. By contrast, those who had health and wellness apps on tablets or smartphones, used other electronic devices to monitor health, and shared information from devices or smartphones with health care professionals had higher odds of reporting that tablets or smartphones helped them make a medical decision, compared with those who did not. Conclusions: A limitation of this research is that information was not available regarding the specific health condition for which a tablet or smartphone helped people make a decision or the type of decision made (eg, surgery, medication changes). In US adults, mHealth and eHealth use, and also certain sociodemographic factors are associated with using tablets or smartphones to support medical decision making. Findings from this study may inform future mHealth and other digital health interventions designed to support medical decision making. ", doi="10.2196/19531", url="https://mhealth.jmir.org/2020/8/e19531", url="http://www.ncbi.nlm.nih.gov/pubmed/32784181" } @Article{info:doi/10.2196/17193, author="Maidment, W. David and Heyes, Rachel and Gomez, Rachel and Coulson, S. Neil and Wharrad, Heather and Ferguson, A. Melanie", title="Evaluating a Theoretically Informed and Cocreated Mobile Health Educational Intervention for First-Time Hearing Aid Users: Qualitative Interview Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="5", volume="8", number="8", pages="e17193", keywords="hearing loss", keywords="hearing aids", keywords="telemedicine", keywords="behavioral medicine", keywords="qualitative research", keywords="mobile phone", abstract="Background: Adults living with hearing loss have highly variable knowledge of hearing aids, resulting in suboptimal use or nonuse. This issue can be addressed by the provision of high-quality educational resources. Objective: This study aims to assess the everyday experiences of first-time hearing aid users when using a newly developed, theoretically informed cocreated mobile health (mHealth) educational intervention called m2Hear. This intervention aims to deliver greater opportunities for individualization and interactivity compared with our previously developed multimedia intervention, C2Hear. Methods: A total of 16 first-time hearing aid users trialed m2Hear for a period of 10-weeks in their everyday lives, after which individual semistructured interviews were completed. The data were analyzed using an established deductive thematic analysis procedure underpinned by the Capability, Opportunity, Motivation-Behavior model. The model stipulates that to engage in a target behavior, an individual must have physical and psychological capability, physical and social opportunity, and automatic and reflective motivation. Results: Capability---m2Hear was viewed as a concise and comprehensive resource, suitable for a range of digital literacy skills. It was stated that m2Hear could be conveniently reused to provide useful reminders that facilitate knowledge of hearing aids and communication. Opportunity---m2Hear was simple and straightforward to use, enabling greater individualization and independence. The availability of m2Hear via mobile technologies also improved accessibility. Motivation---m2Hear provided greater support and reassurance, improving confidence and empowering users to self-manage their hearing loss. Conclusions: Overall, this qualitative study suggests that m2Hear supports first-time hearing aid users to successfully self-manage their hearing loss postfitting. Furthermore, this study demonstrates the utility of employing a combined theoretical and ecologically valid approach in the development of mHealth educational resources to meet the individual self-management needs of adults living with hearing loss. Trial Registration: ClinicalTrials.gov NCT03136718; https://clinicaltrials.gov/ct2/show/NCT03136718 ", doi="10.2196/17193", url="https://mhealth.jmir.org/2020/8/e17193", url="http://www.ncbi.nlm.nih.gov/pubmed/32755885" } @Article{info:doi/10.2196/18132, author="Wang, Tze-Fang and Huang, Rou-Chen and Yang, Su-Chen and Chou, Chyuan and Chen, Lee-Chen", title="Evaluating the Effects of a Mobile Health App on Reducing Patient Care Needs and Improving Quality of Life After Oral Cancer Surgery: Quasiexperimental Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="27", volume="8", number="7", pages="e18132", keywords="care needs", keywords="health information", keywords="mobile health app", keywords="oral cancer", keywords="technology acceptance", keywords="quality of life", abstract="Background: Intervention with a mobile Health (mHealth) app can improve the efficacy of early detection of oral cancer and the outcomes for patients taking oral anticancer medications. The quality of life of oral cancer patients is significantly reduced within three months after surgery; also, their needs for nursing care and health information increase, mainly due to side effects and associated psychological problems. Objective: This study aimed to evaluate changes in the care needs and quality of life of patients with oral cancer after receiving the intervention of a newly developed mHealth app. Methods: After surgery, oral cancer patients were divided into an experimental group (n=50) who received the mHealth app intervention and a control group (n=50) who received routine health care and instruction. After 3 months of intervention, survey questionnaires were used to assess the patients' quality of life, nursing care needs, and acceptance of the mHealth app. Results: The physiological care needs were significantly decreased in the experimental group compared with the control group (P<.05). Although the differences were not statistically significant, the psychological needs, communication needs, and care support needs all improved after the mHealth app intervention. The overall improvement in quality of life was higher in the experimental group than in the control group (--7.24 vs --4.36). In terms of intention to use, perceived usefulness, and perceived ease of use, the acceptability scores of the mHealth app were significantly increased after 3 months of intervention (P<.05). Conclusions: Compared with routine health care and instruction, for patients after surgery, the education/information intervention using the mHealth app significantly reduced their nursing care needs, improved their quality of life, and increased their acceptance of using an mHealth app on a mobile device. These findings can provide a theoretical basis for future health care app design and improvement. This study suggests that an mHealth app should be incorporated into the routine care of oral cancer patients to provide medical information quickly and improve their self-management abilities, thereby reducing the patients' need for physiological care and improving their quality of life. Trial Registration: ClinicalTrials.gov NCT04049968; https://www.clinicaltrials.gov/ct2/show/NCT04049968 ", doi="10.2196/18132", url="http://mhealth.jmir.org/2020/7/e18132/", url="http://www.ncbi.nlm.nih.gov/pubmed/32716303" } @Article{info:doi/10.2196/16979, author="Garvelink, Marjolein Mirjam and Agbadj{\'e}, Tatiana Titilayo and Freitas, Adriana and Bergeron, Lysa and Petitjean, Thomas and Dugas, Mich{\`e}le and Blair, Louisa and Archambault, Patrick and Roy, No{\'e}mie and Jones, Allyson and L{\'e}gar{\'e}, France", title="Improving a Web-Based Tool to Support Older Adults to Stay Independent at Home: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e16979", keywords="internet-based intervention", keywords="frail elderly", keywords="caregivers", keywords="decision making", keywords="personal autonomy", keywords="housing for the elderly", abstract="Background: Older adults desire to stay independent at home for as long as possible. We developed an interactive website to inform older adults and caregivers about ways to achieve this. Objective: This study aimed to perform an in-depth exploration among potential end users about how to improve the interactive website to better inform older adults and caregivers about ways to stay independent at home. Methods: To complement the results of a quantitative survey on the usability and acceptability of the website before implementation, we conducted a qualitative descriptive study. Using multiple recruitment strategies, we recruited a purposeful sample of older adults (aged ?65 years) and caregivers of older adults struggling to stay independent at home. We conducted face-to-face or telephonic interviews in either English or French. In addition, we collected sociodemographic characteristics, other characteristics of participants (eg, health, digital profile, and perception of retirement homes), and experiences with using the website (factors facilitating the use of the website, barriers to its use, and suggestions for improvement). Interviews were audio recorded, transcribed verbatim, and thematically analyzed by two researchers. Results: We recruited 15 participants, including 5 older adults (mean age 75 years, SD 6) and 10 caregivers (mean age 57 years, SD 14). The mean interview time was 32 min (SD 14). Most older adults had either mobility or health problems or both, and many of them were receiving home care services (eg, blood pressure measurement and body care). Overall, participants found the website easy to navigate using a computer, reassuring, and useful for obtaining information. Barriers were related to navigation (eg, difficult to navigate with a cellphone), relevance (eg, no specific section for caregivers), realism (eg, some resources presented are not state funded), understandability (eg, the actors' accents were difficult to understand), and accessibility (eg, not adapted for low digital literacy). Suggestions for improvement included a needs assessment section to direct users to the support appropriate to their needs, addition of information about moving into residential care, a section for caregivers, distinction between state-provided and private support services, simpler language, expansion of content to be relevant to all of Canada, and video subtitles for the hearing impaired. Conclusions: Users provided a wealth of information about the needs of older adults who were facing a loss of autonomy and about what such a website could usefully provide. The request for less generic and more personalized information reflects the wide range of needs that electronic health innovations, such as our interactive website, need to address. After integrating the changes suggested, the new website---Support for Older Adults to Stay Independent at Home (SUSTAIN)---will be implemented and made available to better assist older adults and caregivers in staying independent at home. ", doi="10.2196/16979", url="https://mhealth.jmir.org/2020/7/e16979", url="http://www.ncbi.nlm.nih.gov/pubmed/32412908" } @Article{info:doi/10.2196/17430, author="Pereira, Claudio Antonio Augusto and Destro, Regina Juliana and Picinin Bernuci, Marcelo and Garcia, Fran{\c{c}}a Lucas and Rodrigues Lucena, Franklin Tiago", title="Effects of a WhatsApp-Delivered Education Intervention to Enhance Breast Cancer Knowledge in Women: Mixed-Methods Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="21", volume="8", number="7", pages="e17430", keywords="mHealth", keywords="WhatsApp", keywords="cancer education", keywords="breast cancer", abstract="Background: Breast cancer is the leading cause of cancer-related death in the female population. Health education interventions based on the use of mobile technologies enable the development of health self-care skills and have emerged as alternative strategies for the control of breast cancer. In previous studies, WhatsApp has stood out as a useful tool in health education strategies; however, it has not yet been applied for breast cancer education. Objective: This study aimed to analyze the potential of WhatsApp as a health education tool used to improve women's knowledge on the risk reduction of breast cancer. It also aimed to understand how women feel sensitized within the WhatsApp group throughout the intervention and how they incorporate information posted to improve knowledge about early detection and risk reduction methods. Methods: The study involved a pre-post health educational intervention with 35 women (aged 45-69 years) included in a WhatsApp group to share information (audio, video, text, and images) over 3 weeks on the early detection and risk reduction of breast cancer. Data were collected through questionnaires on topics related to risk reduction, as well as qualitative content analysis of group interactions. Effectiveness and feasibility were analyzed through conversations and the comparison of the scores obtained in the questionnaires before and after the intervention. Results: A total of 293 messages were exchanged (moderator 120 and users 173). The average scores of the participants were 11.21 and 13.68 points before and after the educational intervention, respectively, with sufficient sample evidence that the difference was significant (P<.001). The intervention enabled women to improve their knowledge on all topics addressed, especially ``myths and truths,'' ``incidence,'' ``clinical manifestations,'' and ``protective factors.'' Some themes emerged from the interactions in the group, including group dynamics, general doubts, personal narratives, religious messages, daily news, and events. Conclusions: The use of groups for women in WhatsApp for health education purposes seems to be a viable alternative in strategies on breast cancer control, especially as it provides a space for the exchange of experiences and disinhibition. However, the need for a moderator to answer the questions and the constant distractions by members of the group represent important limitations that should be considered when improving this strategy. ", doi="10.2196/17430", url="http://mhealth.jmir.org/2020/7/e17430/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706726" } @Article{info:doi/10.2196/14618, author="Papa, Roberta and Efthymiou, Areti and Lamura, Giovanni and Piccinini, Flavia and Onorati, Giulia and Papastavrou, Evridiki and Tsitsi, Theologia and Casu, Giulia and Boccaletti, Licia and Manattini, Alessandra and Seneca, Rita and Vaz de Carvalho, Carlos and Dur{\~a}o, Rita and Barbabella, Francesco and Andr{\'e}asson, Frida and Magnusson, Lennart and Hanson, Elizabeth", title="Review and Selection of Online Resources for Carers of Frail Adults or Older People in Five European Countries: Mixed-Methods Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="17", volume="8", number="6", pages="e14618", keywords="informal carers", keywords="mobile apps", keywords="websites", keywords="usability", keywords="reliability", abstract="Background: Informal carers have a crucial role in the care of older people, but they are at risk of social isolation and psychological exhaustion. Web-based services like apps and websites are increasingly used to support informal carers in addressing some of their needs and tasks, such as health monitoring of their loved ones, information and communication, and stress management. Despite the growing number of available solutions, the lack of knowledge or skills of carers about the solutions often prevent their usage. Objective: This study aimed to review and select apps and websites offering functionalities useful for informal carers of frail adults or older people in 5 European countries (Cyprus, Greece, Italy, Portugal, and Sweden). Methods: A systematic online search was conducted from January 2017 to mid-March 2017 using selected keywords, followed by an assessment based on a set of commonly agreed criteria and standardized tools. Selected resources were rated and classified in terms of scope. Focus groups with informal carers were conducted to validate the list and the classification of resources. The activities were conducted in parallel in the participating countries using common protocols and guidelines, a standardization process, and scheduled group discussions. Results: From a total of 406 eligible resources retrieved, 138 apps and 86 websites met the inclusion criteria. Half of the selected resources (109/224, 48.7\%) were disease-specific, and the remaining resources included information and utilities on a variety of themes. Only 38 resources (38/224, 17.0\%) were devoted specifically to carers, addressing the management of health disturbances and diseases of the care recipient and focusing primarily on neurodegenerative diseases. Focus groups with the carers showed that almost all participants had no previous knowledge of any resource specifically targeting carers, even if interest was expressed towards carer-focused resources. The main barriers for using the resources were low digital skills of the carers and reliability of health-related apps and websites. Results of the focus groups led to a new taxonomy of the resources, comprising 4 categories: carer's wellbeing, managing health and diseases of the care recipient, useful contacts, and technologies for eldercare. Conclusions: The review process allowed the identification of online resources of good quality. However, these resources are still scarce due to a lack of reliability and usability that prevent users from properly benefiting from most of the resources. The involvement of end users provided added value to the resource classification and highlighted the gap between the potential benefits from using information and communication technologies and the real use of online resources by carers. ", doi="10.2196/14618", url="http://mhealth.jmir.org/2020/6/e14618/", url="http://www.ncbi.nlm.nih.gov/pubmed/32554378" } @Article{info:doi/10.2196/17372, author="Tian, Xu and Xu, Ling-Li and Liu, Xiao-Ling and Chen, Wei-Qing", title="Enhanced Patient Education for Colonic Polyp and Adenoma Detection: Meta-Analysis of Randomized Controlled Trials", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="1", volume="8", number="6", pages="e17372", keywords="colonoscopy", keywords="bowel preparation", keywords="patient education", keywords="polyp detection rate", keywords="adenoma detection rate", keywords="meta-analysis", abstract="Background: To improve patients' comprehension of bowel preparation instructions before colonoscopy, enhanced patient education (EPE) such as cartoon pictures or other visual aids, phone calls, mobile apps, multimedia education and social media apps have been proposed. However, it is uncertain whether EPE can increase the detection rate of colonic polyps and adenomas. Objective: This meta-analysis aimed to evaluate the efficacy of EPE in detecting colonic polyps and adenomas. Methods: We searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from their inception to June 2019 for the identification of trials comparing the EPE with standard patient education for outpatients undergoing colonoscopy. We used a random effects model to calculate summary estimates of the polyp detection rate (defined as the number of patients with at least one polyp divided by the total number of patients undergoing selective colonoscopy), adenoma detection rate (defined as the number of patients with at least one adenoma divided by the total number of patients undergoing selective colonoscopy), advanced adenoma detection rate (defined as the number of patients with at least one advanced adenoma divided by the total number of patients undergoing selective colonoscopy), sessile serrated adenoma detection rate (defined as the number of patients with at least one sessile serrated adenoma divided by the total number of patients undergoing selective colonoscopy), cancer detection rate (defined as the number of patients with at least one cancer divided by the total number of patients undergoing selective colonoscopy), or adenoma detection rate - plus (defined as the number of additional adenomas found after the first adenoma per colonoscopy). Moreover, we conducted trial sequential analysis (TSA) to determine the robustness of summary estimates of all primary outcomes. Results: We included 10 randomized controlled trials enrolling 4560 participants for analysis. The meta-analysis suggested that EPE was associated with an increased polyp detection rate (9 trials; 3781 participants; risk ratio [RR] 1.19, 95\% CI 1.05-1.35; P<.05; I2=42\%) and adenoma detection rate (5 trials; 2133 participants; RR 1.37, 95\% CI 1.15-1.64; P<.001; I2=0\%), which were established by TSA. Pooled result from the inverse-variance model illustrated an increase in the sessile serrated adenoma detection rate (3 trials; 1248 participants; odds ratio 1.76, 95\% CI 1.22-2.53; P<.05; I2=0\%). One trial suggested an increase in the adenoma detection rate - plus (RR 4.39, 95\% CI 2.91-6.61; P<.001). Pooled estimates from 3 (1649 participants) and 2 trials (1375 participants) generated no evidence of statistical difference for the advanced adenoma detection rate and cancer detection rate, respectively. Conclusions: The current evidence indicates that EPE should be recommended to instruct bowel preparation in patients undergoing colonoscopy because it can increase the polyp detection rate, adenoma detection rate, and sessile serrated adenoma detection rate. However, further trials are warranted to determine the efficacy of EPE for advanced adenoma detection rate, adenoma detection rate - plus, and cancer detection rate because of limited data. ", doi="10.2196/17372", url="https://mhealth.jmir.org/2020/6/e17372", url="http://www.ncbi.nlm.nih.gov/pubmed/32347798" } @Article{info:doi/10.2196/15111, author="Hussain, Tasmeen and Smith, Patricia and Yee, M. Lynn", title="Mobile Phone--Based Behavioral Interventions in Pregnancy to Promote Maternal and Fetal Health in High-Income Countries: Systematic Review", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="28", volume="8", number="5", pages="e15111", keywords="mHealth", keywords="mobile health", keywords="pregnancy", keywords="smartphone", keywords="text messaging", keywords="mobile applications", keywords="software", keywords="chronic disease", keywords="health behavior", abstract="Background: Chronic diseases have recently had an increasing effect on maternal-fetal health, especially in high-income countries. However, there remains a lack of discussion regarding health management with technological approaches, including mobile health (mHealth) interventions. Objective: This study aimed to systematically evaluate mHealth interventions used in pregnancy in high-income countries and their effects on maternal health behaviors and maternal-fetal health outcomes. Methods: This systematic review identified studies published between January 1, 2000, and November 30, 2018, in MEDLINE via PubMed, Cochrane Library, EMBASE, CINAHL, PsycINFO, Web of Science, and gray literature. Studies were eligible for inclusion if they included only pregnant women in high-income countries and evaluated stand-alone mobile phone interventions intended to promote healthy maternal beliefs, behaviors, and/or maternal-fetal health outcomes. Two researchers independently reviewed and categorized aspects of full-text articles, including source, study design, intervention and control, duration, participant age, attrition rate, main outcomes, and risk of bias. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was registered in PROSPERO before initiation. Results: Of the 2225 records examined, 28 studies were included and categorized into 4 themes: (1) gestational weight gain, obesity and physical activity (n=9); (2) smoking cessation (n=9); (3) influenza vaccination (n=2); and (4) general prenatal health, preventive strategies, and miscellaneous topics (n=8). Reported sample sizes ranged from 16 to 5243 with a median of 91. Most studies were performed in the United States (18/28, 64\%) and were randomized controlled trials (21/28, 75\%). All participants in the included studies were pregnant at the time of study initiation. Overall, 14\% (4/28) of studies showed association between intervention use and improved health outcomes; all 4 studies focused on healthy gestational weight. Among those, 3 studies showed intervention use was associated with less overall gestational weight gain. These 3 studies involved interventions with text messaging or an app in combination with another communication strategy (Facebook or email). Regarding smoking cessation, influenza vaccination, and miscellaneous topics, there was some evidence of positive effects on health behaviors and beliefs, but very limited correlation with improved health outcomes. Data and interventions were heterogeneous, precluding a meta-analysis. Conclusions: In high-income countries, utilization of mobile phone--based health behavior interventions in pregnancy demonstrates some correlation with positive beliefs, behaviors, and health outcomes. More effective interventions are multimodal in terms of features and tend to focus on healthy gestational weight gain. ", doi="10.2196/15111", url="https://mhealth.jmir.org/2020/5/e15111", url="http://www.ncbi.nlm.nih.gov/pubmed/32463373" } @Article{info:doi/10.2196/16137, author="Bowman, Cassandra and Lunyera, Joseph and Alkon, Aviel and Boulware, Ebony L. and St Clair Russell, Jennifer and Riley, Jennie and Fink, C. Jeffrey and Diamantidis, Clarissa", title="A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study", journal="JMIR Form Res", year="2020", month="May", day="28", volume="4", number="5", pages="e16137", keywords="patient safety", keywords="chronic kidney disease", keywords="patient education", keywords="mhealth", abstract="Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet--based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, ``sick day protocol''); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked ``Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?'' Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58\%) and female (n=7, 58\%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3\%) and 15 critical errors (2.1\%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83\%) easily completed 90\% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58\%), the activity length as ``just right'' (rather than too long or too short) (n=10, 83\%), and the use of clinical vignettes as helpful (n=10, 83\%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. ", doi="10.2196/16137", url="http://formative.jmir.org/2020/5/e16137/", url="http://www.ncbi.nlm.nih.gov/pubmed/32463366" } @Article{info:doi/10.2196/13170, author="Hoffmann, Alexandra and Faust-Christmann, A. Corinna and Zolynski, Gregor and Bleser, Gabriele", title="Toward Gamified Pain Management Apps: Mobile Application Rating Scale--Based Quality Assessment of Pain-Mentor's First Prototype Through an Expert Study", journal="JMIR Form Res", year="2020", month="May", day="26", volume="4", number="5", pages="e13170", keywords="mHealth", keywords="chronic pain", keywords="stress management", keywords="pain management", keywords="health app", keywords="gamification", keywords="health professional", abstract="Background: The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective: To determine whether medical professionals would approve of Pain-Mentor's concept and content, this study aimed to evaluate the quality of the app's first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods: A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results: The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app's content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients' motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions: The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app's integrity. This study was therefore a promising first step in the development of Pain-Mentor. ", doi="10.2196/13170", url="http://formative.jmir.org/2020/5/e13170/", url="http://www.ncbi.nlm.nih.gov/pubmed/32452803" } @Article{info:doi/10.2196/15030, author="Summers, Charlotte and Curtis, Kristina", title="Novel Digital Architecture of a ``Low Carb Program'' for Initiating and Maintaining Long-Term Sustainable Health-Promoting Behavior Change in Patients with Type 2 Diabetes", journal="JMIR Diabetes", year="2020", month="Mar", day="4", volume="5", number="1", pages="e15030", keywords="type 2 diabetes", keywords="behaviour change", keywords="nutrition", keywords="digital intervention", keywords="low carb", keywords="type 2 diabetes remission", keywords="eHealth", doi="10.2196/15030", url="http://diabetes.jmir.org/2020/1/e15030/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130113" } @Article{info:doi/10.2196/14737, author="Blackwell, M. Tenya and Dill, J. LeConte and Hoepner, A. Lori and Geer, A. Laura", title="Using Text Messaging to Improve Access to Prenatal Health Information in Urban African American and Afro-Caribbean Immigrant Pregnant Women: Mixed Methods Analysis of Text4baby Usage", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="13", volume="8", number="2", pages="e14737", keywords="Text4baby", keywords="mHealth", keywords="pregnancy", keywords="text messaging", keywords="health information", keywords="prenatal health", keywords="disparities", abstract="Background: The Text4baby (T4B) mobile health (mHealth) program is acclaimed to provide pregnant women with greater access to prenatal health care, resources, and information. However, little is known about whether urban African American and Afro-Caribbean immigrant pregnant women in the United States are receptive users of innovative health communication methods or of the cultural and systematic barriers that inhibit their behavioral intent to use T4B. Objective: This study aimed to understand the lived experiences of urban African American and Afro-Caribbean immigrant pregnant women with accessing quality prenatal health care and health information; to assess usage of mHealth for seeking prenatal health information; and to measure changes in participants' knowledge, perceptions, and behavioral intent to use the T4B mHealth educational intervention. Methods: An exploratory sequential mixed methods study was conducted among pregnant women and clinical professionals for a phenomenological exploration with focus groups, key informants, interviews, and observations. Qualitative themes were aligned with behavioral and information technology communications theoretical constructs to develop a survey instrument used. repeated-measures pre- and post-test design to evaluate changes in participants' knowledge, attitudes, and beliefs, of mHealth and T4B after a minimum of 4 weeks' exposure to the text message--based intervention. Triangulation and mixing of both qualitative and quantitative data occurred primarily during the survey development and also during final analysis. Results: A total of 9 women participated in phase 1, and 49 patients signed up for T4B and completed a 31-item survey at baseline and again during follow-up. Three themes were identified: (1) patient-provider engagement, (2) social support, and (3) acculturation. With time as a barrier to quality care, inadequate patient-provider engagement left participants feeling indifferent about the prenatal care and information they received in the clinical setting. Of 49 survey participants, 63\% (31/49) strongly agreed that T4B would provide them with extra support during their pregnancy. On a Likert scale of 1 to 5, participants' perception of the usefulness of T4B ranked at 4.26, and their perception of the compatibility and relative advantage of using T4B ranked at 4.41 and 4.15, respectively. At follow-up, there was a 14\% increase in participants reporting their intent to use T4B and a 28\% increase from pretest and posttest in pregnant women strongly agreeing to speak more with their doctor about the information learned through T4B. Conclusions: Urban African American and Afro-Caribbean immigrant pregnant women in Brooklyn endure a number of social and ecological determinants like low health literacy, income, and language that serve as barriers to accessing quality prenatal health care and information, which negatively impacts prenatal health behaviors and outcomes. Our study indicates a number of systematic, political, and other microsystem-level factors that perpetuate health inequities in our study population. ", doi="10.2196/14737", url="http://mhealth.jmir.org/2020/2/e14737/", url="http://www.ncbi.nlm.nih.gov/pubmed/32053117" } @Article{info:doi/10.2196/16254, author="Patchen, Loral and Ellis, Lindsey and Ma, Xuyen Tony and Ott, Corilyn and Chang, K. Katie H. and Araya, Brook and Atreyapurapu, Sravanthi and Alyusuf, Amal and Gaines Lanzi, Robin", title="Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study", journal="JMIR Serious Games", year="2020", month="Jan", day="31", volume="8", number="1", pages="e16254", keywords="sexual health", keywords="sex education", keywords="African Americans", keywords="youth", keywords="adolescents", keywords="video games", keywords="games, experimental", keywords="community-based participatory research", keywords="user-centered design", abstract="Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent--Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. ", doi="10.2196/16254", url="http://games.jmir.org/2020/1/e16254/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012041" } @Article{info:doi/10.2196/12113, author="Kamal, Ayeesha and Khoja, Adeel and Usmani, Bushra and Magsi, Shahvaiz and Malani, Aresha and Peera, Zahra and Sattar, Saadia and Ahmed Akram, Masood and Shahnawaz, Sumaira and Zulfiqar, Maryam and Muqeet, Abdul and Zaidi, Fabiha and Sayani, Saleem and Artani, Azmina and Azam, Iqbal and Saleem, Sarah", title="Effect of 5-Minute Movies Shown via a Mobile Phone App on Risk Factors and Mortality After Stroke in a Low- to Middle-Income Country: Randomized Controlled Trial for the Stroke Caregiver Dyad Education Intervention (Movies4Stroke)", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="28", volume="8", number="1", pages="e12113", keywords="stroke", keywords="mobile health", keywords="noncommunicable diseases", keywords="adherence", abstract="Background: Pakistan is the sixth most populous nation in the world and has an estimated 4 million stroke survivors. Most survivors are taken care of by community-based caregivers, and there are no inpatient rehabilitation facilities. Objective: The objective of this study was to evaluate the effectiveness and safety of locally designed 5-min movies rolled out in order of relevance that are thematically delivered in a 3-month program to deliver poststroke education to stroke survivor and caregiver dyads returning to the community. Methods: This study was a randomized controlled, outcome assessor--blinded, parallel group, single-center superiority trial in which participants (stroke survivor-caregiver dyads) with first-ever stroke (both ischemic and hemorrhagic) incidence were randomized within 48 hours of their stroke into either the video-based education intervention group or the control group. The video-based education intervention group had health education delivered through short videos that were shown to the participants and their caregivers at the time of admission, before discharge, and the first and third months of follow-up after discharge. The control group had standardized care including predischarge education and counseling according to defined protocols. All participants enrolled in the video education intervention and control groups were followed for 12 months after discharge for outcome assessment in the outpatient stroke clinics. The primary outcome measures were the proportion of participants achieving control of blood pressure, blood sugar, and blood cholesterol in the video intervention versus the control group. Several predefined secondary outcomes were included in this study, of which we report the mortality and functional disability in this paper. Analysis was by performed using the intention-to-treat principle. Results: A total of 310 stroke survivors and their caregiver dyads (participant dyads) were recruited over a duration of 6 months. In total, 155 participant dyads were randomized into the intervention and control groups, each. The primary outcome of control of three major risk factors revealed that at 12 months, there was a greater percentage of participants with a systolic BP<125 mm Hg (18/54, 33\% vs 11/52, 21\%; P=.16), diastolic BP<85 mm Hg (44/54, 81\% vs 37/52, 71\%; P=.21), HbA1c level<7\% (36/55, 65\% vs 30/40, 75\%; P=.32), and low-density lipoprotein level<100 mg/dL (36/51, 70\% vs 30/45, 67\%; P=.68) in the intervention group than in the control group. The secondary outcome reported is the mortality among the stroke survivors because the number of stroke-related complications was higher in the control group than in the intervention group (13/155, 8.4\% vs 2/155, 1.3\%), and this difference was statistically significant (P<.001). Conclusions: The Movies4Stroke trial failed to achieve its primary specified outcome. However, secondary outcomes that directly related to survival skills of stroke survivors demonstrated the effectiveness of the video-based intervention on improving stroke-related mortality and survival without disability. Trial Registration: ClinicalTrials.gov NCT02202330; https://www.clinicaltrials.gov/ct2/show/NCT02202330 ", doi="10.2196/12113", url="http://mhealth.jmir.org/2020/1/e12113/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012080" } @Article{info:doi/10.2196/15940, author="Roosan, Don and Li, Yan and Law, Anandi and Truong, Huy and Karim, Mazharul and Chok, Jay and Roosan, Moom", title="Improving Medication Information Presentation Through Interactive Visualization in Mobile Apps: Human Factors Design", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="25", volume="7", number="11", pages="e15940", keywords="visual perception", keywords="adverse drug event", keywords="human factors design", keywords="mobile health", abstract="Background: Despite the detailed patient package inserts (PPIs) with prescription drugs that communicate crucial information about safety, there is a critical gap between patient understanding and the knowledge presented. As a result, patients may suffer from adverse events. We propose using human factors design methodologies such as hierarchical task analysis (HTA) and interactive visualization to bridge this gap. We hypothesize that an innovative mobile app employing human factors design with an interactive visualization can deliver PPI information aligned with patients' information processing heuristics. Such an app may help patients gain an improved overall knowledge of medications. Objective: The objective of this study was to explore the feasibility of designing an interactive visualization-based mobile app using an HTA approach through a mobile prototype. Methods: Two pharmacists constructed the HTA for the drug risperidone. Later, the specific requirements of the design were translated using infographics. We transferred the wireframes of the prototype into an interactive user interface. Finally, a usability evaluation of the mobile health app was conducted. Results: A mobile app prototype using HTA and infographics was successfully created. We reiterated the design based on the specific recommendations from the usability evaluations. Conclusions: Using HTA methodology, we successfully created a mobile prototype for delivering PPI on the drug risperidone to patients. The hierarchical goals and subgoals were translated into a mobile prototype. ", doi="10.2196/15940", url="http://mhealth.jmir.org/2019/11/e15940/", url="http://www.ncbi.nlm.nih.gov/pubmed/31763991" } @Article{info:doi/10.2196/13786, author="Therkildsen, B{\"u}low Signe and Hansen, Houlind Linda and Jensen, Dinesen Laura Emilie and Finderup, Jeanette", title="A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study", journal="JMIR Form Res", year="2019", month="Nov", day="21", volume="3", number="4", pages="e13786", keywords="mobile phone", keywords="app", keywords="patient decision aid", keywords="dialysis", keywords="decisional conflict", keywords="usability", abstract="Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90\%) had attended a patient school for kidney disease, and 13 out of 22 (59\%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents' average age. Thus, the applicability of the DG cannot be definitively determined. ", doi="10.2196/13786", url="http://formative.jmir.org/2019/4/e13786/", url="http://www.ncbi.nlm.nih.gov/pubmed/31750836" } @Article{info:doi/10.2196/15544, author="Shan, Wei and Wang, Ying and Luan, Jing and Tang, Pengfei", title="The Influence of Physician Information on Patients' Choice of Physician in mHealth Services Using China's Chunyu Doctor App: Eye-Tracking and Questionnaire Study", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="23", volume="7", number="10", pages="e15544", keywords="mHealth", keywords="physician information", keywords="choice", keywords="trust", abstract="Background: Mobile health (mHealth) is becoming more popular as a way of sharing medical information. For the patient, it saves time, reduces the need for travel, reduces the cost of searching for information, and brings medical services ``to your fingertips.'' However, it also brings information overload and makes the patient's choice of physician more difficult. Objective: This study aimed to identify the types of physician information that play a key role in patients' choice of physician and to explore the mechanism by which this information contributes to this choice. Methods: Based on the stimulus-organism-response (SOR) model and online trust theory, we proposed a research model to explain the influence of physician information on patients' choice of physician. The model was based on cognitive trust and affective trust and considered the moderating role of patient expertise. Study 1 was an eye-tracking experiment (n=42) to identify key factors affecting patients' choice of physician. Study 2 was a questionnaire study (n=272); Partial Least Squares Structural Equation Modeling was used to validate the research model. Results: The results of Study 1 revealed that seven types of physician information played a key role in patients' choice of physician. The results of Study 2 revealed that (1) physicians' profile photo information affected patients' choice of physician by positively influencing affective trust (P<.001); (2) physicians' nonprofile photo information affected patients' choice of physician by positively influencing cognitive trust (P<.001); (3) patient-generated information affected patients' choice of physician by positively affecting cognitive trust (P<.001) and affective trust (P<.001), and patient expertise played a positive moderating role on both (P=.04 and P=.01, respectively); and (4) cognitive trust and affective trust both positively affected patients' choice of physician, with affective trust playing a more significant role (P<.001 and P<.001, respectively). Conclusions: Seven types of physician information were mainly used by patients when choosing physicians offering mHealth services; trust played an important role in this choice. In addition, the level of patient expertise was an important variable in moderating the influence of physician information and patients' trust. This paper supports the theoretical basis of information selection and processing by patients. These findings can help guide app developers in the construction of medical apps and in the management of physician information in order to facilitate patients' choice of physician. ", doi="10.2196/15544", url="http://mhealth.jmir.org/2019/10/e15544/", url="http://www.ncbi.nlm.nih.gov/pubmed/31647466" } @Article{info:doi/10.2196/15323, author="Timmers, Thomas and Janssen, Loes and van der Weegen, Walter and Das, Dirk and Marijnissen, Willem-Jan and Hannink, Gerjon and van der Zwaard, C. Babette and Plat, Adriaan and Thomassen, Bregje and Swen, Jan-Willem and Kool, B. Rudolf and Lambers Heerspink, Okke Frederik", title="The Effect of an App for Day-to-Day Postoperative Care Education on Patients With Total Knee Replacement: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2019", month="Oct", day="21", volume="7", number="10", pages="e15323", keywords="patient education", keywords="postoperative care", keywords="smartphone", keywords="self-management", keywords="ehealth", keywords="telemedicine", abstract="Background: Patients who undergo primary Total Knee Replacement surgery (TKR) are often discharged within 1-3 days after surgery. With this relatively short length of hospital stay, a patient's self-management is a crucial factor in optimizing the outcome of their treatment. In the case of TKR, self-management primarily involves adequate pain management, followed by physiotherapy exercises and daily self-care activities. Patients are educated on all these topics by hospital staff upon discharge from the hospital but often struggle to comprehend this information due to its quantity, complexity, and the passive mode of communication used to convey it. Objective: This study primarily aims to determine whether actively educating TKR patients with timely, day-to-day postoperative care information through an app could lead to a decrease in their level of pain compared to those who only receive standard information about their recovery through the app. In addition, physical functioning, quality of life, ability to perform physiotherapy exercises and daily self-care activities, satisfaction with information, perceived involvement by the hospital, and health care consumption were also assessed. Methods: A multicenter randomized controlled trial was performed in five Dutch hospitals. In total, 213 patients who had undergone elective, primary, unilateral TKR participated. All patients had access to an app for their smartphone and tablet to guide them after discharge. The intervention group could unlock day-to-day information by entering a personal code. The control group only received weekly, basic information. Primary (level of pain) and secondary outcomes (physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption) were measured using self-reported online questionnaires. All outcomes were measured weekly in the four weeks after discharge, except for physical functioning and quality of life, which were measured at baseline and at four weeks after discharge. Data was analyzed using Student t tests, chi-square tests, and linear mixed models for repeated measures. Results: In total, 114 patients were enrolled in the intervention group (IG) and 99 in the control group (CG). Four weeks after discharge, patients in the IG performed significantly better than patients in the CG on all dimensions of pain: pain at rest (mean 3.45 vs mean 4.59; P=.001), pain during activity (mean 3.99 vs mean 5.08; P\<.001) and pain at night (mean 4.18 vs mean 5.21; P=.003). Additionally, significant differences were demonstrated in favor of the intervention group for all secondary outcomes. Conclusions: In the four weeks following TKR, the active and day-to-day education of patients via the app significantly decreased their level of pain and improved their physical functioning, quality of life, ability to perform physiotherapy exercises and activities of daily self-care, satisfaction with information, perceived involvement by the hospital, and health care consumption compared to standard patient education. Given the rising number of TKR patients and the increased emphasis on self-management, we suggest using an app with timely postoperative care education as a standard part of care. Trial Registration: Netherlands Trial Register NTR7182; https://www.trialregister.nl/trial/6992 ", doi="10.2196/15323", url="https://mhealth.jmir.org/2019/10/e15323", url="http://www.ncbi.nlm.nih.gov/pubmed/31638594" } @Article{info:doi/10.2196/13321, author="Abbasgholizadeh Rahimi, Samira and Archambault, M. Patrick and Ravitsky, Vardit and Lemoine, Marie-Eve and Langlois, Sylvie and Forest, Jean-Claude and Gigu{\`e}re, C. Anik M. and Rousseau, Fran{\c{c}}ois and Dolan, G. James and L{\'e}gar{\'e}, France", title="An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2019", month="Oct", day="8", volume="8", number="10", pages="e13321", keywords="shared decision making", keywords="multiple criteria decision analysis", keywords="analytic hierarchy process", keywords="decision aid", keywords="prenatal screening", keywords="mobile app", abstract="Background: Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. Objective: In this mixed methods study, we aim to (1) assess women's needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. Methods: In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants' attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. Results: Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. Conclusions: This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. International Registered Report Identifier (IRRID): DERR1-10.2196/13321 ", doi="10.2196/13321", url="https://www.researchprotocols.org/2019/10/e13321", url="http://www.ncbi.nlm.nih.gov/pubmed/31596249" } @Article{info:doi/10.2196/13656, author="Aguirre, Ayala Patricia Estefania and Lotto, Matheus and Strieder, Paola Anna and Cruvinel, Pereira Agnes F{\'a}tima and Cruvinel, Thiago", title="The Effectiveness of Educational Mobile Messages for Assisting in the Prevention of Early Childhood Caries: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="Sep", day="03", volume="8", number="9", pages="e13656", keywords="eHealth", keywords="dental caries", keywords="randomized controlled trial", abstract="Background: In 2017, approximately 3.7 billion downloads of health apps were made on mobile phones and tablets. In this sense, a massive number of people could benefit by electronic mobile--based health interventions, making information available even with the lack of material and human resources. Hence, the use of electronic apps for dental education might be extremely useful for the prevention of early childhood caries (ECC). Objective: This study aims to evaluate the effectiveness of messages sent via mobile phones as an adjuvant method for the prevention of ECC. Methods: A single-blinded, randomized, and parallel-group clinical trial will be conducted with dyads of parents or caregivers and children aged between 36 and 60 months, recruited from kindergartens and schools of Bauru, S{\~a}o Paulo. The determination of sample size resulted in a total of 104 dyads of parents and children, considering a power of 80\%, a significance level of 5\%, and an attrition of 30\%. This sample will be randomly assigned to test and control groups, being divided in 52 dyads per group according to the health literacy levels of parents and the age, gender, and oral health status of children. Every 2 weeks, only participants in the test group will receive messages via WhatsApp containing preventive and education-related ECC information. The dyads will visit the dentist every 3 months during a year for the assessment of primary outcomes (sugar consumption and the International Caries Detection and Assessment System, visible plaque, and community periodontal indices) and to receive dental care measures. Secondary outcomes (electronic health literacy and general perceived self-efficacy) will be determined only at baseline and after 12-month follow-up. The quality of randomization will be evaluated throughout the study, comparing the test and control groups systematically by Student t tests for continuous variables and chi-square tests for categorical variables. Listwise deletion method will be applied in cases of dropouts, if the missing values satisfy the criteria of missing completely at random; otherwise, multiple imputation data strategy will be conducted. The Kolmogorov-Smirnov and Levene tests will be used to determine the normality and homogeneity of data, respectively, which will indicate further statistical analyses for elucidating significant differences between groups (P<.05). A Student t test or Mann-Whitney U test will be employed for parametric or nonparametric analyses, respectively. Results: The project was funded in 2018, and enrollment was completed in August 2019. Allocation is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions: The results will contribute to understanding the importance of educational mobile messages toward the adoption of healthy behaviors for the prevention of ECC in a given population. Trial Registration: Brazilian Registry of Clinical Trials Universal Trial Number U1111-1216-1393; http://www.ensaiosclinicos.gov.br/rg/RBR-2b6r7q/ International Registered Report Identifier (IRRID): PRR1-10.2196/13656 ", doi="10.2196/13656", url="https://www.researchprotocols.org/2019/9/e13656/", url="http://www.ncbi.nlm.nih.gov/pubmed/31482856" } @Article{info:doi/10.2196/14187, author="Richards, Rebecca and Kinnersley, Paul and Brain, Kate and Staffurth, John and Wood, Fiona", title="The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="31", volume="7", number="7", pages="e14187", keywords="education, medical", keywords="medical information exchange", keywords="smartphone", keywords="mobile apps", abstract="Background: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients' unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted. ", doi="10.2196/14187", url="http://mhealth.jmir.org/2019/7/e14187/", url="http://www.ncbi.nlm.nih.gov/pubmed/31368446" } @Article{info:doi/10.2196/13844, author="Steeb, Theresa and Wessely, Anja and Mastnik, Sebastian and Brinker, Josef Titus and French, Einar Lars and Niesert, Anne-Charlotte and Berking, Carola and Heppt, Vincent Markus", title="Patient Attitudes and Their Awareness Towards Skin Cancer--Related Apps: Cross-Sectional Survey", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="02", volume="7", number="7", pages="e13844", keywords="skin cancer", keywords="melanoma", keywords="mobile applications", keywords="telemedicine", keywords="awareness", keywords="patient education", abstract="Background: In the emerging era of digitalization and electronic health, skin cancer--related apps represent useful tools to support dermatologic consultation and examination. Yet, little is known about how patients perceive the value of such apps. Objective: The aim of this study was to investigate patient attitudes and their awareness toward skin cancer--related apps. Methods: A cross-sectional study including 200 patients from the oncological outpatient unit was conducted at the University Hospital (LMU Munich, Germany) between September and December 2018. Patients were asked to complete a self-administered questionnaire on the popularity and usefulness of health-related and skin cancer--related apps. A descriptive analysis was performed with the expression of categorical variables as frequencies and percentages. For continuous variables, the median and range were indicated. Contingency tables and chi-square tests were performed to investigate associations between sociodemographic data and selected items of the questionnaire. Results: A total of 98.9\% (195/197) of patients had never used skin cancer--related apps or could not remember. In 49.7\% (93/187) of cases, patients were unsure about the usefulness of skin cancer apps, whereas 42.6\% (78/183) thought that skin cancer apps could supplement or support the professional skin examination performed by a physician. However, 47.9\% (90/188) were interested in acquiring more information by their dermatologists about skin cancer apps. Young age (P=.002), male gender (P=.02), a previous history of melanoma (P=.004), and higher educational level (P=.002) were significantly associated with a positive attitude. Nevertheless, 55.9\% (105/188) preferred a printed patient brochure on skin cancer to downloading and using an app. Conclusions: The experience and knowledge of skin cancer--related apps was surprisingly low in this population, although there was a high general interest in more information about such apps. Printed patient brochures were the preferred information source. ", doi="10.2196/13844", url="https://mhealth.jmir.org/2019/7/e13844/", url="http://www.ncbi.nlm.nih.gov/pubmed/31267978" } @Article{info:doi/10.2196/13501, author="Tam, Tammie and Baer, R. Maria and Hsu, L. Lewis and Law, Y. Jennie", title="An Electronic Teaching Module for Improving Knowledge of Self-Management of Vaso-Occlusive Pain Crises in Patients With Sickle Cell Disease: Pilot Questionnaire Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jun", day="20", volume="7", number="6", pages="e13501", keywords="patient education", keywords="teaching materials", keywords="portable electronic applications", keywords="sickle cell disease", abstract="Background: For patients with sickle cell disease (SCD), effective management of vaso-occlusive crises (VOCs) is integral to provision of care, as nearly all affected individuals will suffer from VOCs in their lifetime. A recent systematic review of technological interventions to improve self-management in the care of SCD concluded that electronic health has the potential to improve the care of individuals with SCD. Objective: The aim of this study was to assess the value of an electronic teaching module (ETM) provided by Emmi Solutions for educating adult SCD patients on VOC self-management and treatment options for SCD. Methods: A pretest assessed adults with SCD for baseline knowledge with regard to self-management of VOCs. Participants then watched the 35-min ETM and completed a posttest and survey on the ETM. Results: A total of 20 adults enrolled. Their knowledge scores improved (pretest median 66.5\% and posttest median 85\%; P<.001). In total, 18 participants (18/20, 90\%) agreed that they ``learned a lot'' or ``learned something'' from the ETM. The most common topic about which they reported learning was hydroxyurea. A total of 12 participants (12/20, 60\%) agreed with the statement that they ``would recommend the module to a friend or family member with sickle cell disease.'' Conclusions: The ETM is associated with an increase in knowledge in patients with SCD. Limitations of the study include small sample size, no assessment of knowledge before premodule questionnaire completion, and no longitudinal follow-up. Identifying patients with SCD who demonstrate affinity for self-education via an ETM may further enhance utility of this tool to educate and empower patients. ", doi="10.2196/13501", url="http://mhealth.jmir.org/2019/6/e13501/", url="http://www.ncbi.nlm.nih.gov/pubmed/31223120" } @Article{info:doi/10.2196/12664, author="Ponum, Mahvish and Hasan, Osman and Khan, Saadia", title="EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases", journal="Interact J Med Res", year="2019", month="May", day="14", volume="8", number="2", pages="e12664", keywords="infectious diseases", keywords="mHealth", keywords="causes of death", abstract="Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. ", doi="10.2196/12664", url="http://www.i-jmr.org/2019/2/e12664/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094329" } @Article{info:doi/10.2196/12134, author="Athilingam, Ponrathi and Jenkins, Bradlee and Redding, A. Barbara", title="Reading Level and Suitability of Congestive Heart Failure (CHF) Education in a Mobile App (CHF Info App): Descriptive Design Study", journal="JMIR Aging", year="2019", month="Apr", day="25", volume="2", number="1", pages="e12134", keywords="health literacy", keywords="reading level", keywords="patient education", keywords="heart failure", keywords="mobile app", abstract="Background: Education at the time of diagnosis or at discharge after an index illness is a vital component of improving outcomes in congestive heart failure (CHF). About 90 million Americans have limited health literacy and have a readability level at or below a 5th-grade level, which could affect their understanding of education provided at the time of diagnosis or discharge from hospital. Objective: The aim of this paper was to assess the suitability and readability level of a mobile phone app, the CHF Info App. Methods: A descriptive design was used to assess the reading level and suitability of patient educational materials included in the CHF Info App. The suitability assessment of patient educational materials included in the CHF Info App was independently assessed by two of the authors using the 26-item Suitability Assessment of Materials (SAM) tool. The reading grade level for each of the 10 CHF educational modules included in the CHF Info App was assessed using the comprehensive online Text Readability Consensus Calculator based on the seven most-common readability formulas: the Flesch Reading Ease Formula, the Gunning Fog Index, the Flesch-Kincaid Grade Level Formula, the Coleman-Liau Index, the Simplified Measure of Gobbledygook Index, the Automated Readability Index, and the Linsear Write Formula. The reading level included the text-scale score, the ease-of-reading score, and the corresponding grade level. Results: The educational materials included in the CHF Info App ranged from a 5th-grade to an 8th-grade reading level, with a mean of a 6th-grade level, which is recommended by the American Medical Association. The SAM tool result demonstrated adequate-to-superior levels in all four components assessed, including content, appearance, visuals, and layout and design, with a total score of 77\%, indicating superior suitability. Conclusions: The authors conclude that the CHF Info App will be suitable and meet the recommended health literacy level for American adult learners. Further testing of the CHF Info App in a longitudinal study is warranted to determine improvement in CHF knowledge. ", doi="10.2196/12134", url="http://aging.jmir.org/2019/1/e12134/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518265" } @Article{info:doi/10.2196/12128, author="Adam, Maya and McMahon, A. Shannon and Prober, Charles and B{\"a}rnighausen, Till", title="Human-Centered Design of Video-Based Health Education: An Iterative, Collaborative, Community-Based Approach", journal="J Med Internet Res", year="2019", month="Jan", day="30", volume="21", number="1", pages="e12128", keywords="human-centered design", keywords="health promotion", keywords="health behavior", keywords="health knowledge, attitudes, practice", keywords="community health workers", keywords="telemedicine", keywords="eHealth", keywords="mHealth", doi="10.2196/12128", url="http://www.jmir.org/2019/1/e12128/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698531" } @Article{info:doi/10.2196/10742, author="Timmers, Thomas and Janssen, Loes and Pronk, Yvette and van der Zwaard, C. Babette and Ko{\"e}ter, Sander and van Oostveen, Dirk and de Boer, Stefan and Kremers, Keetie and Rutten, Sebastiaan and Das, Dirk and van Geenen, CI Rutger and Koenraadt, LM Koen and Kusters, Rob and van der Weegen, Walter", title="Assessing the Efficacy of an Educational Smartphone or Tablet App With Subdivided and Interactive Content to Increase Patients' Medical Knowledge: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="21", volume="6", number="12", pages="e10742", keywords="patient education", keywords="shared decision making", keywords="smartphone", keywords="decision aid", keywords="orthopedics", abstract="Background: Modern health care focuses on shared decision making (SDM) because of its positive effects on patient satisfaction, therapy compliance, and outcomes. Patients' knowledge about their illness and available treatment options, gained through medical education, is one of the key drivers for SDM. Current patient education relies heavily on medical consultation and is known to be ineffective. Objective: This study aimed to determine whether providing patients with information in a subdivided, categorized, and interactive manner via an educational app for smartphone or tablet might increase the knowledge of their illness. Methods: A surgeon-blinded randomized controlled trial was conducted with 213 patients who were referred to 1 of the 6 Dutch hospitals by their general practitioner owing to knee complaints that were indicative of knee osteoarthritis. An interactive app that, in addition to standard care, actively sends informative and pertinent content to patients about their illness on a daily basis by means of push notifications in the week before their consultation. The primary outcome was the level of perceived and actual knowledge that patients had about their knee complaints and the relevant treatment options after the intervention. Results: In total, 122 patients were enrolled in the control group and 91 in the intervention group. After the intervention, the level of actual knowledge (measured on a 0-36 scale) was 52\% higher in the app group (26.4 vs 17.4, P<.001). Moreover, within the app group, the level of perceived knowledge (measured on a 0-25 scale) increased by 22\% during the week within the app group (from 13.5 to 16.5, P<.001), compared with no gain in the control group. Conclusions: Actively offering patients information in a subdivided (per day), categorized (per theme), and interactive (video and quiz questions) manner significantly increases the level of perceived knowledge and demonstrates a higher level of actual knowledge, compared with standard care educational practices. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN98629372; http://www.isrctn.com/ISRCTN98629372 (Archived by WebCite at http://www.webcitation.org/73F5trZbb) ", doi="10.2196/10742", url="http://mhealth.jmir.org/2018/12/e10742/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578185" } @Article{info:doi/10.2196/11107, author="Birrell, Louise and Deen, Hannah and Champion, Elizabeth Katrina and Newton, C. Nicola and Stapinski, A. Lexine and Kay-Lambkin, Frances and Teesson, Maree and Chapman, Cath", title="A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="20", volume="6", number="12", pages="e11107", keywords="internet", keywords="methamphetamine", keywords="mobile apps", keywords="mobile phone", keywords="substance-related disorder", abstract="Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (``ice''), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app's influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a ``back'' button. Suggested improvements were incorporated prior to the app's public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. ", doi="10.2196/11107", url="https://mhealth.jmir.org/2018/12/e11107/", url="http://www.ncbi.nlm.nih.gov/pubmed/30573443" } @Article{info:doi/10.2196/10183, author="Bashi, Nazli and Hassanzadeh, Hamed and Varnfield, Marlien and Wee, Yong and Walters, Darren and Karunanithi, Mohanraj", title="Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers' Perspectives", journal="JMIR Cardio", year="2018", month="Oct", day="31", volume="2", number="2", pages="e10183", keywords="acute coronary syndrome", keywords="focus group", keywords="health care professionals", keywords="mobile phone", keywords="multidisciplinary", keywords="thematic analysis", abstract="Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70\% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. ", doi="10.2196/10183", url="http://cardio.jmir.org/2018/2/e10183/", url="http://www.ncbi.nlm.nih.gov/pubmed/31758781" } @Article{info:doi/10.2196/10771, author="Bashi, Nazli and Fatehi, Farhad and Fallah, Mina and Walters, Darren and Karunanithi, Mohanraj", title="Self-Management Education Through mHealth: Review of Strategies and Structures", journal="JMIR Mhealth Uhealth", year="2018", month="Oct", day="19", volume="6", number="10", pages="e10771", keywords="health education", keywords="mHealth", keywords="mobile apps", keywords="mobile phone", keywords="patient education", keywords="self-management education", abstract="Background: Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies. Objective: This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria. Results: In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients' health outcomes, including patients' engagement level, hemoglobin A1c, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions. Conclusions: Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions. ", doi="10.2196/10771", url="https://mhealth.jmir.org/2018/10/e10771/", url="http://www.ncbi.nlm.nih.gov/pubmed/30341042" } @Article{info:doi/10.2196/mhealth.9811, author="Nguyen, D. Amy and Frensham, J. Lauren and Wong, XC Michael and Meslin, MM Sylvain and Martin, Paige and Lau, YS Annie and Baysari, T. Melissa and Day, O. Richard", title="mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies", journal="JMIR Mhealth Uhealth", year="2018", month="Oct", day="15", volume="6", number="10", pages="e182", keywords="mobile apps", keywords="gout", keywords="self-management", keywords="chronic disease", keywords="uric acid", abstract="Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app's presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. ", doi="10.2196/mhealth.9811", url="http://mhealth.jmir.org/2018/10/e182/", url="http://www.ncbi.nlm.nih.gov/pubmed/30322835" } @Article{info:doi/10.2196/humanfactors.9787, author="AlJaberi, Hana", title="Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study", journal="JMIR Hum Factors", year="2018", month="Oct", day="10", volume="5", number="4", pages="e29", keywords="mHealth", keywords="human computer interaction", keywords="prenatal health", keywords="Caribbean", keywords="immigrant women", keywords="mobile phone", abstract="Background: A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective: The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women's prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods: This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results: The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions: mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions. ", doi="10.2196/humanfactors.9787", url="http://humanfactors.jmir.org/2018/4/e29/", url="http://www.ncbi.nlm.nih.gov/pubmed/30305256" } @Article{info:doi/10.2196/diabetes.9202, author="Bernier, Angelina and Fedele, David and Guo, Yi and Chavez, Sarah and Smith, D. Megan and Warnick, Jennifer and Lieberman, Leora and Modave, Fran{\c{c}}ois", title="New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study", journal="JMIR Diabetes", year="2018", month="Jun", day="06", volume="3", number="2", pages="e10", keywords="mHealth", keywords="information technology", keywords="diabetes education", keywords="pediatrics", abstract="Background: Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients. Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis. Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium ($\Delta$=0.56). Usability ratings of NODE were excellent. Conclusions: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease. ", doi="10.2196/diabetes.9202", url="http://diabetes.jmir.org/2018/2/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/30291069" } @Article{info:doi/10.2196/10057, author="Athilingam, Ponrathi and Jenkins, Bradlee", title="Mobile Phone Apps to Support Heart Failure Self-Care Management: Integrative Review", journal="JMIR Cardio", year="2018", month="May", day="02", volume="2", number="1", pages="e10057", keywords="heart failure", keywords="self-care management", keywords="mobile health", abstract="Background: With an explosive growth in mobile health, an estimated 500 million patients are potentially using mHealth apps for supporting health and self-care of chronic diseases. Therefore, this review focused on mHealth apps for use among patients with heart failure. Objective: The aim of this integrative review was to identify and assess the functionalities of mHealth apps that provided usability and efficacy data and apps that are commercially available without supporting data, all of which are to support heart failure self-care management and thus impact heart failure outcomes. Methods: A search of published, peer-reviewed literature was conducted for studies of technology-based interventions that used mHealth apps specific for heart failure. The initial database search yielded 8597 citations. After filters for English language and heart failure, the final 487 abstracts was reviewed. After removing duplicates, a total of 18 articles that tested usability and efficacy of mobile apps for heart failure self-management were included for review. Google Play and Apple App Store were searched with specified criteria to identify mHealth apps for heart failure. A total of 26 commercially available apps specific for heart failure were identified and rated using the validated Mobile Application Rating Scale. Results: The review included studies with low-quality design and sample sizes ranging from 7 to 165 with a total sample size of 847 participants from all 18 studies. Nine studies assessed usability of the newly developed mobile health system. Six of the studies included are randomized controlled trials, and 4 studies are pilot randomized controlled trials with sample sizes of fewer than 40. There were inconsistencies in the self-care components tested, increasing bias. Thus, risk of bias was assessed using the Cochrane Collaboration's tool for risk of selection, performance, detection, attrition, and reporting biases. Most studies included in this review are underpowered and had high risk of bias across all categories. Three studies failed to provide enough information to allow for a complete assessment of bias, and thus had unknown or unclear risk of bias. This review on the commercially available apps demonstrated many incomplete apps, many apps with bugs, and several apps with low quality. Conclusions: The heterogeneity of study design, sample size, intervention components, and outcomes measured precluded the performance of a systematic review or meta-analysis, thus introducing bias of this review. Although the heart failure--related outcomes reported in this review vary, they demonstrated trends toward making an impact and offer a potentially cost-effective solution with 24/7 access to symptom monitoring as a point of care solution, promoting patient engagement in their own home care. ", doi="10.2196/10057", url="http://cardio.jmir.org/2018/1/e10057/", url="http://www.ncbi.nlm.nih.gov/pubmed/31758762" } @Article{info:doi/10.2196/mhealth.7708, author="AlJaberi, Hana", title="Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study", journal="JMIR Mhealth Uhealth", year="2018", month="Apr", day="13", volume="6", number="4", pages="e61", keywords="mHealth", keywords="mobile health", keywords="participatory design", keywords="pregnancy", keywords="Caribbean", keywords="immigrant women", abstract="Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women's health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women's virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. ", doi="10.2196/mhealth.7708", url="http://mhealth.jmir.org/2018/4/e61/", url="http://www.ncbi.nlm.nih.gov/pubmed/29653919" } @Article{info:doi/10.2196/mhealth.8263, author="Fadda, Marta and Galimberti, Elisa and Fiordelli, Maddalena and Schulz, Johannes Peter", title="Evaluation of a Mobile Phone--Based Intervention to Increase Parents' Knowledge About the Measles-Mumps-Rubella Vaccination and Their Psychological Empowerment: Mixed-Method Approach", journal="JMIR Mhealth Uhealth", year="2018", month="Mar", day="07", volume="6", number="3", pages="e59", keywords="qualitative research", keywords="measles-mumps-rubella vaccine", keywords="surveys and questionnaires", keywords="mobile applications", keywords="knowledge", keywords="patient participation", abstract="Background: There is mixed evidence on the effectiveness of vaccination-related interventions. A major limitation of most intervention studies is that they do not apply randomized controlled trials (RCTs), the method that, over the last 2 decades, has increasingly been considered as the only method to provide proof of the effectiveness of an intervention and, consequently, as the most important instrument in deciding whether to adopt an intervention or not. This study, however, holds that methods other than RCTs also can produce meaningful results. Objective: The aim of this study was to evaluate 2 mobile phone--based interventions aimed at increasing parents' knowledge of the measles-mumps-rubella (MMR) vaccination (through elements of gamification) and their psychological empowerment (through the use of narratives), respectively. The 2 interventions were part of an RCT. Methods: We conducted 2 studies with the RCT participants: a Web-based survey aimed at assessing their rating of the tool regarding a number of qualities such as usability and usefulness (N=140), and qualitative telephonic interviews to explore participants' experiences with the app (N=60). Results: The results of the survey showed that participants receiving the knowledge intervention (alone or together with the empowerment intervention) liked the app significantly better compared with the group that only received the empowerment intervention (F2,137=15.335; P<.001). Parents who were exposed to the empowerment intervention complained that they did not receive useful information but were only invited to make an informed, autonomous MMR vaccination decision. Conclusions: The results suggest that efforts to empower patients should always be accompanied by the provision of factual information. Using a narrative format that promotes parents' identification can be an appropriate strategy, but it should be employed together with the presentation of more points of views and notions regarding, for instance, the risks and benefits of the vaccination at the same time. Trial Registration: International Standard Randomized Controlled Trial Number 30768813; http://www.isrctn.com/ ISRCTN30768813 (Archived by WebCite at http://www.webcitation.org/6xOQSJ3w8) ", doi="10.2196/mhealth.8263", url="http://mhealth.jmir.org/2018/3/e59/", url="http://www.ncbi.nlm.nih.gov/pubmed/29514772" } @Article{info:doi/10.2196/cardio.8543, author="Magnani, W. Jared and Schlusser, L. Courtney and Kimani, Everlyne and Rollman, L. Bruce and Paasche-Orlow, K. Michael and Bickmore, W. Timothy", title="The Atrial Fibrillation Health Literacy Information Technology System: Pilot Assessment", journal="JMIR Cardio", year="2017", month="Dec", day="12", volume="1", number="2", pages="e7", keywords="atrial fibrillation", keywords="mHealth", keywords="health-related quality of life", keywords="medication adherence", abstract="Background: Atrial fibrillation (AF) is a highly prevalent heart rhythm condition that has significant associated morbidity and requires chronic treatment. Mobile health (mHealth) technologies have the potential to enhance multiple aspects of AF care, including education, monitoring of symptoms, and encouraging and tracking medication adherence. We have previously implemented and tested relational agents to improve outcomes in chronic disease and sought to develop a smartphone-based relational agent for improving patient-centered outcomes in AF. Objective: The objective of this study was to pilot a smartphone-based relational agent as preparation for a randomized clinical trial, the Atrial Fibrillation Health Literacy Information Technology Trial (AF-LITT). Methods: We developed the relational agent for use by a smartphone consistent with our prior approaches. We programmed the relational agent as a computer-animated agent to simulate a face-to-face conversation and to serve as a health counselor or coach specific to AF. Relational agent's dialogue content, informed by a review of literature, focused on patient-centered domains and qualitative interviews with patients with AF, encompassed AF education, common symptoms, adherence challenges, and patient activation. We established that the content was accessible to individuals with limited health or computer literacy. Relational agent content coordinated with use of the smartphone AliveCor Kardia heart rate and rhythm monitor. Participants (N=31) were recruited as a convenience cohort from ambulatory clinical sites and instructed to use the relational agent and Kardia for 30 days. We collected demographic, social, and clinical characteristics and conducted baseline and 30-day assessments of health-related quality of life (HRQoL) with the Atrial Fibrillation Effect on Quality of life (AFEQT) measure; self-reported medication adherence with the Morisky 8-item Medication Adherence Scale (MMAS-8); and patient activation with the Patient Activation Measure (PAM). Results: Participants (mean age 68 [SD 11]; 39\% [12/31] women) used the relational agent for an average 17.8 (SD 10.0) days. The mean number of independent log-ins was 19.6 (SD 10.7), with a median of 20 times over 30 days. The mean number of Kardia uses was 26.5 (SD 5.9), and participants using Kardia were in AF for 14.3 (SD 11.0) days. AFEQT scores improved significantly from 64.5 (SD 22.9) at baseline to 76.3 (SD 19.4) units at 30 days (P<.01). We observed marginal but statistically significant improvement in self-reported medication adherence (baseline: 7.3 [SD 0.9], 30 days: 7.7 [SD 0.5]; P=.01). Assessments of acceptability identified that most of the participants found the relational agent useful, informative, and trustworthy. Conclusions: We piloted a 30-day smartphone-based intervention that combined a relational agent with dedicated content for AF alongside Kardia heart rate and rhythm monitoring. Pilot participants had favorable improvements in HRQoL and self-reported medication adherence, as well as positive responses to the intervention. These data will guide a larger, enhanced randomized trial implementing the smartphone relational agent and the Kardia monitor system. ", doi="10.2196/cardio.8543", url="http://cardio.jmir.org/2017/2/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/29473644" } @Article{info:doi/10.2196/resprot.5886, author="Mirk, M. Sean and Wegrzyn, Marie Nicole", title="Apps for Health-Related Education in Pharmacy Practice: Needs Assessment Survey Among Patients Within a Large Metropolitan Area", journal="JMIR Res Protoc", year="2017", month="Jul", day="19", volume="6", number="7", pages="e133", keywords="patient education", keywords="mHealth", keywords="health information management", keywords="user-centered design", abstract="Background: Patient education resources are crucial to the effectiveness of prescribed pharmacotherapy. However, user interest and patient preference for these materials is lacking. Regardless of the field, nearly every article on designing mHealth apps references the lack of end-user involvement as a key flaw to sustainable design. The traditional paper-based methods of patient education are difficult to tailor to a patient's specific needs and learning styles, but a customizable app might be beneficial. Objective: Regarding a mobile app for patient education, the objectives of the study were to (1) quantify patient interest, (2) determine desirable features, and (3) determine if a relationship exists between patient variables and interest in an iPad app for patient education. Methods: A paper-based questionnaire was developed and administered to consenting patients receiving care within three sites: two suburban outpatient sites where ambulatory care services are provided and one urban hospital site where ambulatory care transition services are provided. Results: A total of 121 surveys were completed. Most respondents were female (64/120, 53.3\%), between 50 and 70 years of age, white/Caucasian (94/120, 78.3\%), owned at least one technology device, and knew what an iPad was. Diabetes was the most common disease state (43/120, 35.8\%), followed by heart failure (27/120, 22.5\%), history of venous thromboembolism (VTE) (21/120, 17.5\%), and asthma/chronic obstructive pulmonary disease (17/120, 14.2\%). Overall interest in a mobile health app for patient education was 63.7\% (72/113). Interest increased to 68.4\% (78/114) if a health care provider recommended it. Respondents with one chronic health condition were more likely to be interested in an app compared to those with two or more. Respondents with a history of VTE were mostly likely to be interested in using an app on their own accord, while respondents with diabetes were mostly likely to be interested if their health care provider recommended it. Conclusions: This preliminary needs assessment identified that patients are interested in using mHealth apps for health-related education in pharmacy practice, particularly if their health care provider recommends it. ", doi="10.2196/resprot.5886", url="http://www.researchprotocols.org/2017/7/e133/", url="http://www.ncbi.nlm.nih.gov/pubmed/28724511" } @Article{info:doi/10.2196/mhealth.6367, author="Wilkinson, L. Jessica and Strickling, Kate and Payne, E. Hannah and Jensen, C. Kayla and West, H. Joshua", title="Evaluation of Diet-Related Infographics on Pinterest for Use of Behavior Change Theories: A Content Analysis", journal="JMIR Mhealth Uhealth", year="2016", month="Dec", day="08", volume="4", number="4", pages="e133", keywords="behavioral health", keywords="content analysis", keywords="nutrition", keywords="social media", keywords="Internet", keywords="healthy eating", keywords="theory", abstract="Background: There is increasing interest in Pinterest as a method of disseminating health information. However, it is unclear whether the health information promoted on Pinterest is evidence-based or incorporates behavior change theory. Objectives: The objective of the study was to determine the presence of health behavior theory (HBT) constructs in pins found on Pinterest and assess the relationship between various pin characteristics and the likelihood of inclusion of HBT. Methods: A content analysis was conducted on pins collected from Pinterest identified with the search terms ``nutrition infographic'' and ``healthy eating infographic.'' The coding rubric included HBT constructs, pin characteristics, and visual communication tools. Each HBT construct was coded as present or not present (yes=1, no=0). A total theory score was calculated by summing the values for each of the 9 constructs (range 0-9). Adjusted regression analysis was used to identify factors associated with the inclusion of health behavior change theory in pins (P<.05). Results: The mean total theory score was 2.03 (SD 1.2).?Perceived benefits were present most often (170/236, 72\%), followed by behavioral capability (123/238, 51.7\%) and perceived severity (79/236, 33.5\%). The construct that appeared the least was self-regulation/self-control (2/237, 0.8\%). Pin characteristics associated with the inclusion of HBT included a large amount of text (P=.01), photographs of real people (P=.001), cartoon pictures of food (P=.01), and the presence of references (P=.001). The number of repins (P=.04), likes (P=.01), and comments (P=.01) were positively associated with the inclusion of HBT. Conclusions: These findings suggest that current Pinterest infographics targeting healthy eating contain few HBT elements. Health professionals and organizations should create and disseminate infographics that contain more elements of HBT to better influence healthy eating behavior. This may be accomplished by creating pins that use both text and images of people and food in order to portray elements of HBT and convey nutritional information. ", doi="10.2196/mhealth.6367", url="http://mhealth.jmir.org/2016/4/e133/", url="http://www.ncbi.nlm.nih.gov/pubmed/27932316" } @Article{info:doi/10.2196/jmir.6205, author="Panatto, Donatella and Domnich, Alexander and Gasparini, Roberto and Bonanni, Paolo and Icardi, Giancarlo and Amicizia, Daniela and Arata, Lucia and Carozzo, Stefano and Signori, Alessio and Bechini, Angela and Boccalini, Sara", title="An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign", journal="J Med Internet Res", year="2016", month="Dec", day="02", volume="18", number="12", pages="e316", keywords="invasive pneumococcal disease", keywords="pneumococcus", keywords="eHealth", keywords="mHealth", keywords="mobile app", abstract="Background: The recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines. Objective: The objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality. Methods: At 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users. Results: Over 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project's Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ?.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562\% (95\% CI 456\%-4870\%) for the app and 620\% (95\% CI 176\%-1777\%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9\% (95\% CI 0.0\%-1.8\%) for the app and 1.4\% (95\% CI 0.7\%-2.1\%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15\% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5\% (397/500). Conclusions: Despite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted. ", doi="10.2196/jmir.6205", url="http://www.jmir.org/2016/12/e316/", url="http://www.ncbi.nlm.nih.gov/pubmed/27913372" } @Article{info:doi/10.2196/mental.6202, author="Rickard, Nikki and Arjmand, Hussain-Abdulah and Bakker, David and Seabrook, Elizabeth", title="Development of a Mobile Phone App to Support Self-Monitoring of Emotional Well-Being: A Mental Health Digital Innovation", journal="JMIR Ment Health", year="2016", month="Nov", day="23", volume="3", number="4", pages="e49", keywords="eHealth", keywords="emotions", keywords="mental health", keywords="mobile phone", keywords="feedback", abstract="Background: Emotional well-being is a primary component of mental health and well-being. Monitoring changes in emotional state daily over extended periods is, however, difficult using traditional methodologies. Providing mental health support is also challenging when approximately only 1 in 2 people with mental health issues seek professional help. Mobile phone technology offers a sustainable means of enhancing self-management of emotional well-being. Objective: This paper aims to describe the development of a mobile phone tool designed to monitor emotional changes in a natural everyday context and in real time. Methods: This evidence-informed mobile phone app monitors emotional mental health and well-being, and it provides links to mental health organization websites and resources. The app obtains data via self-report psychological questionnaires, experience sampling methodology (ESM), and automated behavioral data collection. Results: Feedback from 11 individuals (age range 16-52 years; 4 males, 7 females), who tested the app over 30 days, confirmed via survey and focus group methods that the app was functional and usable. Conclusions: Recommendations for future researchers and developers of mental health apps to be used for research are also presented. The methodology described in this paper offers a powerful tool for a range of potential mental health research studies and provides a valuable standard against which development of future mental health apps should be considered. ", doi="10.2196/mental.6202", url="http://mental.jmir.org/2016/4/e49/", url="http://www.ncbi.nlm.nih.gov/pubmed/27881358" } @Article{info:doi/10.2196/mhealth.6611, author="Chen, Elizabeth and Mangone, Rose Emily", title="A Systematic Review of Apps using Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP)", journal="JMIR Mhealth Uhealth", year="2016", month="Nov", day="10", volume="4", number="4", pages="e122", keywords="mHealth", keywords="eHealth", keywords="smartphone", keywords="mobile phone", keywords="app", keywords="teen", keywords="adolescent", keywords="young adult", keywords="systematic review", keywords="unintended pregnancy", keywords="family planning", keywords="pregnancy prevention", keywords="contraception", abstract="Background: Adolescents in the United States and globally represent a high-risk population for unintended pregnancy, which leads to high social, economic, and health costs. Access to smartphone apps is rapidly increasing among youth, but little is known about the strategies that apps employ to prevent pregnancy among adolescents and young adults. Further, there are no guidelines on best practices for adolescent and young adult pregnancy prevention through mobile apps. Objective: This review developed a preliminary evaluation framework for the assessment of mobile apps for adolescent and young adult pregnancy prevention and used this framework to assess available apps in the Apple App Store and Google Play that targeted adolescents and young adults with family planning and pregnancy prevention support. Methods: We developed an assessment rubric called Mobile Criteria for Adolescent Pregnancy Prevention (mCAPP) for data extraction using evidence-based and promising best practices from the literature. mCAPP comprises 4 domains: (1) app characteristics, (2) user interface features, (3) adolescent pregnancy prevention best practices, and (4) general sexual and reproductive health (SRH) features. For inclusion in the review, apps that advertised pregnancy prevention services and explicitly mentioned youth, were in English, and were free were systematically identified in the Apple App Store and Google Play in 2015. Screening, data extraction, and 4 interrater reliability checks were conducted by 2 reviewers. Each app was assessed for 92 facets of the mCAPP checklist. Results: Our search returned 4043 app descriptions in the Apple App Store (462) and Google Play (3581). After screening for inclusion criteria, 22 unique apps were included in our analysis. Included apps targeted teens in primarily developed countries, and the most common user interface features were clinic and health service locators. While app strengths included provision of SRH education, description of modern contraceptives, and some use of evidence-based adolescent best practices, gaps remain in the implementation of the majority of adolescent best practices and user interface features. Of the 8 best practices for teen pregnancy prevention operationalized through mCAPP, the most commonly implemented best practice was the provision of information on how to use contraceptives to prevent pregnancy (15/22), followed by provision of accurate information on pregnancy risk of sexual behaviors (13/22); information on SRH communication, negotiation, or refusal skills (10/22); and the use of persuasive language around contraceptive use (9/22). Conclusions: The quality and scope of apps for adolescent pregnancy prevention varies, indicating that developers and researchers may need a supportive framework. mCAPP can help researchers and developers consider mobile-relevant evidence-based best practices for adolescent SRH as they develop teen pregnancy prevention apps. Given the novelty of the mobile approach, further research is needed on the impact of mCAPP criteria via mobile channels on adolescent health knowledge, behaviors, and outcomes. ", doi="10.2196/mhealth.6611", url="http://mhealth.jmir.org/2016/4/e122/", url="http://www.ncbi.nlm.nih.gov/pubmed/27833070" } @Article{info:doi/10.2196/mhealth.5771, author="Donaire-Gonzalez, David and Valent{\'i}n, Ant{\`o}nia and de Nazelle, Audrey and Ambros, Albert and Carrasco-Turigas, Gl{\`o}ria and Seto, Edmund and Jerrett, Michael and Nieuwenhuijsen, J. Mark", title="Benefits of Mobile Phone Technology for Personal Environmental Monitoring", journal="JMIR Mhealth Uhealth", year="2016", month="Nov", day="10", volume="4", number="4", pages="e126", keywords="smartphone", keywords="cell phones", keywords="mobile applications", keywords="monitoring, ambulatory", keywords="spatio-temporal analysis", keywords="automatic data processing", keywords="travel", keywords="environmental exposure", abstract="Background: Tracking individuals in environmental epidemiological studies using novel mobile phone technologies can provide valuable information on geolocation and physical activity, which will improve our understanding of environmental exposures. Objective: The objective of this study was to assess the performance of one of the least expensive mobile phones on the market to track people's travel-activity pattern. Methods: Adults living and working in Barcelona (72/162 bicycle commuters) carried simultaneously a mobile phone and a Global Positioning System (GPS) tracker and filled in a travel-activity diary (TAD) for 1 week (N=162). The CalFit app for mobile phones was used to log participants' geographical location and physical activity. The geographical location data were assigned to different microenvironments (home, work or school, in transit, others) with a newly developed spatiotemporal map-matching algorithm. The tracking performance of the mobile phones was compared with that of the GPS trackers using chi-square test and Kruskal-Wallis rank sum test. The minute agreement across all microenvironments between the TAD and the algorithm was compared using the Gwet agreement coefficient (AC1). Results: The mobile phone acquired locations for 905 (29.2\%) more trips reported in travel diaries than the GPS tracker (P<.001) and had a median accuracy of 25 m. Subjects spent on average 57.9\%, 19.9\%, 9.0\%, and 13.2\% of time at home, work, in transit, and other places, respectively, according to the TAD and 57.5\%, 18.8\%, 11.6\%, and 12.1\%, respectively, according to the map-matching algorithm. The overall minute agreement between both methods was high (AC1 .811, 95\% CI .810-.812). Conclusions: The use of mobile phones running the CalFit app provides better information on which microenvironments people spend their time in than previous approaches based only on GPS trackers. The improvements of mobile phone technology in microenvironment determination are because the mobile phones are faster at identifying first locations and capable of getting location in challenging environments thanks to the combination of assisted-GPS technology and network positioning systems. Moreover, collecting location information from mobile phones, which are already carried by individuals, allows monitoring more people with a cheaper and less burdensome method than deploying GPS trackers. ", doi="10.2196/mhealth.5771", url="http://mhealth.jmir.org/2016/4/e126/", url="http://www.ncbi.nlm.nih.gov/pubmed/27833069" } @Article{info:doi/10.2196/jmir.6171, author="Gomez Qui{\~n}onez, Stefanie and Walthouwer, Louis Michel Jean and Schulz, Nadine Daniela and de Vries, Hein", title="mHealth or eHealth? Efficacy, Use, and Appreciation of a Web-Based Computer-Tailored Physical Activity Intervention for Dutch Adults: A Randomized Controlled Trial", journal="J Med Internet Res", year="2016", month="Nov", day="09", volume="18", number="11", pages="e278", keywords="mHealth", keywords="eHealth", keywords="Web-based intervention", keywords="computer-tailored intervention", keywords="physical activity", abstract="Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer-tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8\%) than the mHealth condition (81/108, 75.0\%) and the control group (91/127, 71.7\%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t182=3.07, P=.002) and reading the feedback messages (t181=2.34, P=.02), as well as the clarity of the messages (t181=1.99, P=.049). Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. Trial Registration: Netherlands Trial Register: NTR4503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4503 (Archived by WebCite at http://www.webcitation.org/6lEi1x40s) ", doi="10.2196/jmir.6171", url="http://www.jmir.org/2016/11/e278/", url="http://www.ncbi.nlm.nih.gov/pubmed/27829576" } @Article{info:doi/10.2196/mhealth.5760, author="Huang, Tzu-Yen Evelyn and Williams, Henrietta and Hocking, S. Jane and Lim, SC Megan", title="Safe Sex Messages Within Dating and Entertainment Smartphone Apps: A Review", journal="JMIR Mhealth Uhealth", year="2016", month="Nov", day="08", volume="4", number="4", pages="e124", keywords="mobile apps", keywords="sexual health", keywords="STDs", keywords="sexually transmitted diseases", keywords="mobile health", keywords="mHealth", abstract="Background: Smartphone apps provide a new platform for entertainment, information distribution, and health promotion activities, as well as for dating and casual sexual encounters. Previous research has shown high acceptability of sexual health interventions via smartphone apps; however, sexual health promotion apps were infrequently downloaded and underused. Integrating sexual health promotion into established apps might be a more effective method. Objective: The objective of our study was to critically review popular sex-related apps and dating apps, in order to ascertain whether they contain any sexual health content. Methods: Part 1: In January 2015, we used the term ``sexual'' to search for free apps in the Apple iTunes store and Android Google Play store, and categorized the sexual health content of the 137 apps identified. Part 2: We used the term ``dating'' to search for free geosocial-networking apps in the Apple iTunes and Android Google Play stores. The apps were downloaded to test functionality and to determine whether they included sexual health content. Results: Part 1: Of the 137 apps identified, 15 (11.0\%) had sexual health content and 15 (11.0\%) contained messages about sexual assault or violence. The majority of the apps did not contain any sexual health content. Part 2: We reviewed 60 dating apps: 44 (73\%) targeting heterosexual users, 9 (15\%) targeting men who have sex with men (MSM), 3 (5\%) targeting lesbian women, and 4 (7\%) for group dating. Only 9 dating apps contained sexual health content, of which 7 targeted MSM. Conclusions: The majority of sex-related apps and dating apps contained no sexual health content that could educate users about and remind them of their sexual risks. Sexual health practitioners and public health departments will need to work with app developers to promote sexual health within existing popular apps. For those apps that already contain sexual health messages, further study to investigate the effectiveness of the content is needed. ", doi="10.2196/mhealth.5760", url="http://mhealth.jmir.org/2016/4/e124/", url="http://www.ncbi.nlm.nih.gov/pubmed/27826133" } @Article{info:doi/10.2196/jmir.5691, author="Laws, A. Rachel and Litterbach, V. Eloise-Kate and Denney-Wilson, A. Elizabeth and Russell, G. Catherine and Taki, Sarah and Ong, Kok-Leong and Elliott, M. Rosalind and Lymer, J. Sharyn and Campbell, J. Karen", title="A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program", journal="J Med Internet Res", year="2016", month="Sep", day="15", volume="18", number="9", pages="e248", keywords="recruitment", keywords="mHealth", keywords="parents", keywords="social media", keywords="obesity prevention", keywords="infant feeding", keywords="children", keywords="infants", keywords="practitioners", keywords="primary health care", abstract="Background: Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective: The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods: The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ?18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants' baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results: A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD \$14) and highest for practice nurse recruitment (AUD \$586). Just over half of the intervention group (50.3\%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3\%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3\%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68\% versus 48\%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions: Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. ", doi="10.2196/jmir.5691", url="http://www.jmir.org/2016/9/e248/", url="http://www.ncbi.nlm.nih.gov/pubmed/27634633" } @Article{info:doi/10.2196/mhealth.6187, author="Lyles, R. Courtney and Altschuler, Andrea and Chawla, Neetu and Kowalski, Christine and McQuillan, Deanna and Bayliss, Elizabeth and Heisler, Michele and Grant, W. Richard", title="User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits", journal="JMIR Mhealth Uhealth", year="2016", month="Sep", day="14", volume="4", number="3", pages="e108", keywords="primary health care", keywords="chronic disease", keywords="computers, handheld", keywords="mobile applications", keywords="medical informatics", keywords="health communication", abstract="Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities. ", doi="10.2196/mhealth.6187", url="http://mhealth.jmir.org/2016/3/e108/", url="http://www.ncbi.nlm.nih.gov/pubmed/27627965" } @Article{info:doi/10.2196/mhealth.3726, author="Frisbee, L. Kathleen", title="Variations in the Use of mHealth Tools: The VA Mobile Health Study", journal="JMIR Mhealth Uhealth", year="2016", month="Jul", day="19", volume="4", number="3", pages="e89", keywords="caregivers", keywords="telemedicine", keywords="stress (psychological)", keywords="veterans health", abstract="Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA's Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9\% (837/882) of caregivers were women and 95.7\% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8\% (351/882) lived in rural locations. Most (89\%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA's first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. ", doi="10.2196/mhealth.3726", url="http://mhealth.jmir.org/2016/3/e89/", url="http://www.ncbi.nlm.nih.gov/pubmed/27436165" } @Article{info:doi/10.2196/mhealth.5243, author="Micallef, Christianne and McLeod, Monsey and Castro-S{\'a}nchez, Enrique and Gharbi, Myriam and Charani, Esmita and Moore, SP Luke and Gilchrist, Mark and Husson, Fran and Costelloe, Ceire and Holmes, H. Alison", title="An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients", journal="JMIR Mhealth Uhealth", year="2016", month="Jul", day="06", volume="4", number="3", pages="e83", keywords="mobile electronic devices", keywords="mHealth", keywords="mobile health", keywords="antimicrobial resistance", keywords="patient involvement", abstract="Background: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients' experiences of their interactions with health care professionals in relation to this topic. Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England. Results: A total of 99 surveys were completed and analyzed. A total of 82\% (80/98) of respondents had recently been prescribed antimicrobials; 87\% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65\%) and prevention and/or management (32/65, 49\%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100\%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55\%) stated it was ``fine'' for doctors to use a mobile phone/tablet computer during the consultation while 13\% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30\% (27/89) of respondents reported on the use of health care apps, 95\% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience. Conclusions: The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance. ", doi="10.2196/mhealth.5243", url="http://mhealth.jmir.org/2016/3/e83/", url="http://www.ncbi.nlm.nih.gov/pubmed/27383743" } @Article{info:doi/10.2196/mhealth.5652, author="White, K. Becky and Martin, Annegret and White, A. James and Burns, K. Sharyn and Maycock, R. Bruce and Giglia, C. Roslyn and Scott, A. Jane", title="Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man)", journal="JMIR Mhealth Uhealth", year="2016", month="Jun", day="27", volume="4", number="2", pages="e81", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="app", keywords="breastfeeding", keywords="fathers", keywords="gamification", keywords="social connectivity", abstract="Background: Despite evidence of the benefits of breastfeeding, <15\% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. Objective: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. Methods: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS). Results: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. Conclusions: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695). ", doi="10.2196/mhealth.5652", url="http://mhealth.jmir.org/2016/2/e81/", url="http://www.ncbi.nlm.nih.gov/pubmed/27349756" } @Article{info:doi/10.2196/jmir.5726, author="BinDhim, F. Nasser and Alanazi, M. Eman and Aljadhey, Hisham and Basyouni, H. Mada and Kowalski, R. Stefan and Pont, G. Lisa and Shaman, M. Ahmed and Trevena, Lyndal and Alhawassi, M. Tariq", title="Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional's Help?", journal="J Med Internet Res", year="2016", month="Jun", day="27", volume="18", number="6", pages="e156", keywords="mental health", keywords="depression", keywords="mobile phone", keywords="public health informatics", keywords="patients' screening", abstract="Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple's App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app's download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74\% of those completed the follow-up; approximately 38\% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. ", doi="10.2196/jmir.5726", url="http://www.jmir.org/2016/6/e156/", url="http://www.ncbi.nlm.nih.gov/pubmed/27349441" } @Article{info:doi/10.2196/mhealth.5715, author="Arvidsson, Susann and Gilljam, Britt-Mari and Nygren, Jens and Ruland, Maria Cornelia and Nordby-B{\o}e, Trude and Svedberg, Petra", title="Redesign and Validation of Sisom, an Interactive Assessment and Communication Tool for Children With Cancer", journal="JMIR Mhealth Uhealth", year="2016", month="Jun", day="24", volume="4", number="2", pages="e76", keywords="cancer", keywords="children", keywords="communication", keywords="mobile app", keywords="participation", keywords="validation", abstract="Background: Children with cancer undergo intensive and long treatment periods that expose them and their families to a number of difficult physical, mental, and social challenges. Empowering children by actively involving them in their care can help them to cope with these challenges. It can, however, be difficult for children to be involved and talk about their illness experiences in a ``traditional'' conversation with health care professionals, especially for younger children. Sisom (Norwegian acronym ``Si det som det er'' or ``Tell it how it is'') is an interactive computer-based assessment and communication tool to give children (aged 6-12 years) with cancer a ``voice'' in their care. Because of technological advances and widespread use of mobile devices Sisom had to be redesigned to better meet the needs of children of today. Objective: To redesign Sisom for use on mobile devices and to validate and adapt it for use in a Swedish population of children with cancer. Methods: A user-experience design was used. Content adaptation included forward-backward translation by Swedish and Norwegian translators. Healthy children (n=5), children with experiences of cancer treatment (n=5) and their parents (n=5), and pediatric nurses (n=2) were then involved in culturally adapting Sisom to the Swedish context. The iterative low- and high-fidelity evaluation was supported by a think aloud method, semistructured interviews, and drawings to capture children's views of Sisom. The redesign and evaluation continued until no further changes or improvements were identified by the participants or the researchers. Results: Children, parents, and pediatric nurses offered many suggestions for improvements to the original version in terms of content, aesthetics, and usability of Sisom. The most significant change that emerged through user input was a modification that entailed not using problem-focused statements in the assessment items. The parents and pediatric nurses considered the revised assessment items to be general and less diagnosis specific. The evaluation of aesthetics resulted in brighter colors and more positive and exciting details in the animations. The evaluation of usability included improvements of the verbal instructions on how to navigate in Sisom 2, and also that the answers to assessment items in Sisom 2 should be saved to provide the children with the option to pause and to continue answering the remaining assessment items at a later stage. Conclusions: Overall, this paper describes the process of using user-experience design with children in order to redesign and validate an interactive assessment and communication tool and how the outcomes of this process resulted in a new version, Sisom 2. All participants confirmed the usability and qualities of using the final version. Future research should be directed toward the implementation of Sisom 2 in clinical practice and to evaluate outcomes from individual and organizational levels. ", doi="10.2196/mhealth.5715", url="http://mhealth.jmir.org/2016/2/e76/", url="http://www.ncbi.nlm.nih.gov/pubmed/27343004" } @Article{info:doi/10.2196/cancer.5380, author="Puszkiewicz, Patrycja and Roberts, L. Anna and Smith, Lee and Wardle, Jane and Fisher, Abigail", title="Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application", journal="JMIR Cancer", year="2016", month="May", day="31", volume="2", number="1", pages="e7", keywords="cancer survivors", keywords="mobile applications", keywords="mHealth", keywords="physical activity", keywords="sleep", abstract="Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors' attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82\% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73\% (16/22) agreed to participate and 100\% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one's lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. ", doi="10.2196/cancer.5380", url="http://cancer.jmir.org/2016/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410168" } @Article{info:doi/10.2196/mhealth.5202, author="Breitenstein, M. Susan and Fogg, Louis and Ocampo, V. Edith and Acosta, I. Diana and Gross, Deborah", title="Parent Use and Efficacy of a Self-Administered, Tablet-Based Parent Training Intervention: A Randomized Controlled Trial", journal="JMIR mHealth uHealth", year="2016", month="Apr", day="20", volume="4", number="2", pages="e36", keywords="Internet, intervention, mobile app, mobile health, parenting, prevention", abstract="Background: Parent training programs are traditionally delivered in face-to-face formats and require trained facilitators and weekly parent attendance. Implementing face-to-face sessions is challenging in busy primary care settings and many barriers exist for parents to attend these sessions. Tablet-based delivery of parent training offers an alternative to face-to-face delivery to make parent training programs easier to deliver in primary care settings and more convenient and accessible to parents. We adapted the group-based Chicago Parent Program (CPP) to be delivered as a self-administered, tablet-based program called the ezParent program. Objective: The purpose of this study was to (1) assess the feasibility of the ezParent program by examining parent satisfaction with the program and the percent of modules completed, (2) test the efficacy of the ezParent program by examining the effects compared with a control condition for improving parenting and child behavior in a sample of low-income ethnic minority parents of young children recruited from a primary care setting, and (3) compare program completion and efficacy with prior studies of the group-based CPP. Methods: The study used a two-group randomized controlled trial (RCT) design with repeated measures follow up. Subjects (n=79) were randomly assigned to an intervention or attention control condition. Data collection was at baseline and 12 and 24 weeks post baseline. Parents were recruited from a large, urban, primary care pediatric clinic. ezParent module completion was calculated as the percentage of the six modules completed by the intervention group parents. Attendance in the group-based CPP was calculated as the percentage of attendance at sessions 1 through 10. Satisfaction data were summarized using item frequencies. Parent and child data were analyzed using a repeated measures analysis of variance (RM-ANOVA) with simple contrasts to determine if there were significant intervention effects on the outcome measures. Effect sizes for between group comparisons were calculated for all outcome variables and compared with CPP group based archival data. Results: ezParent module completion rate was 85.4\% (34.2/40; 95\% confidence interval [CI] = 78.4\%-93.7\%) and was significantly greater (P<.05) than face-to-face CPP group attendance (135.2/267, 50.6\%) attendance of sessions; 95\% CI = 46.8\%-55.6\%). ezParent participants reported the program as very helpful (35/40, 88.0\%) and they would highly recommend the program (33/40, 82.1\%) to another parent. ezParent participants showed greater improvements in parenting warmth (F1,77 = 4.82, P<.05) from time 1 to 3. No other significant differences were found. Cohen's d effect sizes for intervention group improvements in parenting warmth, use of corporal punishment, follow through, parenting stress, and intensity of child behavior problems were comparable or greater than those of the group-based CPP. Conclusions: Data from this study indicate the feasibility and acceptability of the ezParent program in a low-income, ethnic minority population of parents and comparable effect sizes with face-to-face delivery for parents. ", doi="10.2196/mhealth.5202", url="http://mhealth.jmir.org/2016/2/e36/", url="http://www.ncbi.nlm.nih.gov/pubmed/27098111" } @Article{info:doi/10.2196/mhealth.5009, author="Simons, Lucy and Valentine, Z. Althea and Falconer, J. Caroline and Groom, Madeleine and Daley, David and Craven, P. Michael and Young, Zoe and Hall, Charlotte and Hollis, Chris", title="Developing mHealth Remote Monitoring Technology for Attention Deficit Hyperactivity Disorder: A Qualitative Study Eliciting User Priorities and Needs", journal="JMIR mHealth uHealth", year="2016", month="Mar", day="23", volume="4", number="1", pages="e31", keywords="attention deficit hyperactivity disorder", keywords="mHealth", keywords="eMental Health", keywords="remote monitoring technology", keywords="mental health services", keywords="qualitative methods", keywords="feasibility testing", keywords="user requirements", abstract="Background: Guidelines in the United Kingdom recommend that medication titration for attention deficit hyperactivity disorder (ADHD) should be completed within 4-6 weeks and include regular reviews. However, most clinicians think that weekly clinic contact is infeasible, and audits have shown that this timeline is rarely achieved. Thus, a more effective monitoring and review system is needed; remote monitoring technology (RMT) may be one way to improve current practice. However, little is known about whether patients with ADHD, their families, and clinicians would be interested in using RMT. Objective: To explore patients', parents', and health care professionals' views and attitudes toward using digital technology for remote monitoring during titration for ADHD. Methods: This was a qualitative study, and data were collected through 11 focus groups with adults and young people with ADHD, parents of children with ADHD, and health care professionals (N=59). Results: All participant groups were positive about using RMT in the treatment of ADHD, but they were also aware of barriers to its use, especially around access to technology and integrating RMT into clinical care. They identified that RMT had the most potential for use in the ongoing management and support of ADHD, rather than during the distinct titration period. Participants identified features of RMT that could improve the quality of consultations and support greater self-management. Conclusions: RMT has the potential to augment support and care for ADHD, but it needs to go beyond the titration period and offer more to patients and families than monitoring through outcome measures. Developing and evaluating an mHealth app that incorporates the key features identified by end users is required. ", doi="10.2196/mhealth.5009", url="http://mhealth.jmir.org/2016/1/e31/", url="http://www.ncbi.nlm.nih.gov/pubmed/27009498" } @Article{info:doi/10.2196/mhealth.4292, author="Browne, H. Sara and Behzadi, Yashar and Littlewort, Gwen", title="Let Visuals Tell the Story: Medication Adherence in Patients with Type II Diabetes Captured by a Novel Ingestion Sensor Platform", journal="JMIR mHealth uHealth", year="2015", month="Dec", day="31", volume="3", number="4", pages="e108", keywords="ingestion sensor platform", keywords="data visualization", keywords="time domain methods", keywords="medication adherence", keywords="patient self-management", abstract="Background: Chronic diseases such as diabetes require high levels of medication adherence and patient self-management for optimal health outcomes. A novel sensing platform, Digital Health Feedback System (Proteus Digital Health, Redwood City, CA), can for the first time detect medication ingestion events and physiological measures simultaneously, using an edible sensor, personal monitor patch, and paired mobile device. The Digital Health Feedback System (DHFS) generates a large amount of data. Visual analytics of this rich dataset may provide insights into longitudinal patterns of medication adherence in the natural setting and potential relationships between medication adherence and physiological measures that were previously unknown. Objective: Our aim was to use modern methods of visual analytics to represent continuous and discrete data from the DHFS, plotting multiple different data types simultaneously to evaluate the potential of the DHFS to capture longitudinal patterns of medication-taking behavior and self-management in individual patients with type II diabetes. Methods: Visualizations were generated using time domain methods of oral metformin medication adherence and physiological data obtained by the DHFS use in 5 patients with type II diabetes over 37-42 days. The DHFS captured at-home metformin adherence, heart rate, activity, and sleep/rest. A mobile glucose monitor captured glucose testing and level (mg/dl). Algorithms were developed to analyze data over varying time periods: across the entire study, daily, and weekly. Following visualization analysis, correlations between sleep/rest and medication ingestion were calculated across all subjects. Results: A total of 197 subject days, encompassing 141,840 data events were analyzed. Individual continuous patch use varied between 87-98\%. On average, the cohort took 78\% (SD 12) of prescribed medication and took 77\% (SD 26) within the prescribed {\textpm}2-hour time window. Average activity levels per subjects ranged from 4000-12,000 steps per day. The combination of activity level and heart rate indicated different levels of cardiovascular fitness between subjects. Visualizations over the entire study captured the longitudinal pattern of missed doses (the majority of which took place in the evening), the timing of ingestions in individual subjects, and the range of medication ingestion timing, which varied from 1.5-2.4 hours (Subject 3) to 11 hours (Subject 2). Individual morning self-management patterns over the study period were obtained by combining the times of waking, metformin ingestion, and glucose measurement. Visualizations combining multiple data streams over a 24-hour period captured patterns of broad daily events: when subjects rose in the morning, tested their blood glucose, took their medications, went to bed, hours of sleep/rest, and level of activity during the day. Visualizations identified highly consistent daily patterns in Subject 3, the most adherent participant. Erratic daily patterns including sleep/rest were demonstrated in Subject 2, the least adherent subject. Correlation between sleep /rest and medication ingestion in each individual subject was evaluated. Subjects 2 and 4 showed correlation between amount of sleep/rest over a 24-hour period and medication-taking the following day (Subject 2: r=.47, P<.02; Subject 4: r=.35, P<.05). With Subject 2, sleep/rest disruptions during the night were highly correlated (r=.47, P<.009) with missing doses the following day. Conclusions: Visualizations integrating medication ingestion and physiological data from the DHFS over varying time intervals captured detailed individual longitudinal patterns of medication adherence and self-management in the natural setting. Visualizing multiple data streams simultaneously, providing a data-rich representation, revealed information that would not have been shown by plotting data streams individually. Such analyses provided data far beyond traditional adherence summary statistics and may form the foundation of future personalized predictive interventions to drive longitudinal adherence and support optimal self-management in chronic diseases such as diabetes. ", doi="10.2196/mhealth.4292", url="http://mhealth.jmir.org/2015/4/e108/", url="http://www.ncbi.nlm.nih.gov/pubmed/26721413" } @Article{info:doi/10.2196/mhealth.4263, author="Wark, D. John and Henningham, Lucy and Gorelik, Alexandra and Jayasinghe, Yasmin and Hartley, Stefanie and Garland, Marie Suzanne", title="Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study", journal="JMIR mHealth uHealth", year="2015", month="Oct", day="05", volume="3", number="4", pages="e94", keywords="basal body temperature", keywords="young female health initiative", keywords="BodyMedia SenseWear", keywords="ovulation", keywords="menstrual cycle, young women", abstract="Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2{\textdegree}C, BMSW: 29.7-36.7{\textdegree}C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6{\textdegree}C (SD 1.2) versus 36.4{\textdegree}C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0\% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. ", doi="10.2196/mhealth.4263", url="http://mhealth.jmir.org/2015/4/e94/", url="http://www.ncbi.nlm.nih.gov/pubmed/26441468" } @Article{info:doi/10.2196/resprot.3715, author="Sieverdes, Christopher John and Nemeth, S. Lynne and Magwood, S. Gayenell and Baliga, K. Prabhakar and Chavin, D. Kenneth and Brunner-Jackson, Brenda and Patel, K. Sachin and Ruggiero, J. Kenneth and Treiber, A. Frank", title="Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis", journal="JMIR Res Protoc", year="2015", month="Aug", day="10", volume="4", number="3", pages="e84", keywords="kidney transplantation", keywords="living donors", keywords="mobile apps", keywords="qualitative research", keywords="telemedicine", abstract="Background: There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective: The objectives of this study were to investigate African American kidney transplant recipients' and kidney donors'/potential donors' attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods: Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members' perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results: Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85\% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9\% of the participants had a mobile phone and 43.9\% had a tablet. Conclusions: Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience. ", doi="10.2196/resprot.3715", url="http://www.researchprotocols.org/2015/3/e84/", url="http://www.ncbi.nlm.nih.gov/pubmed/26265532" } @Article{info:doi/10.2196/games.4081, author="Brand, Leah and Beltran, Alicia and Buday, Richard and Hughes, Sheryl and O'Connor, Teresia and Baranowski, Janice and Dadabhoy, R. Hafza and Diep, S. Cassandra and Baranowski, Tom", title="Training Vegetable Parenting Practices Through a Mobile Game: Iterative Qualitative Alpha Test", journal="JMIR Serious Games", year="2015", month="Jul", day="24", volume="3", number="2", pages="e6", keywords="mobile games", keywords="games for health", keywords="serious games", keywords="pediatric nutrition", keywords="parenting", abstract="Background: Vegetable consumption protects against chronic diseases, but many young children do not eat vegetables. One quest within the mobile application Mommio was developed to train mothers of preschoolers in effective vegetable parenting practices, or ways to approach getting their child to eat and enjoy vegetables. A much earlier version of the game, then called Kiddio, was alpha tested previously, but the game has since evolved in key ways. Objective: The purpose of this research was to alpha test the first quest, substantiate earlier findings and obtain feedback on new game features to develop an effective, compelling parenting game. Methods: Mothers of preschool children (n=20) played a single quest of Mommio 2 to 4 times, immediately after which a semi-structured interview about their experience was completed. Interviews were transcribed and double coded using thematic analysis methods. Results: Mothers generally liked the game, finding it realistic and engaging. Some participants had difficulties with mechanics for moving around the 3-D environment. Tips and hints were well received, and further expansion and customization were desired. Conclusions: Earlier findings were supported, though Mommio players reported more enjoyment than Kiddio players. Continued development will include more user-friendly mechanics, customization, opportunities for environment interaction, and food parenting scenarios. ", doi="10.2196/games.4081", url="http://games.jmir.org/2015/2/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/26208899" } @Article{info:doi/10.2196/mhealth.4021, author="Boyd, Dallas Andrew and Moores, Kaitlin and Shah, Vicki and Sadhu, Eugene and Shroff, Adhir and Groo, Vicki and Dickens, Carolyn and Field, Jerry and Baumann, Matthew and Welland, Betty and Gutowski, Gerry and Flores Jr, D. Jose and Zhao, Zhongsheng and Bahroos, Neil and Hynes, M. Denise and Wilkie, J. Diana", title="My Interventional Drug-Eluting Stent Educational App (MyIDEA): Patient-Centered Design Methodology", journal="JMIR mHealth uHealth", year="2015", month="Jul", day="02", volume="3", number="3", pages="e74", keywords="drug-eluting stents", keywords="health informatics", keywords="Kolb's learning theory", keywords="mHealth", keywords="patient-centered design", keywords="patient education", abstract="Background: Patient adherence to medication regimens is critical in most chronic disease treatment plans. This study uses a patient-centered tablet app, ``My Interventional Drug-Eluting Stent Educational App (MyIDEA).'' This is an educational program designed to improve patient medication adherence. Objective: Our goal is to describe the design, methodology, limitations, and results of the MyIDEA tablet app. We created a mobile technology-based patient education app to improve dual antiplatelet therapy adherence in patients who underwent a percutaneous coronary intervention and received a drug-eluting stent. Methods: Patient advisers were involved in the development process of MyIDEA from the initial wireframe to the final launch of the product. The program was restructured and redesigned based on the patient advisers' suggestions as well as those from multidisciplinary team members. To accommodate those with low health literacy, we modified the language and employed attractive color schemes to improve ease of use. We assumed that the target patient population may have little to no experience with electronic tablets, and therefore, we designed the interface to be as intuitive as possible. Results: The MyIDEA app has been successfully deployed to a low-health-literate elderly patient population in the hospital setting. A total of 6 patients have interacted with MyIDEA for an average of 17.6 minutes/session. Conclusions: Including patient advisers in the early phases of a mobile patient education development process is critical. A number of changes in text order, language, and color schemes occurred to improve ease of use. The MyIDEA program has been successfully deployed to a low-health-literate elderly patient population. Leveraging patient advisers throughout the development process helps to ensure implementation success. ", doi="10.2196/mhealth.4021", url="http://mhealth.jmir.org/2015/3/e74/", url="http://www.ncbi.nlm.nih.gov/pubmed/26139587" }