@Article{info:doi/10.2196/71535, author="Mohammed, Tallah Heba and Corcoran, Kathleen and Lavergne, Kyle and Graham, Angela and Gill, Daniel and Jones, Kwame and Singal, Shivika and Krishnamoorthy, Malini and Cassata, Amy and Mannion, David and Fraser, J. Robert D.", title="Clinical, Operational, and Economic Benefits of a Digitally Enabled Wound Care Program in Home Health: Quasi-Experimental, Pre-Post Comparative Study", journal="JMIR Nursing", year="2025", month="Apr", day="8", volume="8", pages="e71535", keywords="home health care", keywords="artificial intelligence", keywords="AI", keywords="digital wound care", keywords="wound assessment", keywords="operational efficiency", keywords="clinical outcomes", keywords="healing time", keywords="cost saving", keywords="skilled nursing visits", abstract="Background: The demand for home health care and nursing visits has steadily increased, requiring significant allocation of resources for wound care. Many home health agencies operate below capacity due to clinician shortages, meeting only 61\% to 70\% of demand and frequently declining wound care referrals. Implementing artificial intelligence--powered digital wound care solutions (DWCSs) offers an opportunity to enhance wound care programs by improving scalability and effectiveness through better monitoring and risk identification. Objective: This study assessed clinical and operational outcomes across 14 home health branches that adopted a DWCS, comparing pre- and postadoption data and outcomes with 27 control branches without the technology. Methods: This pre-post comparative study analyzed clinical outcomes, including average days to wound healing, and operational outcomes, such as skilled nursing (SN) visits per episode (VPE) and in-home visit durations, during two 7-month intervals (from November to May in 2020-2021 and 2021-2022). Data were extracted from 14,278 patients who received wound care across adoption and control branches. Projected cost savings were also calculated based on reductions in SN visits. Results: The adoption branches showed a 4.3\% reduction in SN VPE and a 2.5\% reduction in visit duration, saving approximately 309 staff days. In contrast, control branches experienced a 4.5\% increase in SN VPE and a 2.2\% rise in visit duration, adding 42 days. Healing times improved significantly in the adoption branches, with a reduction of 4.3 days on average per wound compared to 1.6 days in control branches (P<.001); pressure injuries, venous ulcers, and surgical wounds showed the most substantial improvements. Conclusions: Integrating digital wound management technology enhances clinical outcomes, operational efficiencies, and cost savings in home health settings. A reduction of 0.3 SN VPE could generate annual savings of up to US \$958,201 across the organization. The adoption branches avoided 1187 additional visits during the study period. If control branches had implemented the DWCS and achieved similar outcomes, they would have saved 18,546 healing days. These findings emphasize the importance of incorporating DWCSs into wound care programs to address increasing demands, clinician shortages, and rising health care costs while maintaining positive clinical outcomes. ", doi="10.2196/71535", url="https://nursing.jmir.org/2025/1/e71535", url="http://www.ncbi.nlm.nih.gov/pubmed/40198913" } @Article{info:doi/10.2196/62741, author="Mbeya-Munkhondya, E. Tiwonge and Meek, J. Caroline and Mphande, Mtisunge and Tembo, A. Tapiwa and Chitani, J. Mike and Jean-Baptiste, Milenka and Kumbuyo, Caroline and Vansia, Dhrutika and Simon, R. Katherine and Rutstein, E. Sarah and Mwapasa, Victor and Go, Vivian and Kim, H. Maria and Rosenberg, E. Nora", title="Anticipated Acceptability of Blended Learning Among Lay Health Care Workers in Malawi: Qualitative Analysis Guided by the Technology Acceptance Model", journal="JMIR Form Res", year="2025", month="Apr", day="7", volume="9", pages="e62741", keywords="blended learning", keywords="technology acceptance model", keywords="index case testing", keywords="acceptability", keywords="partner notification", keywords="contact tracing", abstract="Background: HIV index case testing (ICT) aims to identify people living with HIV and their contacts, engage them in HIV testing services, and link them to care. ICT implementation has faced challenges in Malawi due to limited counseling capacity among lay health care workers (HCWs). Enhancing capacity through centralized face-to-face training is logistically complex and expensive. A decentralized blended learning approach to HCW capacity-building, combining synchronous face-to-face and asynchronous digital modalities, may be an acceptable way to address this challenge. Objective: The objective of this analysis is to describe factors influencing HCW anticipated acceptability of blended learning using the Technology Acceptance Model (TAM). Methods: This formative qualitative study involved conducting 26 in-depth interviews with HCWs involved in the ICT program across 14 facilities in Machinga and Balaka, Malawi (November-December 2021). Results were analyzed thematically using TAM. Themes were grouped into factors affecting the 2 sets of TAM constructs: perceived usefulness and perceived ease of use. Results: A total of 2 factors influenced perceived usefulness. First, HCWs found the idea of self-guided digital learning appealing, as they believed it would allow for reinforcement, which would facilitate competence. They also articulated the need for opportunities to practice and receive feedback through face-to-face interactions in order to apply the digital components. In total, 5 factors influenced perceived ease of use. First, HCWs expressed a need for orientation to the digital technology given limited digital literacy. Second, they requested accessibility of devices provided by their employer, as many lacked personal devices. Third, they wished for adequate communication surrounding their training schedules, especially if they were going to be asynchronous. Fourth, they wished for support for logistical arrangements to avoid work interruptions. Finally, they wanted monetary compensation to motivate learning, a practice comparable with offsite trainings. Conclusions: A decentralized blended learning approach may be an acceptable method of enhancing ICT knowledge and skills among lay HCWs in Malawi, although a broad range of external factors need to be considered. Our next step is to integrate these findings into a blended learning package and examine perceived acceptability of the package in the context of a cluster randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-077706 ", doi="10.2196/62741", url="https://formative.jmir.org/2025/1/e62741" } @Article{info:doi/10.2196/57237, author="Li, Lan and Back, Emma and Lee, Suna and Shipley, Rebecca and Mapitse, N{\'e}o and Elbe, Stefan and Smallman, Melanie and Wilson, James and Yasin, Ifat and Rees, Geraint and Gordon, Ben and Murray, Virginia and Roberts, L. Stephen and Cupani, Anna and Kostkova, Patty", title="Balancing Risks and Opportunities: Data-Empowered-Health Ecosystems", journal="J Med Internet Res", year="2025", month="Mar", day="25", volume="27", pages="e57237", keywords="health policy", keywords="data sharing", keywords="digital healthcare", keywords="healthcare system", keywords="ecosystems", keywords="technologies", keywords="decision-making", keywords="data privacy", keywords="data protection", keywords="social media", keywords="application programming interfaces", doi="10.2196/57237", url="https://www.jmir.org/2025/1/e57237" } @Article{info:doi/10.2196/65241, author="Holetzek, Tim and H{\"a}usler, Andreas and G{\"o}dde, Kathrin and Rapp, Michael and Spallek, Jacob and Holmberg, Christine", title="The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Mar", day="24", volume="27", pages="e65241", keywords="digitalization", keywords="general practitioners", keywords="Germany", keywords="information and communication technologies", keywords="information exchange", keywords="primary health care", keywords="digital transformation", keywords="mixed methods study", keywords="digital health", keywords="health application", keywords="qualitative interview", abstract="Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5\%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2\%, SD 24.64), fax (n=109, 43.9\%, SD 25.40), or post (n=50, 20.2\%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8\%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5\%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs' communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs' practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers' perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. ", doi="10.2196/65241", url="https://www.jmir.org/2025/1/e65241" } @Article{info:doi/10.2196/65373, author="Gao, Lu and Chen, Meilian and Wei, Jingxin and Wang, Jinni and Liao, Xiaoyan", title="The Chinese Version of the DigiHealthCom (Digital Health Competence) Instrument for Assessing Digital Health Competence of Health Care Professionals: Translation, Adaptation, and Validation Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="21", volume="12", pages="e65373", keywords="competence", keywords="digital health", keywords="health care professionals", keywords="instrument", keywords="reliability", keywords="validity", abstract="Background: Digital health competence is increasingly recognized as a core competence for health care professionals. A comprehensive evaluation of knowledge, skills, performance, values, and attitudes necessary to adapt to evolving digital health technologies is essential. DigiHealthCom (Digital Health Competence) is a well-established instrument designed to assess digital health competence across diverse health care professionals. Objective: This study aimed to translate and culturally adapt DigiHealthCom into simplified Chinese (Mandarin) and verify its reliability and validity in assessing digital health competence of Chinese health care professionals. Methods: DigiHealthCom was translated into Chinese following the guideline proposed by its original developers. The cultural adaptation involved expert review and cognitive interviewing. Internal consistency, test-retest reliability, content validity, convergent validity, discriminant validity, and factor structure were examined. Item analysis tested item discrimination, item correlation, and item homogeneity. Internal consistency was assessed using Cronbach $\alpha$, and test-retest reliability was measured using the intraclass correlation coefficient. Content validity was assessed through both item and scale content validity indices. Convergent validity was measured by the Average Variance Extracted and Composite Reliability, while discriminant validity was measured by the heterotrait-monotrait ratio. A five-dimension model of DigiHealthCom was confirmed using confirmatory factor analysis. Results: The finalized Chinese version of the DigiHealthCom was completed after addressing differences between the back-translations and the original version. No discrepancies affecting item clarity were reported during cognitive interviewing. The validation process involved 398 eligible health care professionals from 36 cities across 15 provinces in China, with 43 participants undergoing a retest after a 2-week interval. Critical ratio values (range 16.05?23.77, P<.001), item-total correlation coefficients (range 0.69?0.89), and Cronbach $\alpha$ if the item deleted (range 0.91?0.96) indicated satisfactory item discrimination, item correlation, and item homogeneity. Cronbach $\alpha$ for dimensions and the scale ranged from 0.94 to 0.98, indicating good internal consistency. The intraclass correlation coefficient was 0.90 (95\% CI 0.81?0.95), indicating good test-retest reliability. Item content validity index ranged from 0.82 to 1.00, and the scale content validity index was 0.97, indicating satisfactory content validity. Convergent validity (average variance extracted: 0.60?0.79; composite reliability: 0.94?0.95) and divergent validity (heterotrait-monotrait ratio: 0.72?0.89) were satisfactory. Confirmatory factor analysis confirmed a well-fit five-dimension model (robust chi-square to df ratio=3.10, comparative fit index=0.91, Tucker-Lewis index=0.90, incremental fit index=0.91, root-mean-square error of approximation=0.07, standardized root-mean-square residual=0.05), with each item having a factor loading exceeding 0.40. Conclusions: The Chinese version of DigiHealthCom has been proved to be reliable and valid. It is now available for assessing digital health competence among Chinese health care professionals. This assessment can be used to guide health care policy makers and educators in designing comprehensive and implementable educational programs and interventions. ", doi="10.2196/65373", url="https://humanfactors.jmir.org/2025/1/e65373" } @Article{info:doi/10.2196/64973, author="McCullough, P. Hannah and Moczygemba, R. Leticia and Avance{\~n}a, V. Anton L. and Baffoe, O. James", title="The Interactive Care Coordination and Navigation mHealth Intervention for People Experiencing Homelessness: Cost Analysis, Exploratory Financial Cost-Benefit Analysis, and Budget Impact Analysis", journal="JMIR Form Res", year="2025", month="Mar", day="18", volume="9", pages="e64973", keywords="people experiencing homelessness", keywords="budget impact analysis", keywords="financial cost-benefit analysis", keywords="mHealth", keywords="care coordination", keywords="care", keywords="mobile health", keywords="smartphones", keywords="homeless", keywords="hospitalization", keywords="cost analysis", keywords="health care cost", keywords="economic", keywords="emergency department", keywords="United States", keywords="cost-benefit", keywords="digital health", abstract="Background: The Interactive Care Coordination and Navigation (iCAN) mobile health intervention aims to improve care coordination and reduce hospital and emergency department visits among people experiencing homelessness. Objective: This study aimed to conduct a three-part economic evaluation of iCAN, including a (1) cost analysis, (2) exploratory financial cost-benefit analysis, and (3) budget impact analysis (BIA). Methods: We collected cost and expenditure data from a randomized controlled trial of iCAN to conduct a cost analysis and exploratory financial cost-benefit analysis. Costs were classified as startup and recurring costs for participants and the program. Startup costs included participant supplies for each participant and SMS implementation costs. Recurring costs included the cost of recurring services, SMS text messaging platform maintenance, health information access fees, and personnel salaries. Using the per participant per year (PPPY) costs of iCAN, the minimum savings reduction in the average health care costs among people experiencing homelessness that would lead to a benefit-cost ratio >1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100\%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0\% (no savings) to 50\%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US \$. Results: The total cost of iCAN was US \$2865 PPPY, which was made up of US \$265 in startup (9\%) and US \$2600 (91\%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8\%. This means that if average health care costs (US \$36,917) among people experiencing homelessness were reduced by more than 7.8\% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25\% (\$9229/\$36,917; equal to 56\% [\$9229/\$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US \$2.22 in health care savings per US \$1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US \$28.7 million, which could be reduced to US \$2.2 million if at least 8\% (\$2880/\$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention. Conclusions: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8\% (\$2880/\$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio. Trial Registration: ClinicalTrials NCT05365867; https://clinicaltrials.gov/study/NCT05365867 ", doi="10.2196/64973", url="https://formative.jmir.org/2025/1/e64973" } @Article{info:doi/10.2196/56053, author="Juan, Stephanie and Harxhi, Ante and Kaul, Simrati and Woods, Breeana and Tran, Monica and Geonnotti, Gabrielle and Gupta, Archit and Dean, Emily and Saunders, E. Cassandra and Payne, Gloria", title="Optimization of the Care4Today Digital Health Platform to Enhance Self-Reporting of Medication Adherence and Health Experiences in Patients With Coronary or Peripheral Artery Disease: Mixed Methods Study", journal="JMIR Cardio", year="2025", month="Mar", day="17", volume="9", pages="e56053", keywords="app", keywords="cardiovascular disease", keywords="Care4Today", keywords="coronary artery disease", keywords="digital health", keywords="health tracker", keywords="medication reminder", keywords="mobile health", keywords="mHealth", keywords="qualitative", keywords="peripheral artery disease", abstract="Background: Care4Today is a digital health platform developed by Johnson \& Johnson comprising a patient mobile app (Care4Today Connect), a health care provider (HCP) portal, and an educational website. It aims to improve medication adherence; enable self-reporting of health experiences; provide patient education; enhance connection with HCPs; and facilitate data and analytics learning across disease areas, including cardiovascular disease. Objective: This study aimed to gather patient feedback on Care4Today Connect, specifically the coronary artery disease (CAD) and peripheral artery disease (PAD) module, and to cocreate and validate features with patients to optimize the app experience for those with CAD, PAD, or both. Methods: We conducted 3 research engagements between November 2022 and May 2023. Participants were US-based adults recruited and consented through the sponsor's Patient Engagement Research Council program. Participants self-reported a diagnosis of cardiovascular disease, and in some cases, specifically, CAD, PAD, or both. Part 1, internet survey, posed quantitative questions with Likert-scale answer options about existing app features. Part 2, virtual focus group, and part 3, virtual individual interviews, both used semistructured qualitative discussion to cocreate and validate new app enhancements. The quantitative data from part 1 was evaluated descriptively to categorize mobile health app use, confidence in the ability to use the app, and motivations for app use. The qualitative discussions from parts 2 and 3 were synthesized to understand participants' app needs and preferences to inform an optimal app experience. Results: The response rate for part 1, internet survey, was 67\% (37/55). Most participants felt at least somewhat confident using the app after seeing the newly added app tutorial (33/37, 89\%), and at least somewhat confident in their ability to earn points for completing activities using app instructions (33/37, 89\%). In part 2, virtual focus group (n=3), and part 3, virtual individual interviews (n=8), participants collectively preferred to enhance the app with (1) the ability to automatically add medication data for tracking and (2) the ability to receive relevant care team feedback on their self-reported health experiences. Participants would be willing to spend 10-15 minutes a day tracking 4-5 health experiences, especially those requested by their HCP. Conclusions: Participants prefer apps that can reduce user burden and provide information relevant to them. Care4Today Connect can optimize the user experience for patients with CAD, PAD, or both with the automatic addition of medication data for tracking and in-app care team feedback on patient self-reported health experiences. ", doi="10.2196/56053", url="https://cardio.jmir.org/2025/1/e56053" } @Article{info:doi/10.2196/64721, author="Tawfik, Daniel and Rule, Adam and Alexanian, Aram and Cross, Dori and Holmgren, Jay A. and Lou, S. Sunny and McPeek Hinz, Eugenia and Rose, Christian and Viswanadham, N. Ratnalekha V. and Mishuris, G. Rebecca and Rodr{\'i}guez-Fern{\'a}ndez, M. Jorge and Ford, W. Eric and Florig, T. Sarah and Sinsky, A. Christine and Apathy, C. Nate", title="Emerging Domains for Measuring Health Care Delivery With Electronic Health Record Metadata", journal="J Med Internet Res", year="2025", month="Mar", day="6", volume="27", pages="e64721", keywords="metadata", keywords="health services research", keywords="audit logs", keywords="event logs", keywords="electronic health record data", keywords="health care delivery", keywords="patient care", keywords="healthcare teams", keywords="clinician-patient relationship", keywords="cognitive environment", doi="10.2196/64721", url="https://www.jmir.org/2025/1/e64721", url="http://www.ncbi.nlm.nih.gov/pubmed/40053814" } @Article{info:doi/10.2196/63364, author="Abdulai, Abdul-Fatawu and Duong, Cam and Stroulia, Eleni and Czerniak, Efrat and Chiu, Rachel and Mehta, Aashay and Koike, Ken and Norman, V. Wendy", title="A Health Professional Mentorship Platform to Improve Equitable Access to Abortion: Development, Usability, and Content Evaluation", journal="JMIR Hum Factors", year="2025", month="Feb", day="19", volume="12", pages="e63364", keywords="medication abortion", keywords="mifepristone", keywords="web-based platform", keywords="user-centered design", keywords="underserved populations", keywords="abortion", keywords="equitable", keywords="accessibility", keywords="open-access website", keywords="gender-affirming", keywords="user-centered", keywords="Canada", keywords="unwanted pregnancy", keywords="framework", abstract="Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are overrepresented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help health care and allied helping professionals provide culturally competent and gender-affirming abortion care to such a population group. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations. Methods: We drew on a user-centered design framework to redesign the web platform in 5 iterative phases. Health care and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, review of the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) web-based platform containing comprehensive information and resources on abortion care for health care providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip health care professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of health care professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to accessing care. ", doi="10.2196/63364", url="https://humanfactors.jmir.org/2025/1/e63364" } @Article{info:doi/10.2196/65967, author="Taneja, Shipra and Kalia, Kamini and Tang, Terence and Wodchis, P. Walter and Vanderhout, Shelley", title="Examining Health Care Provider Experiences With Patient Portal Implementation: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e65967", keywords="patient portal", keywords="mixed methods", keywords="implementation", keywords="healthcare provider", keywords="health system", keywords="patient care", keywords="online questionnaire", keywords="Canada", keywords="descriptive statistics", keywords="thematic analysis", abstract="Background: Health systems are increasingly offering patient portals as tools for patients to access their health information with the goal of improving engagement in care. However, understanding health care providers' perspectives on patient portal implementation is crucial. Objective: This study aimed to understand health care providers' experiences of implementing the MyChart patient portal, perspectives about its impact on patient care, clinical practice, and workload, and opportunities for improvement. Methods: Using an explanatory sequential mixed methods approach, we conducted a web-based questionnaire and semistructured individual interviews with health care providers at a large Canadian community hospital, 6 months after MyChart was first offered to patients. We explored perspectives about the impact of MyChart on clinical practice, workload, and patient care. Data were analyzed using descriptive statistics and thematic analysis. Results: In total, 261 health care providers completed the web-based questionnaire, and 15 also participated in interviews. Participants agreed that patients should have access to their health information through MyChart and identified its benefits such as patients gaining a greater understanding of their own health, which could improve patient safety (160/255, 62\%). While many health care providers agreed that MyChart supported better patient care (108/258, 42\%), there was limited understanding of features available to patients and expectations for integrating MyChart into clinical routines. Concerns were raised about the potential negative impacts of MyChart on patient-provider relationships because sensitive notes or results could be inappropriately interpreted (109/251, 43\%), and a potential increase in workload if additional portal features were introduced. Suggested opportunities for improvement included support for both patients and health care providers to learn about MyChart and establishing guidelines for health care providers on how to communicate information available in MyChart to patients. Conclusions: While health care providers acknowledged that MyChart improved patients' access to health information, its implementation introduced some friction and concerns. To reduce the risk of these challenges, health systems can benefit from engaging health care providers early to identify effective patient portal implementation strategies. ", doi="10.2196/65967", url="https://www.jmir.org/2025/1/e65967", url="http://www.ncbi.nlm.nih.gov/pubmed/39888658" } @Article{info:doi/10.2196/53630, author="Sutan, Rosnah and Ismail, Shahida and Ibrahim, Roszita", title="Evaluating the Development, Reliability, and Validation of the Tele-Primary Care Oral Health Clinical Information System Questionnaire: Cross-Sectional Questionnaire Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="29", volume="12", pages="e53630", keywords="telehealth", keywords="electronic health", keywords="eHealth", keywords="public health information system", keywords="psychometric analysis", abstract="Background: Evaluating digital health service delivery in primary health care requires a validated questionnaire to comprehensively assess users' ability to implement tasks customized to the program's needs. Objective: This study aimed to develop, test the reliability of, and validate the Tele-Primary Care Oral Health Clinical Information System (TPC-OHCIS) questionnaire for evaluating the implementation of maternal and child digital health information systems. Methods: A cross-sectional study was conducted in 2 phases. The first phase focused on content item development and was validated by a group of 10 experts using the content validity index. The second phase was to assess its psychometric testing for reliability and validity. Results: A structured questionnaire of 65 items was constructed to assess the TPC-OHCIS delivery for primary health care use based on literature and has been validated by 10 experts, and 319 respondents answered the 65-item TPC-OHCIS questionnaire, with mean item scores ranging from 1.99 (SD 0.67) to 2.85 (SD 1.019). The content validity, reliability, and face validity showed a scale-level content validity index of 0.90, scale-level content validation ratio of 0.90, and item-level face validity index of 0.76, respectively. The internal reliability was calculated as a Cronbach $\alpha$ value of 0.90, with an intraclass correlation coefficient of 0.91. Scales were determined by the scree plot with eigenvalues >1, and 13 subscales were identified based on principal component analysis. The Kaiser-Meyer-Olkin value was 0.90 (P<.049). The total variance explained was 76.07\%, and factor loading scores for all variables were >0.7. The Bartlett test of sphericity, determining construct validity, was found to be significant (P<.049). Conclusions: The TPC-OHCIS questionnaire is valid to be used at the primary health care level to evaluate the TPC-OHCIS implementation. It can assess health care workers' work performance and job acceptance and improve the quality of care. ", doi="10.2196/53630", url="https://humanfactors.jmir.org/2025/1/e53630" } @Article{info:doi/10.2196/66353, author="Vanderhout, Shelley and Taneja, Shipra and Kalia, Kamini and Wodchis, P. Walter and Tang, Terence", title="Patient Experiences and Perspectives When MyChart is Introduced in a Large Community Hospital: Mixed Methods Study", journal="J Med Internet Res", year="2025", month="Jan", day="23", volume="27", pages="e66353", keywords="patient portal", keywords="implementation", keywords="mixed methods", keywords="patient experiences", keywords="patient perspectives", keywords="learning health systems", keywords="LHS", keywords="mixed methods study", keywords="electronic medical records", keywords="health information", keywords="caregiver experience", keywords="Canada", keywords="user satisfaction", keywords="descriptive statistics", keywords="thematic analysis", abstract="Background: Patient portals, or secure websites linked to electronic medical records, have emerged as tools to provide patients with timely access to their health information. To support the potential benefits of patient portals such as improved engagement in health care, it is essential to understand how patients and caregivers experience these portals. Objective: This study aimed to explore patient and caregiver experiences, facilitators, and barriers to accessing and using a patient portal called MyChart during the initial stages of its implementation. Methods: We applied explanatory sequential mixed methods to conduct a web-based questionnaire and semistructured interviews with MyChart users and nonusers at a large community hospital in Ontario, Canada. Among users, we explored user satisfaction with MyChart, its impact on care, and areas for improvement. For nonusers, we explored barriers to MyChart access and willingness to use it in the future. Descriptive statistics and thematic analysis were used for data analysis. Results: A total of 5651 patients and caregivers completed the web-based questionnaire and 18 (12 users and 6 nonusers) participated in interviews. MyChart users primarily learned about the portal through email (n=1288, 39\%), after-visit summaries (n=953, 29\%), and hospital staff (n=408, 12\%). Nonusers cited lack of awareness (n=1291, 59\%) and registration difficulties (n=707, 32\%) as some barriers to activation and adoption, but the majority would consider activating and using MyChart if they could learn more about it (n=1126, 54\%). Users valued MyChart for preparing for health care encounters but expressed dissatisfaction with limited features and access to medical history and test results, whereas nonusers tended to be unsure about the benefits of using MyChart, especially if they were infrequent health care users. Conclusions: Patient portals offer benefits, but barriers to access and limited functionality can hinder widespread use. To enhance the adoption and potential benefits of patient portals, targeted outreach and comprehensive access to health information are essential to promote positive and seamlessly integrated health care experiences. ", doi="10.2196/66353", url="https://www.jmir.org/2025/1/e66353", url="http://www.ncbi.nlm.nih.gov/pubmed/39847431" } @Article{info:doi/10.2196/65725, author="Weimar, Noel Sascha and Martjan, Sophie Rahel and Terzidis, Orestis", title="Business Venturing in Regulated Markets---Taxonomy and Archetypes of Digital Health Business Models in the European Union: Mixed Methods Descriptive and Exploratory Study", journal="J Med Internet Res", year="2025", month="Jan", day="9", volume="27", pages="e65725", keywords="digital health", keywords="telemedicine", keywords="mobile health", keywords="business model", keywords="European Union", keywords="classification", keywords="archetypes", keywords="medical device regulations", keywords="mobile phone", keywords="artificial intelligence", keywords="AI", abstract="Background: Digital health technology (DHT) has the potential to revolutionize the health care industry by reducing costs and improving the quality of care in a sector that faces significant challenges. However, the health care industry is complex, involving numerous stakeholders, and subject to extensive regulation. Within the European Union, medical device regulations impose stringent requirements on various ventures. Concurrently, new reimbursement pathways are also being developed for DHTs. In this dynamic context, establishing a sustainable and innovative business model around DHTs is fundamental for their successful commercialization. However, there is a notable lack of structured understanding regarding the overarching business models within the digital health sector. Objective: This study aims to address this gap and identify key elements and configurations of business models for DHTs in the European Union, thereby establishing a structured understanding of the archetypal business models in use. Methods: The study was conducted in 2 phases. First, a business model taxonomy for DHTs was developed based on a systematic literature review, the analysis of 169 European real-world business models, and qualitative evaluation through 13 expert interviews. Subsequently, a 2-step clustering analysis was conducted on the 169 DHT business models to identify distinct business model archetypes. Results: The developed taxonomy of DHT business models revealed 11 central dimensions organized into 4 meta-dimensions. Each dimension comprises 2 to 9 characteristics capturing relevant aspects of DHT business models. In addition, 6 archetypes of DHT business models were identified: administration and communication supporter (A1), insurer-to-consumer digital therapeutics and care (A2), diagnostic and treatment enabler (A3), professional monitoring platforms (A4), clinical research and solution accelerators (A5), and direct-to-consumer wellness and lifestyle (A6). Conclusions: The findings highlight the critical elements constituting business models in the DHT domain, emphasizing the substantial impact of medical device regulations and revenue models, which often involve reimbursement from stakeholders such as health insurers. Three drivers contributing to DHT business model innovation were identified: direct targeting of patients and private individuals, use of artificial intelligence as an enabler, and development of DHT-specific reimbursement pathways. The study also uncovered surprising business model patterns, including shifts between regulated medical devices and unregulated research applications, as well as wellness and lifestyle solutions. This research enriches the understanding of business models in digital health, offering valuable insights for researchers and digital health entrepreneurs. ", doi="10.2196/65725", url="https://www.jmir.org/2025/1/e65725" } @Article{info:doi/10.2196/64936, author="AlSerkal, Mohamed Yousif and Ibrahim, Mohamed Naseem and Alsereidi, Suhail Aisha and Ibrahim, Mubaraka and Kurakula, Sudheer and Naqvi, Ahsan Sadaf and Khan, Yasir and Oottumadathil, Preman Neema", title="Real-Time Analytics and AI for Managing No-Show Appointments in Primary Health Care in the United Arab Emirates: Before-and-After Study", journal="JMIR Form Res", year="2025", month="Jan", day="6", volume="9", pages="e64936", keywords="electronic health record", keywords="EHR", keywords="artificial intelligence", keywords="AI", keywords="no-show appointments", keywords="real-time data", keywords="primary health care", keywords="risk prediction", keywords="clinic waiting time", keywords="operational efficiency", abstract="Background: Primary health care (PHC) services face operational challenges due to high patient volumes, leading to complex management needs. Patients access services through booked appointments and walk-in visits, with walk-in visits often facing longer waiting times. No-show appointments are significant contributors to inefficiency in PHC operations, which can lead to an estimated 3\%-14\% revenue loss, disrupt resource allocation, and negatively impact health care quality. Emirates Health Services (EHS) PHC centers handle over 140,000 visits monthly. Baseline data indicate a 21\% no-show rate and an average patient wait time exceeding 16 minutes, necessitating an advanced scheduling and resource management system to enhance patient experiences and operational efficiency. Objective: The objective of this study was to evaluate the impact of an artificial intelligence (AI)-driven solution that was integrated with an interactive real-time data dashboard on reducing no-show appointments and improving patient waiting times at the EHS PHCs. Methods: This study introduced an innovative AI-based data application to enhance PHC efficiency. Leveraging our electronic health record system, we deployed an AI model with an 86\% accuracy rate to predict no-shows by analyzing historical data and categorizing appointments based on no-show risk. The model was integrated with a real-time dashboard to monitor patient journeys and wait times. Clinic coordinators used the dashboard to proactively manage high-risk appointments and optimize resource allocation. The intervention was assessed through a before-and-after comparison of PHC appointment dynamics and wait times, analyzing data from 135,393 appointments (67,429 before implementation and 67,964 after implementation). Results: Implementation of the AI-powered no-show prediction model resulted in a significant 50.7\% reduction in no-show rates (P<.001). The odds ratio for no-shows after implementation was 0.43 (95\% CI 0.42-0.45; P<.001), indicating a 57\% reduction in the likelihood of no-shows. Additionally, patient wait times decreased by an average of 5.7 minutes overall (P<.001), with some PHCs achieving up to a 50\% reduction in wait times. Conclusions: This project demonstrates that integrating AI with a data analytics platform and an electronic health record systems can significantly improve operational efficiency and patient satisfaction in PHC settings. The AI model enabled daily assessments of wait times and allowed for real-time adjustments, such as reallocating patients to different clinicians, thus reducing wait times and optimizing resource use. These findings illustrate the transformative potential of AI and real-time data analytics in health care delivery. ", doi="10.2196/64936", url="https://formative.jmir.org/2025/1/e64936" } @Article{info:doi/10.2196/67928, author="Jung, Sun-Young and Lee, Ji-Hyeon", title="Emotional Touch Nursing Competencies Model of the Fourth Industrial Revolution: Instrument Validation Study", journal="Asian Pac Isl Nurs J", year="2024", month="Dec", day="16", volume="8", pages="e67928", keywords="nurse", keywords="therapeutic touch", keywords="clinical competence", keywords="factor analysis", keywords="statistical", keywords="reliability", keywords="scale", keywords="tool", keywords="nursing", keywords="industrial revolution", keywords="competencies", keywords="health care", keywords="emotional", keywords="interview", keywords="collaborative practice", keywords="learning agility", keywords="professional commitment", keywords="positive self-worth", keywords="compliance", keywords="ethics", keywords="practice ability", keywords="relationship ability", keywords="nursing sensitivity", abstract="Background: The Fourth Industrial Revolution is transforming the health care sector through advanced technologies such as artificial intelligence, the Internet of Things, and big data, leading to new expectations for rapid and accurate treatment. While the integration of technology in nursing tasks is on the rise, there remains a critical need to balance technological efficiency with empathy and emotional connection. This study aims to develop and validate a competency model for emotional touch nursing that responds to the evolving demands of the changing health care environment. Objective: The aims of our study are to develop an emotional touch nursing competencies model and to verify its reliability and validity. Methods: A conceptual framework and construct factors were developed based on an extensive literature review and in-depth interviews with nurses. The potential competencies were confirmed by 20 experts, and preliminary questions were prepared. The final version of the scale was verified through exploratory factor analysis (n=255) and confirmatory factor analysis (n=256) to assess its validity and reliability. Results: From the exploratory analysis, 8 factors and 38 items (client-centered collaborative practice, learning agility for nursing, nursing professional commitment, positive self-worth, compliance with ethics and roles, nursing practice competence, nurse-client relationship, and nursing sensitivity) were extracted. These items were verified through convergent and discriminant validity testing. The internal consistency reliability was acceptable (Cronbach $\alpha$=0.95). Conclusions: The findings from this study confirmed that this scale has sufficient validity and reliability to measure emotional touch nursing competencies. It is expected to be used to build a knowledge and educational system for emotional touch nursing. ", doi="10.2196/67928", url="https://apinj.jmir.org/2024/1/e67928" } @Article{info:doi/10.2196/55189, author="Greenall-Ota, Josephine and Yapa, Manisha H. and Fox, J. Greg and Negin, Joel", title="Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review", journal="JMIR Mhealth Uhealth", year="2024", month="Dec", day="13", volume="12", pages="e55189", keywords="mHealth", keywords="implementation", keywords="LMIC", keywords="infectious diseases", keywords="Tailored Implementation for Chronic Diseases", keywords="mobile phone", keywords="interventions", keywords="short messaging service", keywords="chronic disease", keywords="narrative review", keywords="barrier", keywords="mHealth intervention", keywords="infectious disease", keywords="screening", keywords="community", keywords="design", keywords="health system", keywords="SMS", keywords="app", abstract="Background: Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs. Objective: We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework. Results: We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use. Conclusions: Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs. ", doi="10.2196/55189", url="https://mhealth.jmir.org/2024/1/e55189" } @Article{info:doi/10.2196/45763, author="Huang, Xuan and Wang, Ying and Yang, Xixian and Jiang, Ruo and Liu, Yicheng and Wang, Hui", title="Patient-Centric Mobile Medical Services Accessed Through Smartphones in the Top 100 Chinese Public Hospitals: Cross-Sectional Survey Study", journal="JMIR Form Res", year="2024", month="Dec", day="4", volume="8", pages="e45763", keywords="mobile health technology", keywords="smartphones", keywords="mobile phone", keywords="internet hospital", keywords="China", abstract="Background: Smartphone-based technology has been used to enhance the delivery of health care services to the public in numerous countries. Objective: This study aims to investigate the application of patient-centric mobile medical services accessed through smartphones in the top 100 Chinese public hospitals. Methods: Data on 124 tertiary public hospitals, ranked among the top 100 by the China Hospital Science and Technology Evaluation Metrics of the Chinese Academy of Medical Sciences (2019) and China's Hospital Rankings of the Hospital Management Institute of Fudan University (2019), were collected from the WeChat platform (Tencent Inc), mobile phone apps, and official websites until February 10, 2021. Results: A total of 124 tertiary public hospitals, all of which were among the top 100 hospitals according to the 2 ranking lists, were selected for this study. Almost all (122/124, 98.39\%) of the hospitals offered basic services such as appointment scheduling, registration, and health education. The majority also provided online access to test reports (95/124, 76.61\%), consultations (72/124, 58.06\%), and prescriptions (61/124, 49.19\%). Among the hospitals offering online prescriptions, the majority (54/61, 88.52\%) supported home delivery through third-party carriers. Slightly less than half (57/124, 45.97\%) used artificial intelligence for medical guidance. Only a small fraction (8/124, 6.45\%) managed chronic diseases through online monitoring and supervision by experienced doctors. Approximately half (60/124, 48.39\%) of the included hospitals were officially licensed as internet hospitals approved to provide full online services. Hospitals with official internet hospital licenses provided more extensive digital health offerings. A significantly higher proportion of approved hospitals offered online consultations (29.69\% vs 88.33\%, r=43.741; P<.001), test reports (62.5\% vs 91.67\%, r=14.703; P<.001), and chronic disease management (1.56\% vs 11.67\%, r=5.238; P<.05). These officially approved hospitals tended to provide over 6 mobile medical services, mainly in the regions of Shanghai and Guangdong. This geographic distribution aligned with the overall layout of hospitals included in the study. Conclusions: Patient-centric mobile medical services offered by the top 100 Chinese public hospitals accessed through smartphones primarily focus on online appointment scheduling, registration, health education, and accessing test reports. The most popular features include online consultations, prescriptions, medication delivery, medical guidance, and early-stage chronic disease management. Approved internet hospitals offer a significantly greater variety of patient-centric mobile medical services compared with unapproved ones. ", doi="10.2196/45763", url="https://formative.jmir.org/2024/1/e45763" } @Article{info:doi/10.2196/58007, author="Allers, Sanne and Carboni, Chiara and Eijkenaar, Frank and Wehrens, Rik", title="A Cross-Disciplinary Analysis of the Complexities of Scaling Up eHealth Innovation", journal="J Med Internet Res", year="2024", month="Dec", day="2", volume="26", pages="e58007", keywords="innovation", keywords="eHealth", keywords="remote patient monitoring", keywords="scale-up", keywords="cross-disciplinary", keywords="qualitative case study", keywords="health care systems", keywords="adaptation", keywords="complexity", keywords="health care", keywords="framework", keywords="ecological perspective", keywords="barriers and facilitators", doi="10.2196/58007", url="https://www.jmir.org/2024/1/e58007" } @Article{info:doi/10.2196/65281, author="Bellei, Andrei Ericles and Domenighi, Rafael Pedro and Freitas, Sasso Carla Maria Dal and De Marchi, Bertoletti Ana Carolina", title="Digital Solutions for Health Services and Systems Management: Narrative Review of Certified Software Features in the Brazilian Market", journal="JMIR Med Inform", year="2024", month="Nov", day="29", volume="12", pages="e65281", keywords="health services administration", keywords="health information management", keywords="decision support systems", keywords="digital health", keywords="Brazil", keywords="certified software", keywords="features", keywords="systems management", keywords="health services", keywords="interoperability", keywords="digital solutions", doi="10.2196/65281", url="https://medinform.jmir.org/2024/1/e65281" } @Article{info:doi/10.2196/57612, author="Yi, Siyan and Yam, Yan Esabelle Lo and Cheruvettolil, Kochukoshy and Linos, Eleni and Gupta, Anshika and Palaniappan, Latha and Rajeshuni, Nitya and Vaska, Gopal Kiran and Schulman, Kevin and Eggleston, N. Karen", title="Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia", journal="J Med Internet Res", year="2024", month="Nov", day="25", volume="26", pages="e57612", keywords="digital health innovations", keywords="public health", keywords="South and Southeast Asia", keywords="health care challenges", keywords="low- and middle-income countries", keywords="LMICs", keywords="global health", keywords="health AI", keywords="artificial intelligence", keywords="public health responses", keywords="global health contexts", keywords="digital health", doi="10.2196/57612", url="https://www.jmir.org/2024/1/e57612" } @Article{info:doi/10.2196/58624, author="Reynolds, W. Christopher and Lee, HaEun and Sieka, Joseph and Perosky, Joseph and Lori, R. Jody", title="Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia", journal="JMIR Mhealth Uhealth", year="2024", month="Nov", day="13", volume="12", pages="e58624", keywords="mHealth", keywords="mobile triage", keywords="referral pathways", keywords="Liberia", keywords="LMIC", keywords="low- income country", keywords="obstetric triage", keywords="third delay", keywords="mobile health", keywords="mobile application", keywords="digital health", keywords="digital intervention", keywords="smartphone", keywords="middle-income country", abstract="Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61\%), nurses (20/62, 32\%), physicians assistants (3/62, 5\%), and physicians (1/62, 2\%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100\%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92\%), increasing health worker attentiveness (39/62, 63\%), and contributing to improved patient care (34/62, 55\%). MORES was perceived as sustainable and scalable (62/62, 100\%), particularly if technological barriers (21/62, 34\%) and staff training (19/62, 31\%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89\%), feedback mechanisms for hospitals and RHFs (48/62, 77\%), interprofessional teamwork (21/62, 34\%), longitudinal follow-up care (20/62, 32\%), creating a record of care delays (17/62, 27\%), and electronic health record infrastructure (13/62, 21\%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. ", doi="10.2196/58624", url="https://mhealth.jmir.org/2024/1/e58624" } @Article{info:doi/10.2196/57609, author="Liu, Yayuan and Jin, Haofeng and Yu, Zhuoyuan and Tong, Yu", title="Impact of Internet Hospital Consultations on Outpatient Visits and Expenses: Quasi-Experimental Study", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e57609", keywords="internet hospital", keywords="online consultation", keywords="telehealth", keywords="outpatient visits", keywords="outpatient expenses", keywords="urban-rural healthcare disparity", abstract="Background: Internet hospital consultations are emerging in China as a new channel for patients to access health care services. Unlike third-party health care platforms such as Haodf, Teladoc Health, and MDLive, internet hospitals seamlessly integrate patients' offline medical records with online consultations, offering a cohesive online and offline health care experience. However, its impact on outpatient visits remains ambiguous. While it may encourage outpatient visits due to better continuity of care, it could also reduce face-to-face visits because of the convenience of online consultations. Given that patients in China have the autonomy to freely choose their health care providers, it is critical for hospitals to understand the effect of this telehealth technology on outpatient visits. Objective: This study aimed to analyze the impact of patients' adoption of internet hospital consultations on their outpatient frequency and expenses, and whether these impacts vary between urban and rural patients. Methods: The data used in this study were collected from a public tertiary hospital situated in a southeastern county of China, covering internet hospital consultations from January 2021 to October 2022, and offline outpatient records from January 2020 to October 2022. The dataset also includes patient demographic information. To estimate the causal effect, we used a quasi-experimental design, combining the difference-in-differences (DiD) analysis with the propensity score matching (PSM). After performing PSM, 2065 pairs of patients (4130 patients) were obtained for data analysis. Results: Our findings highlight 3 key results. First, patients' adoption of internet hospital consultations increases their frequency of outpatient visits by 2.4\% per month (P<.001), and the associated expenses by 15.5\% per month (P<.001). Second, such positive effects are more pronounced for patients residing in rural areas. Specifically, for every 1\% increase in the distance between patients' residences and the county government (an urban center), the positive effect on monthly outpatient visits increases by 0.3\% (P=.06), and the positive effect on monthly outpatient expenses increases by 2.4\% (P=.03). Third, our post hoc analysis shows that rural patients living in areas with higher local health care quality experience a mitigated positive effect of internet hospital consultations, compared with those in areas with lower health care quality. Conclusions: This study extends the research scope of telehealth technologies by investigating internet hospitals, which are characterized by the integration of online and offline services. Our findings suggest that patients' adoption of internet hospital consultations is associated with an increase in both the frequency and expenses of outpatient visits. In addition, these effects vary based on patients' urban-rural status and local health care quality. These insights offer valuable guidance for policy makers and health care providers in promoting and optimizing the development and operation of internet hospitals. ", doi="10.2196/57609", url="https://www.jmir.org/2024/1/e57609" } @Article{info:doi/10.2196/55140, author="Han, Tao and Wei, Qinpeng and Wang, Ruike and Cai, Yijin and Zhu, Hongyi and Chen, Jiani and Zhang, Zhiruo and Li, Sisi", title="Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire", journal="J Med Internet Res", year="2024", month="Nov", day="8", volume="26", pages="e55140", keywords="service quality", keywords="SERVQUAL", keywords="Service Quality Questionnaire", keywords="internet hospital", keywords="e-hospital", keywords="digital medical care", keywords="health care professionals", keywords="Chinese digital health care", abstract="Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients' use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients' expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients' overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2\% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8\%) did not know internet hospital services well, 68.1\% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients' familiarity with and willingness to use these services. ", doi="10.2196/55140", url="https://www.jmir.org/2024/1/e55140" } @Article{info:doi/10.2196/63456, author="Ashimwe, Aimerence and Davoody, Nadia", title="Exploring Health Care Professionals' Perspectives on the Use of a Medication and Care Support System and Recommendations for Designing a Similar Tool for Family Caregivers: Interview Study Among Health Care Professionals", journal="JMIR Med Inform", year="2024", month="Oct", day="23", volume="12", pages="e63456", keywords="eHealth", keywords="telemedicine", keywords="mobile health", keywords="mHealth", keywords="medication management", keywords="home care", keywords="family caregivers", keywords="mobile phone", abstract="Background: With the aging population on the rise, the demand for effective health care solutions to address adverse drug events is becoming increasingly urgent. Telemedicine has emerged as a promising solution for strengthening health care delivery in home care settings and mitigating drug errors. Due to the indispensable role of family caregivers in daily patient care, integrating digital health tools has the potential to streamline medication management processes and enhance the overall quality of patient care. Objective: This study aims to explore health care professionals' perspectives on the use of a medication and care support system (MCSS) and collect recommendations for designing a similar tool for family caregivers. Methods: Fifteen interviews with health care professionals in a home care center were conducted. Thematic analysis was used, and 5 key themes highlighting the importance of using the MCSS tool to improve medication management in home care were identified. Results: All participants emphasized the necessity of direct communication between health care professionals and family caregivers and stated that family caregivers need comprehensive information about medication administration, patient conditions, and symptoms. Furthermore, the health care professionals recommended features and functions customized for family caregivers. Conclusions: This study underscored the importance of clear communication between health care professionals and family caregivers and the provision of comprehensive instructions to promote safe medication practices. By equipping family caregivers with essential information via a tool similar to the MCSS, a proactive approach to preventing errors and improving outcomes is advocated. ", doi="10.2196/63456", url="https://medinform.jmir.org/2024/1/e63456" } @Article{info:doi/10.2196/51198, author="Tao, Youyou and Zhu, Ruilin and Wu, Dezhi", title="Harnessing the Power of Complementarity Between Smart Tracking Technology and Associated Health Information Technologies: Longitudinal Study", journal="JMIR Form Res", year="2024", month="Oct", day="1", volume="8", pages="e51198", keywords="health IT", keywords="smart tracking technology", keywords="mobile IT", keywords="health information exchange", keywords="electronic health record", keywords="readmission risk", keywords="complementarity effects", keywords="mobile phone", abstract="Background: Smart tracking technology (STT) that was applied for clinical use has the potential to reduce 30-day all-cause readmission risk through streamlining clinical workflows with improved accuracy, mobility, and efficiency. However, previously published literature has inadequately addressed the joint effects of STT for clinical use and its complementary health ITs (HITs) in this context. Furthermore, while previous studies have discussed the symbiotic and pooled complementarity effects among different HITs, there is a lack of evidence-based research specifically examining the complementarity effects between STT for clinical use and other relevant HITs. Objective: Through a complementarity theory lens, this study aims to examine the joint effects of STT for clinical use and 3 relevant HITs on 30-day all-cause readmission risk. These HITs are STT for supply chain management, mobile IT, and health information exchange (HIE). Specifically, this study examines whether the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and whether symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Methods: This study uses a longitudinal in-patient dataset, including 879,122 in-patient hospital admissions for 347,949 patients in 61 hospitals located in Florida and New York in the United States, from 2014 to 2015. Logistic regression was applied to assess the effect of HITs on readmission risks. Time and hospital fixed effects were controlled in the regression model. Robust standard errors (SEs) were used to account for potential heteroskedasticity. These errors were further clustered at the patient level to consider possible correlations within the patient groups. Results: The interaction between STT for clinical use and STT for supply chain management, mobile IT, and HIE was negatively associated with 30-day readmission risk, with coefficients of --0.0352 (P=.003), --0.0520 (P<.001), and --0.0216 (P=.04), respectively. These results indicate that the pooled complementarity effect exists between STT for clinical use and STT for supply chain management, and symbiotic complementarity effects exist between STT for clinical use and mobile IT and between STT for clinical use and HIE. Furthermore, the joint effects of these HITs varied depending on the hospital affiliation and patients' disease types. Conclusions: Our results reveal that while individual HIT implementations have varying impacts on 30-day readmission risk, their joint effects are often associated with a reduction in 30-day readmission risk. This study substantially contributes to HIT value literature by quantifying the complementarity effects among 4 different types of HITs: STT for clinical use, STT for supply chain management, mobile IT, and HIE. It further offers practical implications for hospitals to maximize the benefits of their complementary HITs in reducing the 30-day readmission risk in their respective care scenarios. ", doi="10.2196/51198", url="https://formative.jmir.org/2024/1/e51198" } @Article{info:doi/10.2196/55350, author="Zigdon, Avi and Zwilling, Moti and Zigdon, Ofek and Reges, Orna", title="Health Maintenance Organization--mHealth Versus Face-to-Face Interaction for Health Care in Israel: Cross-Sectional Web-Based Survey Study", journal="J Med Internet Res", year="2024", month="Sep", day="30", volume="26", pages="e55350", keywords="HMO-mHealth", keywords="mHealth", keywords="face-to-face", keywords="digital health", keywords="digital health apps", keywords="eHealth", keywords="HMO-mHealth adoption", keywords="health care", keywords="mHealth adoption", keywords="mobile phone", keywords="HMO", keywords="health maintenance organization", abstract="Background: Health maintenance organization--mobile health (HMO-mHealth) services have a direct impact on patients' daily lives, and HMOs regularly expand their range of mHealth services. HMO-mHealth apps are saving HMOs time and money, as services are becoming more accessible to patients. However, the willingness to use mHealth apps depends on user perception. Although mHealth apps can change the relationship dynamic between HMOs and patients, patients prefer to use them to facilitate face-to-face interactions rather than replace them. Objective: This study aims to examine the extent to which Israeli adults prefer adopting health care services using HMO-mHealth as a replacement for face-to-face interaction. Methods: Israeli adults aged ?18 years completed an electronic questionnaire. Data were collected from December 2020 to February 2021. All services in the main HMO-mHealth apps of the 4 Israeli HMOs were mapped. The 29 health care services used in this study were identical in all 4 HMO-mHealth apps in Israel. The association between sociodemographic characteristics and health condition with preference for HMO-mHealth or face-to-face interaction was analyzed separately for each health service by using a logistic model. Results: A total of 6321 respondents completed the questionnaire (female: 4296/6321, 68\%; male: 2025/6321, 32\%). Approximately 80.9\% (5115/6321) to 88.2\% (5578/6321) of the respondents preferred using HMO-mHealth apps for administrative matters. However, 55.3\% (3498/6321), 52.2\% (3301/6321), and 46.9\% (2969/6321) preferred face-to-face meetings for the initial medical diagnosis, medical treatment, and medical diagnosis results, respectively. Seven main variables were found to be associated with HMO-mHealth adoption, including gender, age, education, marital status, religious affiliation, and subjective health condition. Female respondents were more likely than male respondents to prefer HMO-mHealth apps for administrative matters and face-to-face interaction for personal medical diagnosis and treatment (odds ratio [OR] 0.74, 95\% CI 0.67-0.83; P<.001 and OR 0.82, 95\% CI 0.74-0.92; P<.001, respectively). Married individuals preferred using HMO-mHealth apps over face-to-face meetings for a new medical diagnosis (OR 1.31, 95\% CI 1.15-1.49; P<.001) or treatment (OR 1.34, 95\% CI 1.18-1.52; P<.001). Improved health perception was associated with higher preference for HMO-mHealth apps across all health care services in this study (OR 1.11, 95\% CI 1.02-1.22; P<.02 to OR 1.38, 95\% CI 1.25-1.53; P<.001). No significant association was found between the presence of a chronic disease and the preferred mode of interaction for most services. Conclusions: HMO-mHealth is proving to be a robust and efficient tool for health care service delivery. However, there are barriers that affect vulnerable populations when adopting HMO-mHealth. Therefore, it is important to tailor HMO-mHealth apps for older adults, the chronically ill, and minorities in society, as these groups have a greater need for these services. Future studies should focus on identifying the barriers that affect the utilization of HMO-mHealth in these groups. ", doi="10.2196/55350", url="https://www.jmir.org/2024/1/e55350" } @Article{info:doi/10.2196/52798, author="Ramachandran, Swathi and Chang, Hsiu-Ju and Worthington, Catherine and Kushniruk, Andre and Ib{\'a}{\~n}ez-Carrasco, Francisco and Davies, Hugh and McKee, Geoffrey and Brown, Adalsteinn and Gilbert, Mark and Iyamu, Ihoghosa", title="Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations", journal="JMIR Public Health Surveill", year="2024", month="Sep", day="9", volume="10", pages="e52798", keywords="digital public health", keywords="digital transformation", keywords="digital transformations", keywords="rapid review", keywords="rapid reviews", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="competencies", keywords="competency", keywords="training and practice recommendations", keywords="public health workforce", keywords="workforce", keywords="worker", keywords="workers", keywords="practitioner", keywords="practitioners", keywords="public health", keywords="digital health", keywords="training", keywords="continuing education", keywords="skills", keywords="skill", keywords="recommendation", keywords="recommendations", keywords="best practice", keywords="guideline", keywords="guidelines", abstract="Background: The COVID-19 pandemic highlighted gaps in the public health workforce's capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles. Existing public health competency frameworks have not been updated to reflect the prominent role digital technologies play in contemporary public health, and public health training institutions are seeking to integrate digital technologies in their curricula. Objective: As a first step in a multiphase study exploring recommendations for updates to public health competency frameworks within the Canadian public health context, we conducted a rapid review of literature aiming to identify recommendations for digital competencies, training approaches, and inter- or transdisciplinary partnerships that can enhance public health practitioners' capacity to support the digital transformation of public health. Methods: Following the World Health Organization's (2017) guidelines for rapid reviews, a systematic search was conducted on Ovid MEDLINE, Ovid Embase, ERIC (Education Resources Information Center), and Web of Science for peer-reviewed articles. We also searched Google Scholar and various public health agency and public health association websites for gray literature using search terms related to public health, digital health, practice competencies, and training approaches. We included articles with explicit practice competencies and training recommendations related to digital technologies among public health practitioners published between January 2010 and December 2022. We excluded articles describing these concepts in passing or from a solely clinical perspective. Results: Our search returned 2023 titles and abstracts, of which only 12 studies met the inclusion criteria. We found recommendations for new competencies to enable public health practitioners to appropriately use digital technologies that cut across all existing categories of the core competencies for public health framework of the Public Health Agency of Canada. We also identified a new competency category related to data, data systems management, and governance. Training approaches identified include adapted degree-awarding programs like combined public health and informatics or data science degree programs and ongoing professional certifications with integration of practice-based learning in multi- and interdisciplinary training. Disciplines suggested as important to facilitate practice competency and training recommendations included public health, public health informatics, data, information and computer sciences, biostatistics, health communication, and business. Conclusions: Despite the growth of digital technologies in public health, recommendations about practice competencies and training approaches necessary to effectively support the digital transformation of public health remain limited in the literature. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing public health competencies, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity through adapted degree-awarding public health training programs and ongoing professional development. ", doi="10.2196/52798", url="https://publichealth.jmir.org/2024/1/e52798" } @Article{info:doi/10.2196/50505, author="Straw, Isabel and Brass, Irina and Mkwashi, Andrew and Charles, Inika and Soares, Amelie and Steer, Caroline", title="Insights From a Clinically Orientated Workshop on Health Care Cybersecurity and Medical Technology: Observational Study and Thematic Analysis", journal="J Med Internet Res", year="2024", month="Jul", day="11", volume="26", pages="e50505", keywords="digital health", keywords="clinical medicine", keywords="biotechnology", keywords="medical device", keywords="device regulation", keywords="medical education", keywords="eHealth", keywords="digital medicine", keywords="health care", keywords="health care cybersecurity", keywords="internet of medical things", abstract="Background: Health care professionals receive little training on the digital technologies that their patients rely on. Consequently, practitioners may face significant barriers when providing care to patients experiencing digitally mediated harms (eg, medical device failures and cybersecurity exploits). Here, we explore the impact of technological failures in clinical terms. Objective: Our study explored the key challenges faced by frontline health care workers during digital events, identified gaps in clinical training and guidance, and proposes a set of recommendations for improving digital clinical practice. Methods: A qualitative study involving a 1-day workshop of 52 participants, internationally attended, with multistakeholder participation. Participants engaged in table-top exercises and group discussions focused on medical scenarios complicated by technology (eg, malfunctioning ventilators and malicious hacks on health care apps). Extensive notes from 5 scribes were retrospectively analyzed and a thematic analysis was performed to extract and synthesize data. Results: Clinicians reported novel forms of harm related to technology (eg, geofencing in domestic violence and errors related to interconnected fetal monitoring systems) and barriers impeding adverse event reporting (eg, time constraints and postmortem device disposal). Challenges to providing effective patient care included a lack of clinical suspicion of device failures, unfamiliarity with equipment, and an absence of digitally tailored clinical protocols. Participants agreed that cyberattacks should be classified as major incidents, with the repurposing of existing crisis resources. Treatment of patients was determined by the role technology played in clinical management, such that those reliant on potentially compromised laboratory or radiological facilities were prioritized. Conclusions: Here, we have framed digital events through a clinical lens, described in terms of their end-point impact on the patient. In doing so, we have developed a series of recommendations for ensuring responses to digital events are tailored to clinical needs and center patient care. ", doi="10.2196/50505", url="https://www.jmir.org/2024/1/e50505", url="http://www.ncbi.nlm.nih.gov/pubmed/38990611" } @Article{info:doi/10.2196/55061, author="Jiang, Jiayi and Zheng, Zexing", title="Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="21", volume="12", pages="e55061", keywords="hospital apps", keywords="privacy policy", keywords="personal information protection", keywords="policy evaluation", keywords="content analysis", abstract="Background: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. Objective: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. Methods: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. Results: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4\%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9\%, SD 24.2\%) lagged behind general PI protection (mean 90.4\%, SD 14.7\%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9\%, SD 24.2\%). Although most apps (n=41, 79\%) committed to supervising subcontractors, only a quarter (n=13, 25\%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2\%, SD 29.3\%) and incident management (mean 71.8\%, SD 36.6\%), half of the assessed apps (n=27, 52\%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46\%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77\%) and instances of PI deletion or anonymization (n=41, 79\%), but fewer (n=20, 38.5\%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42\%) or to refuse advertisement based on automated decision-making (n=13, 25\%). Significant deficiencies remained in regular compliance audits (mean 11.5\%, SD 37.8\%), impact assessments (mean 13.5\%, SD 15.2\%), and PI officer disclosure (mean 48.1\%, SD 49.3\%). Conclusions: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages. ", doi="10.2196/55061", url="https://mhealth.jmir.org/2024/1/e55061", url="http://www.ncbi.nlm.nih.gov/pubmed/38904994" } @Article{info:doi/10.2196/54250, author="Babona Nshuti, Aimee Marie and Touray, Kebba and Muluh, Johnson Ticha and Ubong, Akpan Godwin and Ngofa, Opara Reuben and Mohammed, Isa Bello and Roselyne, Ishimwe and Oviaesu, David and Bakata, Oliver Evans Mawa and Lau, Fiona and Kipterer, John and Green, W. Hugh Henry and Seaman, Vincent and Ahmed, A. Jamal and Ndoutabe, Modjirom", title="Development of a Consolidated Health Facility Masterlist Using Data From Polio Electronic Surveillance in the World Health Organization African Region", journal="JMIR Public Health Surveill", year="2024", month="Jun", day="21", volume="10", pages="e54250", keywords="African region", keywords="electronic surveillance", keywords="geographic information systems", keywords="Global Polio Eradication Initiative", keywords="integrated supportive supervision", keywords="polio", doi="10.2196/54250", url="https://publichealth.jmir.org/2024/1/e54250", url="http://www.ncbi.nlm.nih.gov/pubmed/38904997" } @Article{info:doi/10.2196/54642, author="Wang, Panzhang and Yu, Lei and Li, Tao and Zhou, Liang and Ma, Xin", title="Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study", journal="JMIR Mhealth Uhealth", year="2024", month="Jun", day="7", volume="12", pages="e54642", keywords="overcrowding", keywords="overcrowded", keywords="crowding", keywords="smartphone", keywords="queueing", keywords="pretriage", keywords="self-service", keywords="triage", keywords="emergency", keywords="urgent", keywords="ambulatory", keywords="mHealth", keywords="mobile health", keywords="workflow", keywords="health care management", keywords="hospital", abstract="Background: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. Objective: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. Methods: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. Results: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7\% vs 8.8\%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for ``ease of task completion'' (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), ``satisfaction with completion time'' (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and ``satisfaction with support'' (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3\% vs 93.3\%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. Conclusions: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED. ", doi="10.2196/54642", url="https://mhealth.jmir.org/2024/1/e54642", url="http://www.ncbi.nlm.nih.gov/pubmed/38848554" } @Article{info:doi/10.2196/50857, author="Legg, David and Napierala, Hendrik and Holzinger, Felix and Slagman, Anna", title="Where Do I Go When My Doctor's Office Is Closed? The Availability of Out-of-Hours Care Information on Primary Care Practitioners' Websites", journal="JMIR Form Res", year="2024", month="May", day="29", volume="8", pages="e50857", keywords="out of hours", keywords="primary care", keywords="telephone triage", keywords="websites", keywords="care information", doi="10.2196/50857", url="https://formative.jmir.org/2024/1/e50857", url="http://www.ncbi.nlm.nih.gov/pubmed/38809600" } @Article{info:doi/10.2196/53898, author="Zhou, Yaxu and Zhou, Ying and Xu, Di and Min, Jie and Du, Yu and Duan, Qi and Bao, Wen and Sun, Yingying and Xi, Huiqin and Wang, Chunming and Bischof, Evelyne", title="Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study", journal="JMIR Form Res", year="2024", month="May", day="13", volume="8", pages="e53898", keywords="patients", keywords="international medical service", keywords="demand", keywords="satisfaction", keywords="strategy", keywords="health care optimization", keywords="smart hospital", abstract="Background: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. Objective: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. Methods: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements (``high demand, high satisfaction''; ``high demand, low satisfaction''; ``low demand, high satisfaction''; and ``low demand, low satisfaction''), enabling a detailed cross-sectional analysis to identify areas for improvement. Results: Elements falling under ``high demand, high satisfaction'' for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as ``high demand, low satisfaction'' were significantly different between the two patient groups. Conclusions: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China's leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China's medical services for this demographic. ", doi="10.2196/53898", url="https://formative.jmir.org/2024/1/e53898", url="http://www.ncbi.nlm.nih.gov/pubmed/38739428" } @Article{info:doi/10.2196/49163, author="Bene, Ayaka Benard and Ibeneme, Sunny and Fadahunsi, Philip Kayode and Harri, Isa Bala and Ukor, Nkiruka and Mastellos, Nikolaos and Majeed, Azeem and Car, Josip", title="Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review", journal="J Med Internet Res", year="2024", month="Apr", day="11", volume="26", pages="e49163", keywords="regulation", keywords="standard", keywords="framework", keywords="guidance", keywords="guideline", keywords="health app", keywords="self-management", keywords="World Health Organization", keywords="WHO African Region", keywords="sub-Saharan Africa", abstract="Background: Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. Objective: This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. Methods: A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. Results: The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Conclusions: Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025714 ", doi="10.2196/49163", url="https://www.jmir.org/2024/1/e49163", url="http://www.ncbi.nlm.nih.gov/pubmed/38602718" } @Article{info:doi/10.2196/47523, author="Zhong, Yuqiong and Hahne, Jessica and Wang, Xiaomin and Wang, Xuxi and Wu, Ying and Zhang, Xin and Liu, Xing", title="Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication", journal="J Med Internet Res", year="2024", month="Mar", day="29", volume="26", pages="e47523", keywords="China", keywords="internet hospital", keywords="health care access", keywords="telehealth", keywords="doctor-patient relationship", keywords="mobile phone", abstract="Background: Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. Objective: We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. Methods: We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Results: Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. Conclusions: This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults. ", doi="10.2196/47523", url="https://www.jmir.org/2024/1/e47523", url="http://www.ncbi.nlm.nih.gov/pubmed/38551618" } @Article{info:doi/10.2196/44422, author="Cheng, Weibin and Cao, Xiaowen and Lian, Wanmin and Tian, Junzhang", title="An Introduction to Smart Home Ward--Based Hospital-at-Home Care in China", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="30", volume="12", pages="e44422", keywords="smart home ward", keywords="telemonitoring", keywords="telemedicine", keywords="home care", keywords="hospital at home", keywords="healthcare delivery", keywords="implementation", keywords="smart ward", keywords="medical monitoring", keywords="medical care", keywords="rehabilitation", keywords="health care", doi="10.2196/44422", url="https://mhealth.jmir.org/2024/1/e44422" } @Article{info:doi/10.2196/48842, author="Zhou, Linyun and Jiang, Minghuan and Duan, Ran and Zuo, Feng and Li, Zongfang and Xu, Songhua", title="Barriers and Implications of 5G Technology Adoption for Hospitals in Western China: Integrated Interpretive Structural Modeling and Decision-Making Trial and Evaluation Laboratory Analysis", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="23", volume="12", pages="e48842", keywords="5G health care", keywords="5G adoption barriers", keywords="5G adoption strategy", keywords="smart health care", keywords="Western China hospitals", abstract="Background: 5G technology is gaining traction in Chinese hospitals for its potential to enhance patient care and internal management. However, various barriers hinder its implementation in clinical settings, and studies on their relevance and importance are scarce. Objective: This study aimed to identify critical barriers hampering the effective implementation of 5G in hospitals in Western China, to identify interaction relationships and priorities of the above-identified barriers, and to assess the intensity of the relationships and cause-and-effect relations between the adoption barriers. Methods: This paper uses the Delphi expert consultation method to determine key barriers to 5G adoption in Western China hospitals, the interpretive structural modeling to uncover interaction relationships and priorities, and the decision-making trial and evaluation laboratory method to reveal cause-and-effect relationships and their intensity levels. Results: In total, 14 barriers were determined by literature review and the Delphi method. Among these, ``lack of policies on ethics, rights, and responsibilities in core health care scenarios'' emerged as the fundamental influencing factor in the entire system, as it was the only factor at the bottom level of the interpretive structural model. Overall, 8 barriers were classified as the ``cause group,'' and 6 as the ``effect group'' by the decision-making trial and evaluation laboratory method. ``High expense'' and ``organizational barriers within hospitals'' were determined as the most significant driving barrier (the highest R--C value of 1.361) and the most critical barrier (the highest R+C value of 4.317), respectively. Conclusions: Promoting the integration of 5G in hospitals in Western China faces multiple complex and interrelated barriers. The study provides valuable quantitative evidence and a comprehensive approach for regulatory authorities, hospitals, and telecom operators, helping them develop strategic pathways for promoting widespread 5G adoption in health care. It is suggested that the stakeholders cooperate to explore and solve the problems in the 5G medical care era, aiming to achieve the coverage of 5G medical care across the country. To our best knowledge, this study is the first academic exploration systematically analyzing factors resisting 5G integration in Chinese hospitals, and it may give subsequent researchers a solid foundation for further studying the application and development of 5G in health care. ", doi="10.2196/48842", url="https://mhealth.jmir.org/2024/1/e48842", url="http://www.ncbi.nlm.nih.gov/pubmed/38261368" } @Article{info:doi/10.2196/48345, author="Schroeder, Tanja and Haug, Maximilian and Georgiou, Andrew and Seaman, Karla and Gewald, Heiko", title="Evidence of How Physicians and Their Patients Adopt mHealth Apps in Germany: Exploratory Qualitative Study", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="17", volume="12", pages="e48345", keywords="mobile health apps", keywords="DiGA", keywords="adoption", keywords="prescription", keywords="mHealth", keywords="aging and individual differences", abstract="Background: The enactment of the ``Act to Improve Healthcare Provision through Digitalisation and Innovation '' (Digital Healthcare Act; Digitale-Versorgung-Gesetz [DVG]) in Germany has introduced a paradigm shift in medical practice, allowing physicians to prescribe mobile health (mHealth) apps alongside traditional medications. This transformation imposes a dual responsibility on physicians to acquaint themselves with qualifying apps and align them with patient diagnoses, while requiring patients to adhere to the prescribed app use, similar to pharmaceutical adherence. This transition, particularly challenging for older generations who are less skilled with technology, underscores a significant evolution in Germany's medical landscape. Objective: This study aims to investigate physicians' responses to this novel treatment option, their strategies for adapting to this form of prescription, and the willingness of patients to adhere to prescribed mHealth apps. Methods: Using an exploratory qualitative study design, we conducted semistructured interviews with 28 physicians and 30 potential patients aged 50 years and older from August 2020 to June 2021. Results: The findings reveal several factors influencing the adoption of mHealth apps, prompting a nuanced understanding of adoption research. Notably, both physicians and patients demonstrated a lack of information regarding mHealth apps and their positive health impacts, contributing to a deficiency in trust. Physicians' self-perceived digital competence and their evaluation of patients' digital proficiency emerge as pivotal factors influencing the prescription of mHealth apps. Conclusions: Our study provides comprehensive insights into the prescription process and the fundamental factors shaping the adoption of mHealth apps in Germany. The identified information gaps on both the physicians' and patients' sides contribute to a trust deficit and hindered digital competence. This research advances the understanding of adoption dynamics regarding digital health technologies and highlights crucial considerations for the successful integration of digital health apps into medical practice. ", doi="10.2196/48345", url="https://mhealth.jmir.org/2024/1/e48345", url="http://www.ncbi.nlm.nih.gov/pubmed/38231550" } @Article{info:doi/10.2196/46744, author="Cheung, Kin and Yip, Sum Chak", title="Documentation Completeness and Nurses' Perceptions of a Novel Electronic App for Medical Resuscitation in the Emergency Room: Mixed Methods Approach", journal="JMIR Mhealth Uhealth", year="2024", month="Jan", day="5", volume="12", pages="e46744", keywords="tablet computer", keywords="nursing documentation", keywords="paper resuscitation record", keywords="electronic resuscitation record", keywords="medical resuscitation", keywords="electronic medical record", keywords="documentation", keywords="resuscitation", keywords="electronic health record", keywords="nurses' perception", keywords="traditional paper record", keywords="nurse", abstract="Background: Complete documentation of critical care events in the accident and emergency department (AED) is essential. Due to the fast-paced and complex nature of resuscitation cases, missing data is a common issue during emergency situations. Objective: This study aimed to evaluate the impact of a tablet-based resuscitation record on documentation completeness during medical resuscitations and nurses' perceptions of the use of the tablet app. Methods: A mixed methods approach was adopted. To collect quantitative data, randomized retrospective reviews of paper-based resuscitation records before implementation of the tablet (Pre-App Paper; n=176), paper-based resuscitation records after implementation of the tablet (Post-App Paper; n=176), and electronic tablet-based resuscitation records (Post-App Electronic; n=176) using a documentation completeness checklist were conducted. The checklist was validated by 4 experts in the emergency medicine field. The content validity index (CVI) was calculated using the scale CVI (S-CVI). The universal agreement S-CVI was 0.822, and the average S-CVI was 0.939. The checklist consisted of the following 5 domains: basic information, vital signs, procedures, investigations, and medications. To collect qualitative data, nurses' perceptions of the app for electronic resuscitation documentation were obtained using individual interviews. Reporting of the qualitative data was guided by Consolidated Criteria for Reporting Qualitative Studies (COREQ) to enhance rigor. Results: A significantly higher documentation rate in all 5 domains (ie, basic information, vital signs, procedures, investigations, and medications) was present with Post-App Electronic than with Post-App Paper, but there were no significant differences in the 5 domains between Pre-App Paper and Post-App Paper. The qualitative analysis resulted in main categories of ``advantages of tablet-based documentation of resuscitation records,'' ``challenges with tablet-based documentation of resuscitation records,'' and ``areas for improvement of tablet-based resuscitation records.'' Conclusions: This study demonstrated that higher documentation completion rates are achieved with electronic tablet-based resuscitation records than with traditional paper records. During the transition period, the nurse documenters faced general problems with resuscitation documentation such as multitasking and unique challenges such as software updates and a need to familiarize themselves with the app's layout. Automation should be considered during future app development to improve documentation and redistribute more time for patient care. Nurses should continue to provide feedback on the app's usability and functionality during app refinement to ensure a successful transition and future development of electronic documentation records. ", doi="10.2196/46744", url="https://mhealth.jmir.org/2024/1/e46744", url="http://www.ncbi.nlm.nih.gov/pubmed/38180801" } @Article{info:doi/10.2196/48335, author="Folkvord, Frans and Bol, Nadine and Stazi, Giacomo and Peschke, Lutz and Lupi{\'a}{\~n}ez-Villanueva, Francisco", title="Preferences in the Willingness to Download an mHealth App: Discrete Choice Experimental Study in Spain, Germany, and the Netherlands", journal="JMIR Form Res", year="2023", month="Dec", day="25", volume="7", pages="e48335", keywords="mHealth adoption", keywords="discrete choice task", keywords="mobile apps", keywords="self-monitoring", keywords="willingness", keywords="mobile health app", keywords="mobile app", keywords="mobile health", keywords="mHealth", keywords="adoption", keywords="mHealth tools", keywords="health care cost", keywords="effectiveness", keywords="mobile phone", abstract="Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the adoption of mHealth is low, and only a limited number of studies have examined the intention to download mHealth apps. Objective: In this study, we investigated individuals' preferences in the adoption of a health app. Methods: We conducted a discrete choice experimental study in 3 countries (Spain: n=800, Germany: n=800, and the Netherlands: n=416) with 4 different attributes and levels (ie, price: {\texteuro}1.99 vs {\texteuro}4.99 [a currency exchange rate of {\texteuro}1=US \$1.09 is applicable] vs for free, data protection: data protection vs no information, recommendation: patients' association vs doctors, and manufacturer: medical association vs pharmaceutical company). Participants were randomly assigned. For the analyses, we used the conditional logistic model separately for each country. Results: The results showed that price and data protection were considered important factors that significantly increased the probability to download an mHealth app. In general, the source of the recommendation and the manufacturer affected the probability to download the mHealth app less. However, in Germany and the Netherlands, we found that if the app was manufactured by a pharmaceutical company, the probability to download the mHealth app decreased. Conclusions: mHealth tools are highly promising to reduce health care costs and increase the effectiveness of traditional health interventions and therapies. Improving data protection, reducing costs, and creating sound business models are the major driving forces to increase the adoption of mHealth apps in the future. It is thereby essential to create trustworthy standards for mobile apps, whereby prices, legislation concerning data protection, and health professionals can have a leading role to inform the potential consumers. ", doi="10.2196/48335", url="https://formative.jmir.org/2023/1/e48335", url="http://www.ncbi.nlm.nih.gov/pubmed/38145470" } @Article{info:doi/10.2196/50148, author="Esumi, Ryo and Ito-Masui, Asami and Kawamoto, Eiji and Ito, Mami and Hayashi, Tomoyo and Shinkai, Toru and Hane, Atsuya and Okuno, Fumito and Park, Jeong Eun and Kaku, Ryuji and Shimaoka, Motomu", title="Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study", journal="Interact J Med Res", year="2023", month="Nov", day="29", volume="12", pages="e50148", keywords="social network analysis", keywords="Center for Epidemiological Studies--Depression", keywords="CES-D", keywords="distributed leadership", keywords="intensive care unit", keywords="wearable sensor", keywords="face-to-face interaction", abstract="Background: Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. Objective: We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP's importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. Methods: Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies--Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. Results: Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=?0.318; P=.01). In 2018, the degree (r=?0.280; P=.01) and eigenvector (r=?0.284; P=.01) centralities were negatively correlated with CES-D scores. Conclusions: Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr\_e/ctr\_view.cgi?recptno=R000042211 ", doi="10.2196/50148", url="https://www.i-jmr.org/2023/1/e50148", url="http://www.ncbi.nlm.nih.gov/pubmed/37935050" } @Article{info:doi/10.2196/50886, author="Bibi, Igor and Schaffert, Daniel and Blauth, Mara and Lull, Christian and von Ahnen, Alwin Jan and Gross, Georg and Weigandt, Alexander Wanja and Knitza, Johannes and Kuhn, Sebastian and Benecke, Johannes and Leipe, Jan and Schmieder, Astrid and Olsavszky, Victor", title="Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study", journal="J Med Internet Res", year="2023", month="Nov", day="28", volume="25", pages="e50886", keywords="automated machine learning", keywords="psoriasis", keywords="hand and foot eczema", keywords="medical smartphone app", keywords="application", keywords="smartphone", keywords="machine learning", keywords="digitalization", keywords="skin", keywords="skin disease", keywords="use", keywords="hand", keywords="foot", keywords="mobile phone", abstract="Background: Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps. Objective: We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use. Methods: After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis. Results: Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use. Conclusions: This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care. ", doi="10.2196/50886", url="https://www.jmir.org/2023/1/e50886", url="http://www.ncbi.nlm.nih.gov/pubmed/38015608" } @Article{info:doi/10.2196/41551, author="Khalemsky, Michael and Khalemsky, Anna and Lankenau, Stephen and Ataiants, Janna and Roth, Alexis and Marcu, Gabriela and Schwartz, G. David", title="Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation", journal="JMIR Mhealth Uhealth", year="2023", month="Nov", day="28", volume="11", pages="e41551", keywords="volunteer", keywords="emergency", keywords="dispatch", keywords="responder", keywords="smartphone", keywords="emergency response", keywords="smartphone-based apps", keywords="mobile phone apps", keywords="first responders", keywords="medical emergency", keywords="dispatch algorithms", keywords="dispatch decisions", keywords="dispatch prediction", keywords="smartphone app", keywords="decision-making", keywords="algorithm", keywords="mobile health", keywords="mHealth intervention", keywords="mobile phone", abstract="Background: Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17\% to 47\%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. Objective: This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. Methods: We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. Results: The highest accuracy (260/329, 79.1\%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4\%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2\%) of ignored alerts but a low-accuracy prediction (153/329, 46.5\%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. Conclusions: VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives. ", doi="10.2196/41551", url="https://mhealth.jmir.org/2023/1/e41551", url="http://www.ncbi.nlm.nih.gov/pubmed/38015602" } @Article{info:doi/10.2196/50419, author="Alsahli, Sultan and Hor, Su-yin and Lam, Mary", title="Factors Influencing the Acceptance and Adoption of Mobile Health Apps by Physicians During the COVID-19 Pandemic: Systematic Review", journal="JMIR Mhealth Uhealth", year="2023", month="Nov", day="8", volume="11", pages="e50419", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="adoption", keywords="acceptance", keywords="barrier", keywords="attitude", keywords="physician", keywords="doctor", keywords="practitioner", keywords="mobile phone", abstract="Background: During the COVID-19 pandemic, the provision of and access to health care have been uniquely challenging, particularly during lockdowns or when dealing with COVID-19 cases. Health care professionals have had to provide patients with the necessary health care. However, delivering health care services while reducing face-to-face interaction puts an immense strain on health systems that are already overburdened. Against this backdrop, it is now more critical than ever to ensure the accessibility of health care services. Such access has been made increasingly available through mobile health (mHealth) apps. These apps have the potential to significantly improve health care outcomes and expectations and address some of the challenges confronting health care systems worldwide. Despite the advantages of mHealth, its acceptance and adoption remain low. Hence, health care organizations must consider the perceptions and opinions of physicians if the technology is to be successfully implemented. Objective: The objective of this systematic review was to explore and synthesize the scientific literature on the factors influencing the acceptance and adoption of mHealth among physicians during the COVID-19 pandemic. Methods: A systematic review of the studies published between March 2020 and December 2022 was conducted using the MEDLINE, Scopus, Embase, and ProQuest databases. The database search yielded an initial sample of 455 potential publications for analysis, of which 9 (2\%) met the inclusion criteria. The methodology of this review was based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Results: The factors influencing mHealth acceptance and adoption by physicians were divided into perceived barriers and perceived facilitators, which were further grouped into the following 3 major thematic categories: technological, individual, and organizational barriers and facilitators, respectively. The technological barriers were accessibility, technical issues, usefulness, and data management; individual barriers were perceived patient barriers, time and workload pressure, technical literacy, knowledge of mHealth, and peer support; and organizational barriers were financial factors, management support and engagement, data security, telemonitoring policy, and collaboration. The technological facilitators of uptake were technical factors, clinical usefulness, and data management; individual facilitators were patient-related care, intrinsic motivation, collaboration, and data sharing (individual); and organizational facilitators were workflow-related determinants, organizational financial support, recommendation of mHealth services, and evidence-based guidelines. Conclusions: This review summarized the evidence on the factors influencing mHealth acceptance and adoption by physicians during the COVID-19 pandemic. The main findings highlighted the importance of addressing organizational readiness to support physicians with adequate resources, shifting the focus from technological to patient-centered factors, and the seamless integration of mHealth into routine practice during and beyond the pandemic. Trial Registration: PROSPERO CRD42022356125; https://tinyurl.com/2mmhn5yu ", doi="10.2196/50419", url="https://mhealth.jmir.org/2023/1/e50419", url="http://www.ncbi.nlm.nih.gov/pubmed/37938873" } @Article{info:doi/10.2196/47813, author="Yan, Xinghui and Newman, W. Mark and Park, Young Sun and Sander, Angelle and Choi, Won Sung and Miner, Jennifer and Wu, Zhenke and Carlozzi, Noelle", title="Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners", journal="JMIR Form Res", year="2023", month="Oct", day="24", volume="7", pages="e47813", keywords="mHealth intervention", keywords="mobile health", keywords="behavior change", keywords="qualitative study", keywords="user adherence", keywords="behavioral messages", keywords="general well-being", abstract="Background: Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. Objective: The goal of this study was to understand the factors that impact care partners' decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. Methods: We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64\%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants' thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. Results: The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one's ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. Conclusions: Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people's perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). International Registered Report Identifier (IRRID): RR2-10.2196/32842 ", doi="10.2196/47813", url="https://formative.jmir.org/2023/1/e47813", url="http://www.ncbi.nlm.nih.gov/pubmed/37874621" } @Article{info:doi/10.2196/46058, author="Bakker, J. Caitlin and Wyatt, H. Tami and Breth, CS Melissa and Gao, Grace and Janeway, M. Lisa and Lee, A. Mikyoung and Martin, L. Christie and Tiase, L. Victoria", title="Nurses' Roles in mHealth App Development: Scoping Review", journal="JMIR Nursing", year="2023", month="Oct", day="17", volume="6", pages="e46058", keywords="mobile health", keywords="mHealth", keywords="mobile app", keywords="product development", keywords="software design", keywords="scoping", keywords="search strategy", keywords="nursing", keywords="health app", keywords="nurse", keywords="allied health", keywords="development", keywords="design", keywords="software", keywords="scoping literature review", keywords="scoping review", keywords="app", keywords="sensor", keywords="wearable", keywords="software development", keywords="mobile phone", abstract="Background: Although mobile health (mHealth) apps for both health consumers and health care providers are increasingly common, their implementation is frequently unsuccessful when there is a misalignment between the needs of the user and the app's functionality. Nurses are well positioned to help address this challenge. However, nurses' engagement in mHealth app development remains unclear. Objective: This scoping review aims to determine the extent of the evidence of the role of nurses in app development, delineate developmental phases in which nurses are involved, and to characterize the type of mHealth apps nurses are involved in developing. Methods: We conducted a scoping review following the 6-stage methodology. We searched 14 databases to identify publications on the role of nurses in mHealth app development and hand searched the reference lists of relevant publications. Two independent researchers performed all screening and data extraction, and a third reviewer resolved any discrepancies. Data were synthesized and grouped by the Software Development Life Cycle phase, and the app functionality was described using the IMS Institute for Healthcare Informatics functionality scoring system. Results: The screening process resulted in 157 publications being included in our analysis. Nurses were involved in mHealth app development across all stages of the Software Development Life Cycle but most frequently participated in design and prototyping, requirements gathering, and testing. Nurses most often played the role of evaluators, followed by subject matter experts. Nurses infrequently participated in software development or planning, and participation as patient advocates, research experts, or nurse informaticists was rare. Conclusions: Although nurses were represented throughout the preimplementation development process, nurses' involvement was concentrated in specific phases and roles. ", doi="10.2196/46058", url="https://nursing.jmir.org/2023/1/e46058", url="http://www.ncbi.nlm.nih.gov/pubmed/37847533" } @Article{info:doi/10.2196/49150, author="Poulsen, Adam and Song, C. Yun J. and Fosch-Villaronga, Eduard and LaMonica, M. Haley and Iannelli, Olivia and Alam, Mafruha and Hickie, B. Ian", title="Digital Rights and Mobile Health in Low- and Middle-Income Countries: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2023", month="Oct", day="3", volume="12", pages="e49150", keywords="human right", keywords="digital right", keywords="mobile health", keywords="mHealth", keywords="smartphone", keywords="mobile phone", keywords="digital health", keywords="scoping review", keywords="health equity", keywords="patient empowerment", abstract="Background: Digital technology is a means to uphold or violate human rights in various domains, including business, military, and health. Given the pervasiveness of mobile technology in low- and middle-income countries (LMICs), mobile health (mHealth) interventions present an opportunity to reach remote populations and enable them to exercise civil and political rights and economic, social, and cultural rights, such as the right to health and education. Simultaneously, the ubiquity of mobile phones involves processing sensitive data which can threaten rights, including the right to privacy and nondiscrimination. Digital health is often promoted as advancing human rights and health equity; however, digital rights are underexplored in the literature on mHealth in LMICs. As such, creating an understanding of the digital rights topics covered in the 2022 literature is important to avoid exacerbating existing inequities relating to digital health design, use, implementation, and access. Objective: This scoping review aims to identify digital rights topics in the 2022 peer-reviewed literature on mHealth in LMICs. Methods: The Arksey and O'Malley framework for scoping reviews guides this review. Searches were performed across 7 electronic databases (Web of Science, Scopus, Ovid, ACM Digital Library, IEEE Xplore, ProQuest, and PubMed). The screening processes were guided by the research question ``What digital rights topics have been explored in the 2022 literature on mHealth in LMICs?'' Only papers addressing mHealth in LMICs and digital rights topics were included. Data extraction will include publication title, year, and type; first author's affiliation country; LMICs implicated; infrastructure challenges; study aims, design, limitations, and future work; health area; mHealth technology, functions, purpose or application, and target end users; human or digital right terms used; explicit rights topics cited; and implied rights topics. The results will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: This scoping review was registered in Open Science Framework (December 22, 2022). Title and abstract screening and full-text paper screening were completed in 2023. This resulted in 56 papers being included in the study. The target date for completing data extraction and publishing a case study of the initial findings is the end of 2023. The full scoping review findings are expected to be disseminated through various pathways benefiting academia, practice, and policy making by the end of 2024. These include journal papers, conference presentations, publicly available toolkits for research and practice, public webinars, and policy briefs with evidence-based policy recommendations emerging from this review. Conclusions: The planned scoping review will identify digital rights topics in the 2022 literature at the intersection of mHealth and LMICs. Furthermore, it will highlight the importance of patient empowerment, data protection, and inclusion in mHealth research and related policies in LMICs. Trial Registration: Open Science Framework osf.io/7mz24; https://osf.io/7mz24 International Registered Report Identifier (IRRID): DERR1-10.2196/49150 ", doi="10.2196/49150", url="https://www.researchprotocols.org/2023/1/e49150", url="http://www.ncbi.nlm.nih.gov/pubmed/37788054" } @Article{info:doi/10.2196/45250, author="Thomas, Verghese and Kalidindi, Bharat and Waghmare, Abijeet and Bhatia, Abhishek and Raj, Tony and Balsari, Satchit", title="The Vinyasa Tool for mHealth Solutions: Supporting Human-Centered Design in Nascent Digital Health Ecosystems", journal="JMIR Form Res", year="2023", month="Oct", day="2", volume="7", pages="e45250", keywords="community health workers", keywords="digital health", keywords="focus group discussions", keywords="health care workers", keywords="human centered design", keywords="key informant interviews", keywords="LMICs", keywords="low- and middle-income countries", keywords="mHealth", keywords="mobile health", keywords="qualitative research", abstract="Background: mHealth (mobile health) systems have been deployed widely in low- and middle-income countries (LMICs) for health system strengthening, requiring considerable resource allocation. However, most solutions have not achieved scale or sustainability. Poor usability and failure to address perceived needs are among the principal reasons mHealth systems fail to achieve acceptance and adoption by health care workers. A human-centered design approach to improving mHealth system use requires an exploration of users' perceptions of mHealth systems, including the environmental, user-related, and technological aspects of a system. At present, there is a dearth of contextually intelligent tools available to mHealth developers that can guide such exploration before full-scale development and deployment. Objective: To develop a tool to aid optimization of mHealth solutions in LMICs to facilitate human-centered design and, consequently, successful adoption. Methods: We collated findings and themes from key qualitative studies on mHealth deployment in LMICs. We then used the Informatics Stack framework by Lehmann to label, sort, and collate findings and themes into a list of questions that explore the environment, users, artifacts, information governance, and interoperability of mHealth systems deployed in LMICs. Results: We developed the Vinyasa Tool to aid qualitative research about the need and usability of mHealth solutions in LMICs. The tool is a guide for focus group discussions and key informant interviews with community-based health care workers and primary care medical personnel who use or are expected to use proposed mHealth solutions. The tool consists of 71 questions organized in 11 sections that unpack and explore multiple aspects of mHealth systems from the perspectives of their users. These include the wider world and organization in which an mHealth solution is deployed; the roles, functions, workflow, and adoption behavior of a system's users; the security, privacy, and interoperability afforded by a system; and the artifacts of an information system---the data, information, knowledge, algorithms, and technology that constitute the system. The tool can be deployed in whole or in part, depending on the context of the study. Conclusions: The Vinyasa Tool is the first such comprehensive qualitative research instrument incorporating questions contextualized to the LMIC setting. We expect it to find wide application among mHealth developers, health system administrators, and researchers developing and deploying mHealth tools for use by patients, providers, and administrators. The tool is expected to guide users toward human-centered design with the goal of improving relevance, usability, and, therefore, adoption. ", doi="10.2196/45250", url="https://formative.jmir.org/2023/1/e45250", url="http://www.ncbi.nlm.nih.gov/pubmed/37607881" } @Article{info:doi/10.2196/49003, author="van Kessel, Robin and Srivastava, Divya and Kyriopoulos, Ilias and Monti, Giovanni and Novillo-Ortiz, David and Milman, Ran and Zhang-Czabanowski, Wilhelm Wojciech and Nasi, Greta and Stern, Dora Ariel and Wharton, George and Mossialos, Elias", title="Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping", journal="JMIR Mhealth Uhealth", year="2023", month="Sep", day="29", volume="11", pages="e49003", keywords="digital health", keywords="telehealth", keywords="telemedicine", keywords="reimbursement", keywords="policy", keywords="Europe", keywords="policy mapping", keywords="mapping", keywords="pricing", keywords="digital health app", keywords="application", keywords="health care ecosystem", keywords="framework", keywords="integration", abstract="Background: The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. Objective: This study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. Methods: We mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts. Results: Our search strategy yielded a total of 1559 records, of which 40 (2.57\%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health--specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic. Conclusions: Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves. ", doi="10.2196/49003", url="https://mhealth.jmir.org/2023/1/e49003", url="http://www.ncbi.nlm.nih.gov/pubmed/37773610" } @Article{info:doi/10.2196/49473, author="Willemsen, Fleur Romy and Meijer, Eline and van den Berg, Nicoline Liselot and van der Burg, Luuk and Chavannes, Henrik Niels and Aardoom, Joelle Jiska", title="A Health App Platform Providing a Budget to Purchase Preselected Apps as an Innovative Way to Support Public Health: Qualitative Study With End Users and Other Stakeholders", journal="JMIR Form Res", year="2023", month="Sep", day="29", volume="7", pages="e49473", keywords="eHealth", keywords="health apps", keywords="health app platform", keywords="prevention", keywords="public health", keywords="health platform", keywords="health promotion", keywords="digital health", keywords="app evaluation", keywords="Framework Method", keywords="focus group", keywords="focus groups", keywords="evaluate", keywords="evaluation", keywords="platform", keywords="acceptability", keywords="feasibility", keywords="mHealth", keywords="mobile health", keywords="app", keywords="apps", keywords="application", keywords="applications", keywords="mobile phone", abstract="Background: eHealth has the potential to improve health outcomes. However, this potential is largely untapped. Individuals face an overload of apps and have difficulties choosing suitable apps for themselves. In the FitKnip experiment, individuals were given access to a health app platform, where they could purchase reliable preselected health apps with a personal budget of {\texteuro}100 (US \$107.35). By conducting a prospective study, we aimed to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. Objective: The aim of the experiment was to scientifically evaluate the FitKnip experiment as an innovative way to improve population health. More specifically, we conducted an in-depth qualitative evaluation of the concept and acceptability of FitKnip, its perceived impact on health empowerment, as well as the roles of stakeholders for the future implementation of a health app platform through focus group interviews. Methods: This study followed a phenomenological research design and included 7 focus group interviews with end users and 1 with stakeholders, held between July and December 2020. End users were recruited through various institutions in the Netherlands, for example, insurance companies and local governments. All focus groups were semistructured using interview guides and were held via videoconferencing due to the COVID-19 pandemic measures. Each participant received access to a health app platform where they were enabled to purchase reliable, preselected health apps with a budget of {\texteuro}100 (US \$107.35). The budget was valid for the entire research period. The health app platform offered 38 apps. A third party, a health care coalition, selected the apps to be included in FitKnip. The analyses were conducted according to the principles of the Framework Method. Results: A priori formulated themes were concept, acceptability, health empowerment, and outcomes, and the roles of stakeholders for the future implementation of a health app platform. Both end users (n=31) and stakeholders (n=5) were enthusiastic about the concept of a health app platform. End users indicated missing apps regarding physical health and lifestyle and needing more guidance toward suitable apps. End users saw health empowerment as a precondition to using a health app platform and achieving health outcomes depending on the purchased mobile apps. End users and stakeholders identified potential providers and financing parties of FitKnip. Stakeholders recommended the establishment of a reputable national or international quality guidelines or certification for health and wellbeing apps, that can demonstrate the quality and reliability of mobile health applications. Conclusions: This study showed the need for a personalized and flexible platform. Next to this, a deeper understanding of the roles of stakeholders in such initiatives is needed especially on financing and reimbursement of health promotion and digital health services. A personalized, flexible health app platform is a promising initiative to support individuals in their health. ", doi="10.2196/49473", url="https://formative.jmir.org/2023/1/e49473", url="http://www.ncbi.nlm.nih.gov/pubmed/37773608" } @Article{info:doi/10.2196/48739, author="Caldwell, Sylvia and Flickinger, Tabor and Hodges, Jacqueline and Waldman, D. Ava Lena and Garofalini, Chloe and Cohn, Wendy and Dillingham, Rebecca and Castel, Amanda and Ingersoll, Karen", title="An mHealth Platform for People With HIV Receiving Care in Washington, District of Columbia: Qualitative Analysis of Stakeholder Feedback", journal="JMIR Form Res", year="2023", month="Sep", day="19", volume="7", pages="e48739", keywords="HIV", keywords="mobile health", keywords="mHealth", keywords="cluster randomized controlled trial", keywords="formative", keywords="adaptation", keywords="qualitative methods", keywords="smartphone", keywords="mobile phone", abstract="Background: HIV viral suppression and retention in care continue to be challenging goals for people with HIV in Washington, District of Columbia (DC). The PositiveLinks mobile app is associated with increased retention in care and viral load suppression in nonurban settings. The app includes features such as daily medication reminders, mood and stress check-ins, an anonymized community board for peer-to-peer social support, secure messaging to care teams, and resources for general and clinic-specific information, among other features. PositiveLinks has not been tailored or tested for this distinct urban population of people with HIV. Objective: This study aimed to inform the tailoring of a mobile health app to the needs of people with HIV and their providers in Washington, DC. Methods: We conducted a 3-part formative study to guide the tailoring of PositiveLinks for patients in the DC Cohort, a longitudinal cohort of >12,000 people with HIV receiving care in Washington, DC. The study included in-depth interviews with providers (n=28) at study clinics, focus groups with people with HIV enrolled in the DC Cohort (n=32), and a focus group with members of the DC Regional Planning Commission on Health and HIV (COHAH; n=35). Qualitative analysis used a constant comparison iterative approach; thematic saturation and intercoder agreement were achieved. Emerging themes were identified and grouped to inform an adaptation of PositiveLinks tailored for patients and providers. Results: Emerging themes for patients, clinic providers, and COHAH providers included population needs and concerns, facilitators and barriers to engagement in care and viral suppression, technology use, anticipated benefits, questions and concerns, and suggestions. DC Cohort clinic and COHAH provider interviews generated an additional theme: clinic processes. For patients, the most commonly discussed potential benefits included improved health knowledge and literacy (mentioned n=10 times), self-monitoring (n=7 times), and connection to peers (n=6 times). For providers, the most common anticipated benefits were improved communication with the clinic team (n=21), connection to peers (n=14), and facilitation of self-monitoring (n=11). Following data review, site principal investigators selected core PositiveLinks features, including daily medication adherence, mood and stress check-ins, resources, frequently asked questions, and the community board. Principal investigators wanted English and Spanish versions depending on the site. Two additional app features (messaging and documents) were selected as optional for each clinic site. Overall, 3 features were not deployed as not all participating clinics supported them. Conclusions: Patient and provider perspectives of PositiveLinks had some overlap, but some themes were unique to each group. Beta testing of the tailored app was conducted (August 2022). This formative work prepared the team for a cluster randomized controlled trial of PositiveLinks' efficacy. Randomization of clinics to PositiveLinks or usual care occurred in August 2022, and the randomized controlled trial launched in November 2022. International Registered Report Identifier (IRRID): RR2-10.2196/37748 ", doi="10.2196/48739", url="https://formative.jmir.org/2023/1/e48739", url="http://www.ncbi.nlm.nih.gov/pubmed/37725419" } @Article{info:doi/10.2196/45477, author="Bottani, Eleonora and Bellini, Valentina and Mordonini, Monica and Pellegrino, Mattia and Lombardo, Gianfranco and Franchi, Beatrice and Craca, Michelangelo and Bignami, Elena", title="Internet of Things and New Technologies for Tracking Perioperative Patients With an Innovative Model for Operating Room Scheduling: Protocol for a Development and Feasibility Study", journal="JMIR Res Protoc", year="2023", month="Jul", day="5", volume="12", pages="e45477", keywords="internet of things", keywords="artificial intelligence", keywords="machine learning", keywords="perioperative organization", keywords="operating rooms", abstract="Background: Management of operating rooms is a critical point in health care organizations because surgical departments represent a significant cost in hospital budgets. Therefore, it is increasingly important that there is effective planning of elective, emergency, and day surgery and optimization of both the human and physical resources available, always maintaining a high level of care and health treatment. This would lead to a reduction in patient waiting lists and better performance not only of surgical departments but also of the entire hospital. Objective: This study aims to automatically collect data from a real surgical scenario to develop an integrated technological-organizational model that optimizes operating block resources. Methods: Each patient is tracked and located in real time by wearing a bracelet sensor with a unique identifier. Exploiting the indoor location, the software architecture is able to collect the time spent for every step inside the surgical block. This method does not in any way affect the level of assistance that the patient receives and always protects their privacy; in fact, after expressing informed consent, each patient will be associated with an anonymous identification number. Results: The preliminary results are promising, making the study feasible and functional. Times automatically recorded are much more precise than those collected by humans and reported in the organization's information system. In addition, machine learning can exploit the historical data collection to predict the surgery time required for each patient according to the patient's specific profile. Simulation can also be applied to reproduce the system's functioning, evaluate current performance, and identify strategies to improve the efficiency of the operating block. Conclusions: This functional approach improves short- and long-term surgical planning, facilitating interaction between the various professionals involved in the operating block, optimizing the management of available resources, and guaranteeing a high level of patient care in an increasingly efficient health care system. Trial Registration: ClinicalTrials.gov NCT05106621; https://clinicaltrials.gov/ct2/show/NCT05106621 International Registered Report Identifier (IRRID): DERR1-10.2196/45477 ", doi="10.2196/45477", url="https://www.researchprotocols.org/2023/1/e45477", url="http://www.ncbi.nlm.nih.gov/pubmed/37405821" } @Article{info:doi/10.2196/40834, author="Lee, Junbok and Oh, Yumi and Kim, Meelim and Cho, Belong and Shin, Jaeyong", title="Willingness to Use and Pay for Digital Health Care Services According to 4 Scenarios: Results from a National Survey", journal="JMIR Mhealth Uhealth", year="2023", month="Mar", day="29", volume="11", pages="e40834", keywords="digital health intervention", keywords="service experience", keywords="willingness to pay", keywords="willingness to use", keywords="digital health", keywords="health technology", abstract="Background: Smartphones and their associated technology have evolved to an extent where these devices can be used to provide digital health interventions. However, few studies have been conducted on the willingness to use (WTU) and willingness to pay (WTP) for digital health interventions. Objective: The purpose of this study was to investigate how previous service experience, the content of the services, and individuals' health status affect WTU and WTP. Methods: We conducted a nationwide web-based survey in 3 groups: nonusers (n=506), public service users (n=368), and private service users (n=266). Participants read scenarios about an imagined health status (such as having a chronic illness) and the use of digital health intervention models (self-management, expert management, and medical management). They were then asked to respond to questions on WTU and WTP. Results: Public service users had a greater intention to use digital health intervention services than nonusers and private service users: scenario A (health-risk situation and self-management), nonusers=odd ratio [OR] .239 (SE .076; P<.001) and private service users=OR .138 (SE .044; P<.001); scenario B (health-risk situation and expert management), nonusers=OR .175 (SE .040; P<.001) and private service users=OR .219 (SE .053; P<.001); scenario C (chronic disease situation and expert management), nonusers=OR .413 (SE .094; P<.001) and private service users=OR .401 (SE .098; P<.001); and scenario D (chronic disease situation and medical management), nonusers=OR .480 (SE .120; P=.003) and private service users=OR .345 (SE .089; P<.001). In terms of WTP, in scenarios A and B, those who used the public and private services had a higher WTP than those who did not (scenario A: $\beta$=--.397, SE .091; P<.001; scenario B: $\beta$=--.486, SE .098; P<.001). In scenario C, private service users had greater WTP than public service users ($\beta$=.264, SE .114; P=.02), whereas public service users had greater WTP than nonusers ($\beta$=--.336, SE .096; P<.001). In scenario D, private service users were more WTP for the service than nonusers ($\beta$=--.286, SE .092; P=.002). Conclusions: We confirmed that the WTU and WTP for digital health interventions differed based on individuals' prior experience with health care services, health status, and demographics. Recently, many discussions have been made to expand digital health care beyond the early adapters and fully into people's daily lives. Thus, more understanding of people's awareness and acceptance of digital health care is needed. ", doi="10.2196/40834", url="https://mhealth.jmir.org/2023/1/e40834", url="http://www.ncbi.nlm.nih.gov/pubmed/36989025" } @Article{info:doi/10.2196/43507, author="Topp, Robert and Greenstein, Jay and Etnoyer-Slaski, Jena", title="The Effect of a Mobile Health App on Treatment Adherence and Revenue at Physical Health Clinics: Retrospective Record Review", journal="JMIR Rehabil Assist Technol", year="2023", month="Mar", day="28", volume="10", pages="e43507", keywords="physical health", keywords="completion of therapy", keywords="phone app", keywords="clinic charges and payments", keywords="payment", keywords="cost", keywords="physiotherapy", keywords="physical therapy", keywords="adherence", keywords="attrition", keywords="mobile phone", keywords="reminder", keywords="mobile health", keywords="mHealth", keywords="health app", keywords="mobile app", abstract="Background: A significant number of patients do not adhere to their prescribed course of physical therapy or discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contributes to patients achieving the goals of therapy including reducing pain and increasing functionality. Web-based platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain, similar to managing them in person. Behavior change techniques introduced through digital or web-based platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. Literature also indicates that a phone-based app provided to patients, which includes a reward-incentive gamification to complement their care, contributed to a greater number of kept appointments in a physical therapy clinic. Objective: This study aims to compare the rate of provider discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based app to complement their care. Methods: A retrospective analysis of all new outpatient medical records (N=5328) from a multisite physical health practice was conducted between January 2018 and December 2019. Patients in the sample self-selected the 2018 Usual Care, the 2019 Usual Care, or the 2019 Kanvas App groups. Kanvas is a customized private practice app, designed for patient engagement with their specific health care provider. This app included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record, each patient was classified as completing their prescribed therapy (provider discharged) or not completing their prescribed therapy (self-discharged). Additionally, the total number of clinic visits each patient attended, the total charges for services, and the total payments received by the clinic per patient were extracted from each patient's medical record. Results: Patients in the 2019 Kanvas App Group exhibited a higher rate of provider discharge compared to patients who did not adopt the app. This greater rate of provider discharges among the patients who adopted the Kanvas app likely contributed to this group attending more clinic visits (13.21, SD 12.09) than the other study groups who did not download the app (10.72, SD 9.80 to 11.35, SD 11.10). This greater number of clinic visits in turn contributed to the patients who adopted the app generating more clinic charges and payments. Conclusions: Future investigators need to employ more rigorous methods to confirm these findings, and clinicians need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas app. ", doi="10.2196/43507", url="https://rehab.jmir.org/2023/1/e43507", url="http://www.ncbi.nlm.nih.gov/pubmed/36889337" } @Article{info:doi/10.2196/41861, author="Brown, Carter and Roucoux, Guillaume and Dimi, Svetlane and Fahmi, Saleh and Jeevan, Raj-Banou and Chassany, Olivier and Chaplin, John and Duracinsky, Martin", title="Evaluating Clinician Expectations of mHealth Solutions to Increase Rapid-Screening for HIV and Hepatitis in Migrant Populations in France: Qualitative Study", journal="JMIR Hum Factors", year="2023", month="Feb", day="3", volume="10", pages="e41861", keywords="app development", keywords="acceptability", keywords="mobile health", keywords="mHealth", keywords="user-centered design", keywords="communication barriers", keywords="migrants", keywords="HIV", keywords="AIDS", keywords="hepatitis", keywords="rapid diagnostic testing", keywords="public health", keywords="communication tool", keywords="screening", keywords="language barrier", abstract="Background: Migrants underuse screening opportunities for HIV, hepatitis B, and hepatitis C despite elevated risk factors for contracting these infections. Language barriers are an often given as reasons for limiting access to services. Translation and communication apps increase communication and overall patient satisfaction in the patient-provider relationship. In the development and adoption of new technology, expectations play an important role. Objective: This study aimed to explore health care professionals' opinions and attitudes regarding their screening practices with migrants and their expectations for a new communication tool that could improve migrants' screening use. Methods: In this qualitative study, a purposive (diverse) sampling method was used to invite doctors and nurses who conduct rapid screening tests with migrants from 4 centers of the French Office of Immigration and Integration in 3 geographic regions of France. Semistructured interviews were conducted to survey their opinions on the rapid testing of migrants, the use of telephone interpreters, the concept of health literacy, and their expectations of a new communication tool that could overcome language barriers and promote rapid screening in the new migrant population. Results: In all, 20 interviews were conducted with 11 doctors and 9 nurses with a median age of 58 (range 25-67) years. Participants favored the integration of an innovative communication tool in the context of rapid screening of migrants. However, there were concerns related to the implementation and added value of the tool while migrants were already reluctant to be screened. Expectations were for a tool that would present information in simplified French or a chosen language but also supports a positive attitude toward screening. Health professionals also expressed the wish that the technology could help with the collection of health data. Conclusions: Feedback from health professionals provides a better understanding of potential formats, characteristics, functions, content, and use of an innovative, digital method to communicate with migrants with limited French proficiency. Findings contribute to the conceptual development of an electronic app and its implementation within the ApiD{\'e} study, which aims to validate a digital app to address language barriers to increase the use of screening among migrants with limited French proficiency in France. ", doi="10.2196/41861", url="https://humanfactors.jmir.org/2023/1/e41861", url="http://www.ncbi.nlm.nih.gov/pubmed/36735323" } @Article{info:doi/10.2196/25361, author="Verma, Neha and Lehmann, Harold and Alam, Afroz Amal and Yazdi, Youseph and Acharya, Soumyadipta", title="Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach", journal="JMIR Hum Factors", year="2023", month="Feb", day="2", volume="10", pages="e25361", keywords="telemedicine", keywords="telehealth", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="community health workers", keywords="frontline health workers", keywords="digital health assistant", keywords="task shifting", abstract="Background: Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker--to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. Objective: We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker--to-physician telemedicine programs and develop and refine a solution that addresses those needs. Methods: We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14\% physicians; n=1, 3\% public health program manager; n=12, 32\% community health workers; and n=19, 51\% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. Results: We identified 74 unmet needs through our immersion in health worker--to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. Conclusions: The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker--to-physician telemedicine programs. ", doi="10.2196/25361", url="https://humanfactors.jmir.org/2023/1/e25361", url="http://www.ncbi.nlm.nih.gov/pubmed/36729578" } @Article{info:doi/10.2196/43167, author="Xie, Wanhua and Cao, Xiaojun", title="The Effect of Mobile Payment on Payment Waiting Time for Outpatients With Medical Insurance: Historically Controlled Study", journal="JMIR Form Res", year="2023", month="Jan", day="26", volume="7", pages="e43167", keywords="smartphone", keywords="mobile payment for health insurance", keywords="waiting time", keywords="outpatient service", keywords="patient satisfaction", keywords="medical insurance", keywords="mobile payment", keywords="mobile app", abstract="Background: Waiting for a long time to make payments in outpatient wards and long queues of insured patients at the checkout window are common in many hospitals across China. To alleviate the problem of long queues for payment, many hospitals in China have established various mobile apps that those without health insurance can use. However, medically insured outpatients are still required to pay manually at the checkout window. Therefore, it is urgent to use information technology to innovate and optimize the outpatient service process, implement mobile payment for medically insured outpatients, and shorten the waiting time for outpatients, especially in the context of the COVID-19 epidemic. Furthermore, smartphone-based mobile payment for outpatients with health insurance could be superior to on-site cashier billing. Objective: This study aimed to investigate the impact of smartphone-based mobile payment in relation to different aspects, such as waiting time, satisfaction with patients' waiting time, payment experience, the proportion of those dissatisfied with payment, total outpatient satisfaction, and outpatient volume, and compare mobile payment with on-site payment. Methods: This was a historically controlled study. This study analyzed the outpatients' waiting time to make a medical insurance payment, their satisfaction with the waiting time and payment experience, the proportion of those dissatisfied with payment, and the outpatient volume of patients at Guangzhou Women and Children's Medical Center 1 year before and after the implementation of mobile payment for medical insurance in January 2021. An independent sample 2-tailed t test was used to compare waiting time, satisfaction with waiting time, and overall satisfaction. Paired sample 2-tailed t test was used to compare monthly outpatient visits. The chi-square test was used to compare the percentages of patients dissatisfied with payment. Results: After the implementation of mobile payment for medical insurance outpatients, the patients' payment waiting time was significantly shortened (mean 45.28, SD 10.35 min vs mean 1.02, SD 0.25 min; t9014=53.396; P<.001), and satisfaction with waiting time and payment experience were significantly improved (mean 82.08, SD 3.17 vs mean 90.36, SD 3.45; t9014=--118.65; P<.001). Dissatisfaction with payment significantly decreased (10.27\%, SD 2.18\% vs 1.19\% vs SD 0.30\%; P<.001). The total satisfaction of outpatients significantly improved (mean 86.91, SD 3.23 vs mean 89.98, SD 3.31; t9014=--44.57; P<.001), and the outpatient volume increased (248,105.58, SD 89,280.76 vs 303,194.75, SD 53,773.12; t11=2.414; P=.03). Furthermore, payment efficiency improved, and the number of the on-site cashiers substantially decreased. Conclusions: Mobile payment for health insurance significantly shortened patients' payment waiting time; improved patient satisfaction on waiting time and payment experience and overall satisfaction; reduced the proportion of patients who were dissatisfied with payment and the cashier at the hospital; and increased monthly outpatient volume. This approach was effective and thus worthy of promoting. ", doi="10.2196/43167", url="https://formative.jmir.org/2023/1/e43167", url="http://www.ncbi.nlm.nih.gov/pubmed/36696970" } @Article{info:doi/10.2196/43905, author="Hoogendoorn, Petra and Versluis, Anke and van Kampen, Sanne and McCay, Charles and Leahy, Matt and Bijlsma, Marlou and Bonacina, Stefano and Bonten, Tobias and Bonthuis, Marie-Jos{\'e} and Butterlin, Anouk and Cobbaert, Koen and Duijnhoven, Thea and Hallensleben, Cynthia and Harrison, Stuart and Hastenteufel, Mark and Holappa, Terhi and Kokx, Ben and Morlion, Birgit and Pauli, Norbert and Ploeg, Frank and Salmon, Mark and Schnoor, Kyma and Sharp, Mary and Sottile, Angelo Pier and V{\"a}rri, Alpo and Williams, Patricia and Heidenreich, Georg and Oughtibridge, Nicholas and Stegwee, Robert and Chavannes, H. Niels", title="What Makes a Quality Health App---Developing a Global Research-Based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: Delphi Study", journal="JMIR Form Res", year="2023", month="Jan", day="23", volume="7", pages="e43905", keywords="health app", keywords="wellness app", keywords="mobile health", keywords="mHealth", keywords="Delphi technique", keywords="quality assessment", keywords="assessment framework", keywords="standard", keywords="standardization", keywords="COVID-19", abstract="Background: The lack of an international standard for assessing and communicating health app quality and the lack of consensus about what makes a high-quality health app negatively affect the uptake of such apps. At the request of the European Commission, the international Standard Development Organizations (SDOs), European Committee for Standardization, International Organization for Standardization, and International Electrotechnical Commission have joined forces to develop a technical specification (TS) for assessing the quality and reliability of health and wellness apps. Objective: This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality. Methods: A 2-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42, 51\%) or both (n=41, 49\%) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the maximum 100 requirement questions for the uptake of apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries that participated in the SDO technical committees were invited to comment on 4 working drafts and subsequently vote on the TS. Results: The final quality assessment framework includes 81 questions, 67 (83\%) of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as ``Healthy and safe,'' ``Easy to use,'' ``Secure data,'' and ``Robust build.'' The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2-4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software -- Part 2: Health and wellness apps -- Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs, including 6 of the 10 most populous countries worldwide. Conclusions: A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers enhance and efficiently demonstrate the quality of health apps, consumers, and health care professionals to make informed decisions on health apps. It will also help insurers to make reimbursement decisions on health apps. ", doi="10.2196/43905", url="https://formative.jmir.org/2023/1/e43905", url="http://www.ncbi.nlm.nih.gov/pubmed/36538379" } @Article{info:doi/10.2196/37624, author="Angerer, Alfred and Stahl, Johanna and Krasniqi, Egzona and Banning, Stefan", title="The Management Perspective in Digital Health Literature: Systematic Review", journal="JMIR Mhealth Uhealth", year="2022", month="Nov", day="10", volume="10", number="11", pages="e37624", keywords="digital health", keywords="management", keywords="health care management", keywords="literature review", keywords="health technology", keywords="eHealth", keywords="data health", keywords="trend health", keywords="tech health", abstract="Background: New digital health technologies are considered one solution to challenges in the health sector, which include rising numbers of chronic diseases and increased health spending. As digitalization in health care is still in its infancy, there are many unanswered questions about the impact of digital health on management. Objective: This paper assesses the current state of knowledge in the field of digital health from a management perspective. It highlights research gaps within this field to determine future research opportunities. Methods: A systematic review of digital health literature was conducted using 3 databases. The chosen articles (N=38) were classified according to a taxonomy developed for the purpose, and research gaps were identified based on the topic areas discussed. Results: The literature review revealed a slight prevalence of practical (n=21, 55\%) over theoretical (n=17, 45\%) approaches. Most of the papers (n=23, 61\%) deal with information technology (IT) and are, therefore, focused more on technology and less on management. The research question in most of the papers (n=31, 82\%) deals with the creation of concepts, and very few (n=4, 11\%) evaluate or even question existing solutions. Most consider the main reason for digitalization to be the optimization of operational processes (n=26, 68\%), and 42\% (n=16) deal with new business models. The topic area discussed most frequently was found to be eHealth (n=30, 79\%). By contrast, the field of tech health with topics such as sensors receives the least attention (n=3, 8\%), despite its significant potential for health care processes and strategy. Conclusions: Three main research propositions were identified. First, research into digital health innovation should not focus solely on the technology aspects but also on its implications for strategic and operational management. Second, the research community should target other domains besides eHealth. Third, we observed a lack of quantitative research on the real impact of digital health on organizations and their management. More quantitative evidence is required regarding the expected outcome and impact of the implementation of digital health solutions into our health care organizations. ", doi="10.2196/37624", url="https://mhealth.jmir.org/2022/11/e37624", url="http://www.ncbi.nlm.nih.gov/pubmed/36355426" } @Article{info:doi/10.2196/25735, author="Tahsina, Tazeen and Iqbal, Afrin and Rahman, Ehsanur Ahmed and Chowdhury, Kanti Suman and Chowdhury, Iqbal Atique and Billah, Masum Sk and Rahman, Ataur and Parveen, Monira and Ahmed, Lubana and Rahman, Sadequr Qazi and Ashrafi, Akbar Shah Ali and Arifeen, El Shams", title="Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study", journal="JMIR Public Health Surveill", year="2022", month="Aug", day="29", volume="8", number="8", pages="e25735", keywords="notification", keywords="registration", keywords="birth", keywords="death", keywords="CRVS", keywords="mobile phone", keywords="mobile app", keywords="mobile technology", keywords="technology-based platform", keywords="community health", keywords="low- and middle-income countries", keywords="mHealth", keywords="Bangladesh", abstract="Background: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54\% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5\% of births and 35.9\% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. Objective: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. Methods: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology--based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey--based assessment at the end of the notification period. Results: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92\% of the births and 93\% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87\% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. Conclusions: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source. ", doi="10.2196/25735", url="https://publichealth.jmir.org/2022/8/e25735", url="http://www.ncbi.nlm.nih.gov/pubmed/36036979" } @Article{info:doi/10.2196/37482, author="Alexander, L. Gregory and Liu, Jianfang and Powell, R. Kimberly and Stone, W. Patricia", title="Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity", journal="JMIR Aging", year="2022", month="Aug", day="23", volume="5", number="3", pages="e37482", keywords="nursing homes", keywords="health information technology", keywords="policy", keywords="nursing informatics", keywords="electronic health record", keywords="electronic data", keywords="data sharing", keywords="care providers", keywords="resident", keywords="care", keywords="quality of care", keywords="structural disparity", keywords="clinical support", keywords="administration", abstract="Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20\%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7\%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes. ", doi="10.2196/37482", url="https://aging.jmir.org/2022/3/e37482", url="http://www.ncbi.nlm.nih.gov/pubmed/35998030" } @Article{info:doi/10.2196/18188, author="Sibuyi, Idon-Nkhenso and de la Harpe, Retha and Nyasulu, Peter", title="A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="16", volume="10", number="6", pages="e18188", keywords="MomConnect", keywords="mHealth", keywords="patient-facing eHealth", keywords="digital health innovation ecosystem", keywords="practitioner-researcher", keywords="stakeholder-centered design", keywords="re-engineering in health services", keywords="sustainable development goals", keywords="principles of digital development", keywords="global digital health index", keywords="strong structuration theory", abstract="Background: The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector's benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies. Objective: This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa. Methods: This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies. Results: Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government's MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth. Conclusions: This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa. ", doi="10.2196/18188", url="https://mhealth.jmir.org/2022/6/e18188", url="http://www.ncbi.nlm.nih.gov/pubmed/35708756" } @Article{info:doi/10.2196/35155, author="Kateera, Fredrick and Riviello, Robert and Goodman, Andrea and Nkurunziza, Theoneste and Cherian, Teena and Bikorimana, Laban and Nkurunziza, Jonathan and Nahimana, Evrard and Habiyakare, Caste and Ntakiyiruta, Georges and Matousek, Alexi and Gaju, Erick and Gruendl, Magdalena and Powell, Brittany and Sonderman, Kristin and Koch, Rachel and Hedt-Gauthier, Bethany", title="The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Jun", day="8", volume="10", number="6", pages="e35155", keywords="obstetric surgery", keywords="community health workers", keywords="mobile health", keywords="surgical site infections", keywords="c-section", keywords="infection", keywords="community health", keywords="Rwanda", abstract="Background: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)--led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. Objective: This trial assesses whether CHW's use of a mobile health (mHealth)--facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. Methods: A total of 1025 women aged ?18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7\%), (2) phone call intervention (n=334, 32.6\%), and (3) standard of care (n=356, 34.7\%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. Results: The majority of women in Arm 1 (n=295, 88.1\%) and Arm 2 (n=226, 67.7\%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7\%, Arm 2: 98.4\%, and Arm 3: 99.7\%, respectively). Conclusions: Home-based post--c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. Trial Registration: ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399 ", doi="10.2196/35155", url="https://mhealth.jmir.org/2022/6/e35155", url="http://www.ncbi.nlm.nih.gov/pubmed/35675108" } @Article{info:doi/10.2196/29985, author="Garc{\'i}a-S{\'a}nchez, Sebasti{\'a}n and Somoza-Fern{\'a}ndez, Beatriz and de Lorenzo-Pinto, Ana and Ortega-Navarro, Cristina and Herranz-Alonso, Ana and Sanjurjo, Mar{\'i}a", title="Mobile Health Apps Providing Information on Drugs for Adult Emergency Care: Systematic Search on App Stores and Content Analysis", journal="JMIR Mhealth Uhealth", year="2022", month="Apr", day="20", volume="10", number="4", pages="e29985", keywords="emergency drugs", keywords="emergency medicine", keywords="emergency departments", keywords="emergency professionals", keywords="medication errors", keywords="drug characteristics", keywords="drug management", keywords="apps", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="smartphone", keywords="mobile phone", abstract="Background: Drug-referencing apps are among the most frequently used by emergency health professionals. To date, no study has analyzed the quantity and quality of apps that provide information on emergency drugs. Objective: This study aimed to identify apps designed to assist emergency professionals in managing drugs and to describe and analyze their characteristics. Methods: We performed an observational, cross-sectional, descriptive study of apps that provide information on drugs for adult emergency care. The iOS and Android platforms were searched in February 2021. The apps were independently evaluated by 2 hospital clinical pharmacists. We analyzed developer affiliation, cost, updates, user ratings, and number of downloads. We also evaluated the main topic (emergency drugs or emergency medicine), the number of drugs described, the inclusion of bibliographic references, and the presence of the following drug information: commercial presentations, usual dosage, dose adjustment for renal failure, mechanism of action, therapeutic indications, contraindications, interactions with other medicinal products, use in pregnancy and breastfeeding, adverse reactions, method of preparation and administration, stability data, incompatibilities, identification of high-alert medications, positioning in treatment algorithms, information about medication reconciliation, and cost. Results: Overall, 49 apps were identified. Of these 49 apps, 32 (65\%) were found on both digital platforms; 11 (22\%) were available only for Android, and 6 (12\%) were available only for iOS. In total, 41\% (20/49) of the apps required payment (ranging from {\texteuro}0.59 [US \$0.64] to {\texteuro}179.99 [US \$196.10]) and 22\% (11/49) of the apps were developed by non--health care professionals. The mean weighted user rating was 4.023 of 5 (SD 0.71). Overall, 45\% (22/49) of the apps focused on emergency drugs, and 55\% (27/49) focused on emergency medicine. More than half (29/47, 62\%) did not include bibliographic references or had not been updated for more than a year (29/49, 59\%). The median number of drugs was 66 (range 4 to >5000). Contraindications (26/47, 55\%) and adverse reactions (24/47, 51\%) were found in only half of the apps. Less than half of the apps addressed dose adjustment for renal failure (15/47, 32\%), interactions (10/47, 21\%), and use during pregnancy and breastfeeding (15/47, 32\%). Only 6\% (3/47) identified high-alert medications, and 2\% (1/47) included information about medication reconciliation. Health-related developer, main topic, and greater amount of drug information were not statistically associated with higher user ratings (P=.99, P=.09, and P=.31, respectively). Conclusions: We provide a comprehensive review of apps with information on emergency drugs for adults. Information on authorship, drug characteristics, and bibliographic references is frequently scarce; therefore, we propose recommendations to consider when developing an app of these characteristics. Future efforts should be made to increase the regulation of drug-referencing apps and to conduct a more frequent and documented review of their clinical content. ", doi="10.2196/29985", url="https://mhealth.jmir.org/2022/4/e29985", url="http://www.ncbi.nlm.nih.gov/pubmed/35442212" } @Article{info:doi/10.2196/32340, author="Cotte, Fabienne and Mueller, Tobias and Gilbert, Stephen and Bl{\"u}mke, Bibiana and Multmeier, Jan and Hirsch, Christian Martin and Wicks, Paul and Wolanski, Joseph and Tutschkow, Darja and Schade Brittinger, Carmen and Timmermann, Lars and Jerrentrup, Andreas", title="Safety of Triage Self-assessment Using a Symptom Assessment App for Walk-in Patients in the Emergency Care Setting: Observational Prospective Cross-sectional Study", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="28", volume="10", number="3", pages="e32340", keywords="symptom checker", keywords="emergency medicine", keywords="app", keywords="triage", keywords="safety", keywords="innovative", keywords="eHealth", keywords="artificial intelligence", abstract="Background: Increasing use of emergency departments (EDs) by patients with low urgency, combined with limited availability of medical staff, results in extended waiting times and delayed care. Technological approaches could possibly increase efficiency by providing urgency advice and symptom assessments. Objective: The purpose of this study is to evaluate the safety of urgency advice provided by a symptom assessment app, Ada, in an ED. Methods: The study was conducted at the interdisciplinary ED of Marburg University Hospital, with data collection performed between August 2019 and March 2020. This study had a single-center cross-sectional prospective observational design and included 378 patients. The app's urgency recommendation was compared with an established triage concept (Manchester Triage System [MTS]), including patients from the lower 3 MTS categories only. For all patients who were undertriaged, an expert physician panel assessed the case to detect potential avoidable hazardous situations (AHSs). Results: Of 378 participants, 344 (91\%) were triaged the same or more conservatively and 34 (8.9\%) were undertriaged by the app. Of the 378 patients, 14 (3.7\%) had received safe advice determined by the expert panel and 20 (5.3\%) were considered to be potential AHS. Therefore, the assessment could be considered safe in 94.7\% (358/378) of the patients when compared with the MTS assessment. From the 3 lowest MTS categories, 43.4\% (164/378) of patients were not considered as emergency cases by the app, but could have been safely treated by a general practitioner or would not have required a physician consultation at all. Conclusions: The app provided urgency advice after patient self-triage that has a high rate of safety, a rate of undertriage, and a rate of triage with potential to be an AHS, equivalent to telephone triage by health care professionals while still being more conservative than direct ED triage. A large proportion of patients in the ED were not considered as emergency cases, which could possibly relieve ED burden if used at home. Further research should be conducted in the at-home setting to evaluate this hypothesis. Trial Registration: German Clinical Trial Registration DRKS00024909; https://www.drks.de/drks\_web/navigate.do? navigationId=trial.HTML\&TRIAL\_ID=DRKS00024909 ", doi="10.2196/32340", url="https://mhealth.jmir.org/2022/3/e32340", url="http://www.ncbi.nlm.nih.gov/pubmed/35343909" } @Article{info:doi/10.2196/35879, author="Martinon, Prescilla and Saliasi, Ina and Bourgeois, Denis and Smentek, Colette and Dussart, Claude and Fraticelli, Laurie and Carrouel, Florence", title="Nutrition-Related Mobile Apps in the French App Stores: Assessment of Functionality and Quality", journal="JMIR Mhealth Uhealth", year="2022", month="Mar", day="14", volume="10", number="3", pages="e35879", keywords="mobile apps", keywords="behavior change", keywords="diet", keywords="healthy food", keywords="nutrition", keywords="prevention", keywords="mHealth", keywords="mobile health", keywords="lifestyle", keywords="French", abstract="Background: The global burden of disease attributes 20\% of deaths to poor nutrition. Although hundreds of nutrition-related mobile apps have been created, and these have been downloaded by millions of users, the effectiveness of these technologies on the adoption of healthy eating has had mixed Objective: The aim of this study was to review which nutrition-related mobile apps are currently available on the French market and assess their quality. Methods: We screened apps on the Google Play Store and the French Apple App Store, from March 10 to 17, 2021, to identify those related to nutritional health. A shortlist of 15 apps was identified, and each was assessed using the French version of the Mobile App Rating Scale: 8 dietitians and nutritionists assessed 7 apps, and the remaining apps were randomly allocated to ensure 4 assessments per app. Intraclass correlation was used to evaluate interrater agreement. Means and standard deviations of scores for each section and each item were calculated. Results: The top scores for overall quality were obtained by Yazio - R{\'e}gime et Calories (mean 3.84, SD 0.32), FeelEat (mean 3.71, SD 0.47), and Bonne App (mean 3.65, SD 0.09). Engagement scores ranged from a mean of 1.95 (SD 0.5) for iEatBetter: Journal alimentaire to a mean of 3.85 (SD 0.44) for FeelEat. Functionality scores ranged from a mean of 2.25 (SD 0.54) for Naor to a mean of 4.25 (SD 0.46) for Yazio. Aesthetics scores ranged from a mean of 2.17 (SD 0.34) for Naor to a mean of 3.88 (SD 0.47) for Yazio. Information scores ranged from a mean of 2.38 (SD 0.60) for iEatBetter to a mean of 3.73 (SD 0.29) for Yazio. Subjective quality scores ranged from a mean of 1.13 (SD 0.25) for iEatBetter to a mean of 2.28 (SD 0.88) for Compteur de calories FatSecret. Specificity scores ranged from a mean of 1.38 (SD 0.64) for iEatBetter to a mean of 3.50 (SD 0.91) for FeelEat. The app-specific score was always lower than the subjective quality score, which was always lower than the quality score, which was lower than the rating from the iOS or Android app stores. Conclusions: Although prevention and information messages in apps regarding nutritional habits are not scientifically verified before marketing, we found that app quality was good. Subjective quality and specificity were associated with lower ratings. Further investigations are needed to assess whether information from these apps is consistent with recommendations and to determine the long-term impacts of these apps on users. ", doi="10.2196/35879", url="https://mhealth.jmir.org/2022/3/e35879", url="http://www.ncbi.nlm.nih.gov/pubmed/35285817" } @Article{info:doi/10.2196/34894, author="Helminski, Danielle and Kurlander, E. Jacob and Renji, Deep Anjana and Sussman, B. Jeremy and Pfeiffer, N. Paul and Conte, L. Marisa and Gadabu, J. Oliver and Kokaly, N. Alex and Goldberg, Rebecca and Ranusch, Allison and Damschroder, J. Laura and Landis-Lewis, Zach", title="Dashboards in Health Care Settings: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="Mar", day="2", volume="11", number="3", pages="e34894", keywords="dashboard", keywords="mHealth", keywords="medical informatics", keywords="quality improvement", keywords="scoping review", keywords="health care", keywords="Cochrane library", keywords="Cochrane", keywords="stakeholder", keywords="health care sector", keywords="digital health", keywords="design", keywords="end user", keywords="development", keywords="implementation", keywords="evaluation", keywords="user need", abstract="Background: Health care organizations increasingly depend on business intelligence tools, including ``dashboards,'' to capture, analyze, and present data on performance metrics. Ideally, dashboards allow users to quickly visualize actionable data to inform and optimize clinical and organizational performance. In reality, dashboards are typically embedded in complex health care organizations with massive data streams and end users with distinct needs. Thus, designing effective dashboards is a challenging task and theoretical underpinnings of health care dashboards are poorly characterized; even the concept of the dashboard remains ill-defined. Researchers, informaticists, clinical managers, and health care administrators will benefit from a clearer understanding of how dashboards have been developed, implemented, and evaluated, and how the design, end user, and context influence their uptake and effectiveness. Objective: This scoping review first aims to survey the vast published literature of ``dashboards'' to describe where, why, and for whom they are used in health care settings, as well as how they are developed, implemented, and evaluated. Further, we will examine how dashboard design and content is informed by intended purpose and end users. Methods: In July 2020, we searched MEDLINE, Embase, Web of Science, and the Cochrane Library for peer-reviewed literature using a targeted strategy developed with a research librarian and retrieved 5188 results. Following deduplication, 3306 studies were screened in duplicate for title and abstract. Any abstracts mentioning a health care dashboard were retrieved in full text and are undergoing duplicate review for eligibility. Articles will be included for data extraction and analysis if they describe the development, implementation, or evaluation of a dashboard that was successfully used in routine workflow. Articles will be excluded if they were published before 2015, the full text is unavailable, they are in a non-English language, or they describe dashboards used for public health tracking, in settings where direct patient care is not provided, or in undergraduate medical education. Any discrepancies in eligibility determination will be adjudicated by a third reviewer. We chose to focus on articles published after 2015 and those that describe dashboards that were successfully used in routine practice to identify the most recent and relevant literature to support future dashboard development in the rapidly evolving field of health care informatics. Results: All articles have undergone dual review for title and abstract, with a total of 2019 articles mentioning use of a health care dashboard retrieved in full text for further review. We are currently reviewing all full-text articles in duplicate. We aim to publish findings by mid-2022. Findings will be reported following guidance from the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Conclusions: This scoping review will provide stakeholders with an overview of existing dashboard tools, highlighting the ways in which dashboards have been developed, implemented, and evaluated in different settings and for different end user groups, and identify potential research gaps. Findings will guide efforts to design and use dashboards in the health care sector more effectively. International Registered Report Identifier (IRRID): DERR1-10.2196/34894 ", doi="10.2196/34894", url="https://www.researchprotocols.org/2022/3/e34894", url="http://www.ncbi.nlm.nih.gov/pubmed/35234650" } @Article{info:doi/10.2196/28372, author="Della Vecchia, Claire and Leroy, Tanguy and Bauquier, Charlotte and Pannard, Myriam and Sarradon-Eck, Aline and Darmon, David and Dufour, Jean-Charles and Preau, Marie", title="Willingness of French General Practitioners to Prescribe mHealth Apps and Devices: Quantitative Study", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="11", volume="10", number="2", pages="e28372", keywords="mHealth", keywords="health applications", keywords="connected health and wellness devices", keywords="general practitioners", keywords="patients", keywords="prescription", keywords="quantitative study", keywords="mobile phone", abstract="Background: The field of mobile health (mHealth) is constantly expanding. Integrating mHealth apps and devices in clinical practice is a major and complex challenge. General practitioners (GPs) are an essential link in a patient's care pathway. As they are patients' preferred health care intermediaries, GPs play an important role in supporting patients' transition to mHealth. Objective: This study aims to identify the factors associated with the willingness of French GPs to prescribe mHealth apps and devices to their patients. Methods: This study was part of the ApiAppS project whose overall objective was to help remove barriers GPs face when prescribing mHealth apps and devices by developing a custom-built platform to aid them. The study included GPs recruited from the general practice department of several medical faculties in France (Lyon, Nice, and Rouen) and mailing lists of academic GPs, health care professional associations, and social and professional networks. Participants were asked to complete a web-based questionnaire that collected data on various sociodemographic variables, indicators of their involvement in continued education programs and the amount of time they dedicated to promoting healthy behaviors during patient consultations, and indicators characterizing their patient population. Data on their perceptions of mHealth apps and devices were also collected. Finally, the questionnaire included items to measure GPs' acceptability of prescribing mHealth apps and devices for several health-related dimensions. Results: Of the 174 GPs, 129 (74.1\%) declared their willingness to prescribe mHealth apps and devices to their patients. In multivariate analysis, involvement in continued education programs (odds ratio [OR] 6.17, 95\% CI 1.52-28.72), a better patient base command of the French language (OR 1.45, 95\% CI 1.13-1.88), GP-perceived benefits of mHealth apps and devices for both patients and their medical practice and GP-perceived drivers for mHealth apps and device implementation in their medical practice (OR 1.04, 95\% CI 1.01-1.07), and validation of mHealth apps and devices through randomized clinical trials (OR 1.02, 95\% CI 1.00-1.04) were all associated with GPs' willingness to prescribe mHealth apps and devices. In contrast, older GPs (OR 0.95, 95\% CI 0.91-0.98), female GPs (OR 0.26, 95\% CI 0.09-0.69), and those who perceived risks for the patient or their medical practice (OR 0.96, 95\% CI 0.94-0.99) were less inclined to prescribe mHealth apps and devices. Conclusions: mHealth apps and devices were generally seen by GPs as useful in general medicine and were, for the most part, favorable to prescribing them. Their full integration in general medicine will be conditioned by the need for conclusive certification, transparency (reliable and precise data concerning mHealth app and device methods of construction and clinical validation), software aids to assist GPs prescribe them, and dedicated training programs. ", doi="10.2196/28372", url="https://mhealth.jmir.org/2022/2/e28372", url="http://www.ncbi.nlm.nih.gov/pubmed/35147508" } @Article{info:doi/10.2196/31497, author="Aggarwal, Ravi and Visram, Sheena and Martin, Guy and Sounderajah, Viknesh and Gautama, Sanjay and Jarrold, Kevin and Klaber, Robert and Maxwell, Shona and Neal, John and Pegg, Jack and Redhead, Julian and King, Dominic and Ashrafian, Hutan and Darzi, Ara", title="Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care--Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="8", volume="10", number="2", pages="e31497", keywords="mHealth", keywords="implementation science", keywords="mobile technology", keywords="mobile apps", keywords="clinical applications", keywords="smartphone apps", keywords="health care industry", keywords="stakeholders", keywords="mobile phone", abstract="Background: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. Objective: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. Methods: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants' views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. Results: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. Conclusions: Despite partnering with one of the world's biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation. ", doi="10.2196/31497", url="https://mhealth.jmir.org/2022/2/e31497", url="http://www.ncbi.nlm.nih.gov/pubmed/35133287" } @Article{info:doi/10.2196/33413, author="Pit, Winona Sabrina and Tan, H. Aaron J. and Ramsden, Robyn and Payne, Kristy and Freihaut, Winona and Hayes, Oliver and Eames, Benjamin and Edwards, Mike and Colbran, Richard", title="Persuasive Design Solutions for a Sustainable Workforce: Review of Persuasive Apps for Real-Time Capability Support for Rural Health Care Professionals", journal="JMIR Mhealth Uhealth", year="2022", month="Feb", day="7", volume="10", number="2", pages="e33413", keywords="health", keywords="wellness", keywords="mobile apps", keywords="persuasive strategies", keywords="behavior change", keywords="review", keywords="health workforce", keywords="capability", keywords="career", keywords="employment", keywords="rural", keywords="workforce planning", abstract="Background: There is a need to further investigate how persuasive design principles can change rural health professionals' behaviors to look after their own health workforce capability. Several theories are used when developing apps to persuade people to change behavior, including the Persuasive System Design Model, consisting of primary task, dialogue, system credibility, and social support categories, and Cialdini's principles of persuasion. These have not been analyzed yet in the field of health workforce capability. Objective: This study aims to determine the persuasive design techniques used in capability building--related apps and to provide recommendations for designing a health workforce app to increase their persuasiveness. Methods: A Python script was used to extract a total of 3060 apps from Google Play. Keywords centered around health workforce capability elements. App inclusion criteria were as follows: been updated since 2019, rated by users on average 4 and above, and more than 100,000 downloads. Next, 2 experts reviewed whether 32 persuasive strategies were used in the selected apps, and these were further analyzed by capability categories: competencies and skills, health and personal qualities, values and attitudes, and work organization. Results: In all, 53 mobile apps were systematically reviewed to identify the persuasive design techniques. The most common were surface credibility (n=48, 90.6\%) and liking (n=48), followed by trustworthiness (n=43, 81.1\%), reminders (n=38, 71.7\%), and suggestion (n=30, 56.6\%). The techniques in the social support domain were the least used across the different apps analyzed for health workforce capability, whereas those in the primary task support domain were used most frequently. The recommendations reflect learnings from our analysis. These findings provided insight into mobile app design principles relevant to apps used in improving health workforce capability. Conclusions: Our review showed that there are many persuasive design techniques that can assist in building health workforce capability. Additionally, several apps are available in the market that can assist in improving health workforce capability. There is, however, a specific lack of digital, real-time support to improve health workforce capability. Social support strategies through using social support persuasive design techniques will need to be integrated more prominently into a health workforce capability app. An app to measure and monitor health workforce capability scores can be used in conjunction with direct real-world person and real-time support to discuss and identify solutions to improve health workforce capability for rural and remote health professionals who are at high risk of burnout or leaving the rural health workforce. ", doi="10.2196/33413", url="https://mhealth.jmir.org/2022/2/e33413", url="http://www.ncbi.nlm.nih.gov/pubmed/35129447" } @Article{info:doi/10.2196/28783, author="Savoy, April and Saleem, J. Jason and Barker, C. Barry and Patel, Himalaya and Kara, Areeba", title="Clinician Perspectives on Unmet Needs for Mobile Technology Among Hospitalists: Workflow Analysis Based on Semistructured Interviews", journal="JMIR Hum Factors", year="2022", month="Jan", day="4", volume="9", number="1", pages="e28783", keywords="electronic health records", keywords="hospital medicine", keywords="user-computer interface", keywords="human-computer interaction", keywords="usability", keywords="mental workload", keywords="workflow analysis", abstract="Background: The hospitalist workday is cognitively demanding and dominated by activities away from patients' bedsides. Although mobile technologies are offered as solutions, clinicians report lower expectations of mobile technology after actual use. Objective: The purpose of this study is to better understand opportunities for integrating mobile technology and apps into hospitalists' workflows. We aim to identify difficult tasks and contextual factors that introduce inefficiencies and characterize hospitalists' perspectives on mobile technology and apps. Methods: We conducted a workflow analysis based on semistructured interviews. At a Midwestern US medical center, we recruited physicians and nurse practitioners from hospitalist and inpatient teaching teams and internal medicine residents. Interviews focused on tasks perceived as frequent, redundant, and difficult. Additionally, participants were asked to describe opportunities for mobile technology interventions. We analyzed contributing factors, impacted workflows, and mobile app ideas. Results: Over 3 months, we interviewed 12 hospitalists. Participants collectively identified chart reviews, orders, and documentation as the most frequent, redundant, and difficult tasks. Based on those tasks, the intake, discharge, and rounding workflows were characterized as difficult and inefficient. The difficulty was associated with a lack of access to electronic health records at the bedside. Contributing factors for inefficiencies were poor usability and inconsistent availability of health information technology combined with organizational policies. Participants thought mobile apps designed to improve team communications would be most beneficial. Based on our analysis, mobile apps focused on data entry and presentation supporting specific tasks should also be prioritized. Conclusions: Based on our results, there are prioritized opportunities for mobile technology to decrease difficulty and increase the efficiency of hospitalists' workflows. Mobile technology and task-specific mobile apps with enhanced usability could decrease overreliance on hospitalists' memory and fragmentation of clinical tasks across locations. This study informs the design and implementation processes of future health information technologies to improve continuity in hospital-based medicine. ", doi="10.2196/28783", url="https://humanfactors.jmir.org/2022/1/e28783", url="http://www.ncbi.nlm.nih.gov/pubmed/34643530" } @Article{info:doi/10.2196/23236, author="Ogundaini, Oluwamayowa and de la Harpe, Retha", title="The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach", journal="JMIR Form Res", year="2022", month="Jan", day="4", volume="6", number="1", pages="e23236", keywords="agency", keywords="health care professionals", keywords="technology performativity", keywords="sub-Saharan Africa", keywords="service design", keywords="work activities", keywords="mobile phone", abstract="Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. ", doi="10.2196/23236", url="https://formative.jmir.org/2022/1/e23236", url="http://www.ncbi.nlm.nih.gov/pubmed/34982713" } @Article{info:doi/10.2196/26763, author="Wang, Hsiao-Han and Lin, Yu-Hsuan", title="Assessing Physicians' Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison", journal="J Med Internet Res", year="2021", month="Dec", day="24", volume="23", number="12", pages="e26763", keywords="smartphone", keywords="mobile app", keywords="work hours", keywords="recall bias", keywords="time perception", keywords="physicians", keywords="labor policy", abstract="Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians' well-being. Objective: The aim of this study was to estimate physicians' recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians' work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the ``Staff Hours'' app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by --8.97 (SD 8.60) hours and --6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=--0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=--0.119, P=.48). The percentage of hours not recalled (38.6\%) was significantly higher for the penultimate week (38.6\%) than for the first week (16.0\%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. ", doi="10.2196/26763", url="https://www.jmir.org/2021/12/e26763", url="http://www.ncbi.nlm.nih.gov/pubmed/34951600" } @Article{info:doi/10.2196/32660, author="Acharya, Amish and Judah, Gaby and Ashrafian, Hutan and Sounderajah, Viknesh and Johnstone-Waddell, Nick and Stevenson, Anne and Darzi, Ara", title="Investigating the Implementation of SMS and Mobile Messaging in Population Screening (the SIPS Study): Protocol for a Delphi Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="22", volume="10", number="12", pages="e32660", keywords="mobile messaging", keywords="digital communication", keywords="population screening", keywords="SMS", keywords="implementation", abstract="Background: The use of mobile messaging, including SMS, and web-based messaging in health care has grown significantly. Using messaging to facilitate patient communication has been advocated in several circumstances, including population screening. These programs, however, pose unique challenges to mobile communication, as messaging is often sent from a central hub to a diverse population with differing needs. Despite this, there is a paucity of robust frameworks to guide implementation. Objective: The aim of this protocol is to describe the methods that will be used to develop a guide for the principles of use of mobile messaging for population screening programs in England. Methods: This modified Delphi study will be conducted in two parts: evidence synthesis and consensus generation. The former will include a review of literature published from January 1, 2000, to October 1, 2021. This will elicit key themes to inform an online scoping questionnaire posed to a group of experts from academia, clinical medicine, industry, and public health. Thematic analysis of free-text responses by two independent authors will elicit items to be used during consensus generation. Patient and Public Involvement and Engagement groups will be convened to ensure that a comprehensive item list is generated that represents the public's perspective. Each item will then be anonymously voted on by experts as to its importance and feasibility of implementation in screening during three rounds of a Delphi process. Consensus will be defined a priori at 70\%, with items considered important and feasible being eligible for inclusion in the final recommendation. A list of desirable items (ie, important but not currently feasible) will be developed to guide future work. Results: The Institutional Review Board at Imperial College London has granted ethical approval for this study (reference 20IC6088). Results are expected to involve a list of recommendations to screening services, with findings being made available to screening services through Public Health England. This study will, thus, provide a formal guideline for the use of mobile messaging in screening services and will provide future directions in this field. Conclusions: The use of mobile messaging has grown significantly across health care services, especially given the COVID-19 pandemic, but its implementation in screening programs remains challenging. This modified Delphi approach with leading experts will provide invaluable insights into facilitating the incorporation of messaging into these programs and will create awareness of future developments in this area. International Registered Report Identifier (IRRID): PRR1-10.2196/32660 ", doi="10.2196/32660", url="https://www.researchprotocols.org/2021/12/e32660", url="http://www.ncbi.nlm.nih.gov/pubmed/34941542" } @Article{info:doi/10.2196/31541, author="Lowe, Cabella and Hanuman Sing, Harry and Marsh, William and Morrissey, Dylan", title="Validation of a Musculoskeletal Digital Assessment Routing Tool: Protocol for a Pilot Randomized Crossover Noninferiority Trial", journal="JMIR Res Protoc", year="2021", month="Dec", day="13", volume="10", number="12", pages="e31541", keywords="mHealth", keywords="mobile health", keywords="eHealth", keywords="digital health", keywords="digital technology", keywords="musculoskeletal", keywords="triage", keywords="physiotherapy triage", keywords="validation", keywords="mobile phone", abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on millions of patients and an increasing demand for health care use. Digital technologies to improve health care outcomes and efficiency are considered a priority; however, innovations are rarely tested with sufficient rigor in clinical trials, which is the gold standard for clinical proof of safety and efficacy. We have developed a new musculoskeletal digital assessment routing tool (DART) that allows users to self-assess and be directed to the right care. DART requires validation in a real-world setting before implementation. Objective: This pilot study aims to assess the feasibility of a future trial by exploring the key aspects of trial methodology, assessing the procedures, and collecting exploratory data to inform the design of a definitive randomized crossover noninferiority trial to assess DART safety and effectiveness. Methods: We will collect data from 76 adults with a musculoskeletal condition presenting to general practitioners within a National Health Service (NHS) in England. Participants will complete both a DART assessment and a physiotherapist-led triage, with the order determined by randomization. The primary analysis will involve an absolute agreement intraclass correlation (A,1) estimate with 95\% CI between DART and the clinician for assessment outcomes signposting to condition management pathways. Data will be collected to allow the analysis of participant recruitment and retention, randomization, allocation concealment, blinding, data collection process, and bias. In addition, the impact of trial burden and potential barriers to intervention delivery will be considered. The DART user satisfaction will be measured using the system usability scale. Results: A UK NHS ethics submission was done during June 2021 and is pending approval; recruitment will commence in early 2022, with data collection anticipated to last for 3 months. The results will be reported in a follow-up paper in 2022. Conclusions: This study will inform the design of a randomized controlled crossover noninferiority study that will provide evidence concerning mobile health DART system clinical signposting in an NHS setting before real-world implementation. Success should produce evidence of a safe, effective system with good usability, potentially facilitating quicker and easier patient access to appropriate care while reducing the burden on primary and secondary care musculoskeletal services. This rigorous approach to mobile health system testing could be used as a guide for other developers of similar applications. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): PRR1-10.2196/31541 ", doi="10.2196/31541", url="https://www.researchprotocols.org/2021/12/e31541", url="http://www.ncbi.nlm.nih.gov/pubmed/34898461" } @Article{info:doi/10.2196/34652, author="Castro, R. Aimee and Arnaert, Antonia and Moffatt, Karyn and Kildea, John and Bitzas, Vasiliki and Tsimicalis, Argerie", title="Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study", journal="JMIR Res Protoc", year="2021", month="Dec", day="13", volume="10", number="12", pages="e34652", keywords="respite care", keywords="caregivers", keywords="cancer", keywords="neoplasms", keywords="user-centered design", keywords="mobile applications", keywords="palliative care", keywords="home care services", keywords="information systems research framework", keywords="hospice and palliative care nursing", abstract="Background: Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective: The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Qu{\'e}bec, Canada. Methods: This user-centered design research comprises the core component of the iRespite Services iR{\'e}pit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results: We anticipate that preliminary results will be available by Spring 2022. Conclusions: An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Qu{\'e}bec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID): PRR1-10.2196/34652 ", doi="10.2196/34652", url="https://www.researchprotocols.org/2021/12/e34652", url="http://www.ncbi.nlm.nih.gov/pubmed/34898464" } @Article{info:doi/10.2196/31213, author="Greenstein, Jay and Topp, Robert and Etnoyer-Slaski, Jena and Staelgraeve, Michael and McNulty, John", title="Effect of a Mobile Health App on Adherence to Physical Health Treatment: Retrospective Analysis", journal="JMIR Rehabil Assist Technol", year="2021", month="Dec", day="2", volume="8", number="4", pages="e31213", keywords="adherence", keywords="self-discharge", keywords="phone app", keywords="physical therapy", keywords="chiropractor", keywords="mobile phone", abstract="Background: Adherence to prescribed medical interventions can predict the efficacy of the treatment. In physical health clinics, not adhering to prescribed therapy can take the form of not attending a scheduled clinic visit (no-show appointment) or prematurely terminating treatment against the advice of the provider (self-discharge). A variety of interventions, including mobile phone apps, have been introduced for patients to increase their adherence to attending scheduled clinic visits. Limited research has examined the impact of a mobile phone app among patients attending chiropractic and rehabilitation clinic visits. Objective: This study aims to compare adherence to prescribed physical health treatment among patients attending a chiropractic and rehabilitation clinic who did and did not choose to adopt a phone-based app to complement their treatment. Methods: The medical records of new patients who presented for care during 2019 and 2020 at 5 community-based chiropractic and rehabilitation clinics were reviewed for the number of kept and no-show appointments and to determine whether the patient was provider-discharged or self-discharged. During this 24-month study, 36.28\% (1497/4126) of patients seen in the targeted clinics had downloaded the Kanvas app on their mobile phone, whereas the remaining patients chose not to download the app (usual care group). The gamification component of the Kanvas app provided the patient with a point every time they attended their visits, which could be redeemed as an incentive. Results: During both 2019 and 2020, the Kanvas app group was provider-discharged at a greater rate than the usual care group. The Kanvas app group kept a similar number of appointments compared with the usual care group in 2019 but kept significantly more appointments than the usual care group in 2020. During 2019, both groups exhibited a similar number of no-show appointments; however, in 2020, the Kanvas app group demonstrated more no-show appointments than the usual care group. When collapsed across years and self-discharged, the Kanvas app group had a greater number of kept appointments compared with the usual care group. When provider-discharged, both groups exhibited a similar number of kept appointments. The Kanvas app group and the usual care group were similar in the number of no-show appointments when provider-discharged, and when self-discharged, the Kanvas app group had more no-show appointments compared with the usual care group. Conclusions: Patients who did or did not have access to the Kanvas app and were provider-discharged exhibited a similar number of kept appointments and no-show appointments. When patients were self-discharged and received the Kanvas app, they exhibited 3.2 more kept appointments and 0.94 more no-show appointments than the self-discharged usual care group. ", doi="10.2196/31213", url="https://rehab.jmir.org/2021/4/e31213", url="http://www.ncbi.nlm.nih.gov/pubmed/34655468" } @Article{info:doi/10.2196/31668, author="Nadav, Janna and Kaihlanen, Anu-Marja and Kujala, Sari and Laukka, Elina and Hilama, Pirjo and Koivisto, Juha and Keskim{\"a}ki, Ilmo and Heponiemi, Tarja", title="How to Implement Digital Services in a Way That They Integrate Into Routine Work: Qualitative Interview Study Among Health and Social Care Professionals", journal="J Med Internet Res", year="2021", month="Dec", day="1", volume="23", number="12", pages="e31668", keywords="digital services", keywords="implementation", keywords="health and social care professionals", keywords="integration", keywords="normalization process theory", keywords="interview", keywords="social work", keywords="health care", keywords="focus groups", abstract="Background: Although the COVID-19 pandemic has significantly boosted the implementation of digital services worldwide, it has become increasingly important to understand how these solutions are integrated into professionals' routine work. Professionals who are using the services are key influencers in the success of implementations. To ensure successful implementations, it is important to understand the multiprofessional perspective, especially because implementations are likely to increase even more. Objective: The aim of this study is to examine health and social care professionals' experiences of digital service implementations and to identify factors that support successful implementations and should be considered in the future to ensure that the services are integrated into professionals' routine work. Methods: A qualitative approach was used, in which 8 focus group interviews were conducted with 30 health and social care professionals from 4 different health centers in Finland. Data were analyzed using qualitative content analysis. The resulting categories were organized under the components of normalization process theory. Results: Our results suggested 14 practices that should be considered when implementing new digital services into routine work. To get professionals to understand and make sense of the new service, (1) the communication related to the implementation should be comprehensive and continuous and (2) the implementation process should be consistent. (3) A justification for the service being implemented should also be given. The best way to engage the professionals with the service is (4) to give them opportunities to influence and (5) to make sure that they have a positive attitude toward the service. To enact the new service into professionals' routine work, it is important that (6) the organization take a supportive approach by providing support from several easy and efficient sources. The professionals should also have (7) enough time to become familiar with the service, and they should have (8) enough know-how about the service. The training should be (9) targeted individually according to skills and work tasks, and (10) it should be diverse. The impact of the implementation on the professionals' work should be evaluated. The service (11) should be easy to use, and (12) usage monitoring should happen. An opportunity (13) to give feedback on the service should also be offered. Moreover, (14) the service should support professionals' work tasks. Conclusions: We introduce 14 practices for organizations and service providers on how to ensure sustainable implementation of new digital services and the smooth integration into routine work. It is important to pay more attention to comprehensive and continuing communication. Organizations should conduct a competence assessment before training in order to ensure proper alignment. Follow-ups to the implementation process should be performed to guarantee sustainability of the service. Our findings from a forerunner country of digitalization can be useful for countries that are beginning their service digitalization or further developing their digital services. ", doi="10.2196/31668", url="https://www.jmir.org/2021/12/e31668", url="http://www.ncbi.nlm.nih.gov/pubmed/34855610" } @Article{info:doi/10.2196/26597, author="Chudyk, M. Anna and Ragheb, Sandra and Kent, David and Duhamel, A. Todd and Hyra, Carole and Dave, G. Mudra and Arora, C. Rakesh and Schultz, SH Annette", title="Patient Engagement in the Design of a Mobile Health App That Supports Enhanced Recovery Protocols for Cardiac Surgery: Development Study", journal="JMIR Perioper Med", year="2021", month="Nov", day="30", volume="4", number="2", pages="e26597", keywords="cardiac surgery", keywords="perioperative care", keywords="enhanced recovery protocols", keywords="mobile app", keywords="smartphone app", keywords="mHealth", keywords="development", keywords="patient and public involvement", keywords="patient engagement in research", abstract="Background: Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective: The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods: Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results: The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions: Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users. ", doi="10.2196/26597", url="https://periop.jmir.org/2021/2/e26597", url="http://www.ncbi.nlm.nih.gov/pubmed/34851299" } @Article{info:doi/10.2196/33572, author="Nguyen, Anh Tuan and Tran, Kham and Esterman, Adrian and Brijnath, Bianca and Xiao, Dongxia Lily and Schofield, Penelope and Bhar, Sunil and Wickramasinghe, Nilmini and Sinclair, Ronald and Dang, Ha Thu and Cullum, Sarah and Turana, Yuda and Hinton, Ladson and Seeher, Katrin and Andrade, Q. Andre and Crotty, Maria and Kurrle, Susan and Freel, Stefanie and Pham, Thang and Nguyen, Binh Thanh and Brodaty, Henry", title="Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Nov", day="16", volume="10", number="11", pages="e33572", keywords="Dementia", keywords="informal carer", keywords="iSupport", keywords="virtual assistant", keywords="digital health", abstract="Background: Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). Objective: This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Methods: Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. Results: This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). Conclusions: This protocol outlines how a technologically enhanced version of the WHO iSupport program---the iSupport VA---will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz International Registered Report Identifier (IRRID): PRR1-10.2196/33572 ", doi="10.2196/33572", url="https://www.researchprotocols.org/2021/11/e33572", url="http://www.ncbi.nlm.nih.gov/pubmed/34783660" } @Article{info:doi/10.2196/25553, author="Moczygemba, R. Leticia and Thurman, Whitney and Tormey, Kyler and Hudzik, Anthony and Welton-Arndt, Lauren and Kim, Elizabeth", title="GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study", journal="JMIR Mhealth Uhealth", year="2021", month="Nov", day="3", volume="9", number="11", pages="e25553", keywords="GPS", keywords="mHealth", keywords="care coordination", keywords="people experiencing homelessness", keywords="homelessness", keywords="emergency department", keywords="health outcomes", keywords="health care costs", keywords="mobile phone", abstract="Background: People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. Objective: This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. Methods: This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. Results: In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67\%), White (17/30, 57\%), and not working (19/30, 63\%). Only 19\% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. Conclusions: mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. ", doi="10.2196/25553", url="https://mhealth.jmir.org/2021/11/e25553", url="http://www.ncbi.nlm.nih.gov/pubmed/34730550" } @Article{info:doi/10.2196/25777, author="Chirambo, Baxter Griphin and Thompson, Matthew and Hardy, Victoria and Ide, Nicole and Hwang, H. Phillip and Dharmayat, Kanika and Mastellos, Nikolaos and Heavin, Ciara and O'Connor, Yvonne and Muula, S. Adamson and Andersson, Bo and Carlsson, Sven and Tran, Tammy and Hsieh, Chen-Ling Jenny and Lee, Hsin-Yi and Fitzpatrick, Annette and Joseph Wu, Tsung-Shu and O'Donoghue, John", title="Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial", journal="J Med Internet Res", year="2021", month="Oct", day="20", volume="23", number="10", pages="e25777", keywords="community case management", keywords="mobile health", keywords="pediatrics", keywords="childhood infection", keywords="mobile phone", abstract="Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ?2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited---49.11\% (3421/6965) in the control phase and 50.88\% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95\% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95\% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95\% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 ", doi="10.2196/25777", url="https://www.jmir.org/2021/10/e25777", url="http://www.ncbi.nlm.nih.gov/pubmed/34668872" } @Article{info:doi/10.2196/26358, author="Ogundaini, Oaikhena Oluwamayowa and de la Harpe, Retha and McLean, Nyx", title="Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="13", volume="9", number="10", pages="e26358", keywords="mHealth", keywords="health care professionals", keywords="co-design", keywords="hospitals", keywords="ActAD model", keywords="work activity", keywords="Sub-Saharan Africa", keywords="referrals", keywords="VULA mobile app", keywords="WhatsApp", keywords="mobile phone", abstract="Background: There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle--income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings. Objective: This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, ``How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?'' Methods: A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model. Results: The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery. Conclusions: The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals. ", doi="10.2196/26358", url="https://mhealth.jmir.org/2021/10/e26358", url="http://www.ncbi.nlm.nih.gov/pubmed/34643540" } @Article{info:doi/10.2196/32301, author="Woo, MinJae and Mishra, Prabodh and Lin, Ju and Kar, Snigdhaswin and Deas, Nicholas and Linduff, Caleb and Niu, Sufeng and Yang, Yuzhe and McClendon, Jerome and Smith, Hudson D. and Shelton, L. Stephen and Gainey, E. Christopher and Gerard, C. William and Smith, C. Melissa and Griffin, F. Sarah and Gimbel, W. Ronald and Wang, Kuang-Ching", title="Complete and Resilient Documentation for Operational Medical Environments Leveraging Mobile Hands-free Technology in a Systems Approach: Experimental Study", journal="JMIR Mhealth Uhealth", year="2021", month="Oct", day="12", volume="9", number="10", pages="e32301", keywords="emergency medical services", keywords="prehospital documentation", keywords="speech recognition software", keywords="natural language processing", keywords="military medicine", keywords="documentation", keywords="development", keywords="challenge", keywords="paramedic", keywords="disruption", keywords="attention", keywords="medical information", keywords="audio", keywords="speech recognition", keywords="qualitative", keywords="simulation", abstract="Background: Prehospitalization documentation is a challenging task and prone to loss of information, as paramedics operate under disruptive environments requiring their constant attention to the patients. Objective: The aim of this study is to develop a mobile platform for hands-free prehospitalization documentation to assist first responders in operational medical environments by aggregating all existing solutions for noise resiliency and domain adaptation. Methods: The platform was built to extract meaningful medical information from the real-time audio streaming at the point of injury and transmit complete documentation to a field hospital prior to patient arrival. To this end, the state-of-the-art automatic speech recognition (ASR) solutions with the following modular improvements were thoroughly explored: noise-resilient ASR, multi-style training, customized lexicon, and speech enhancement. The development of the platform was strictly guided by qualitative research and simulation-based evaluation to address the relevant challenges through progressive improvements at every process step of the end-to-end solution. The primary performance metrics included medical word error rate (WER) in machine-transcribed text output and an F1 score calculated by comparing the autogenerated documentation to manual documentation by physicians. Results: The total number of 15,139 individual words necessary for completing the documentation were identified from all conversations that occurred during the physician-supervised simulation drills. The baseline model presented a suboptimal performance with a WER of 69.85\% and an F1 score of 0.611. The noise-resilient ASR, multi-style training, and customized lexicon improved the overall performance; the finalized platform achieved a medical WER of 33.3\% and an F1 score of 0.81 when compared to manual documentation. The speech enhancement degraded performance with medical WER increased from 33.3\% to 46.33\% and the corresponding F1 score decreased from 0.81 to 0.78. All changes in performance were statistically significant (P<.001). Conclusions: This study presented a fully functional mobile platform for hands-free prehospitalization documentation in operational medical environments and lessons learned from its implementation. ", doi="10.2196/32301", url="https://mhealth.jmir.org/2021/10/e32301", url="http://www.ncbi.nlm.nih.gov/pubmed/34636729" } @Article{info:doi/10.2196/31149, author="Alsahali, Saud", title="Awareness, Views, Perceptions, and Beliefs of Pharmacy Interns Regarding Digital Health in Saudi Arabia: Cross-sectional Study", journal="JMIR Med Educ", year="2021", month="Sep", day="3", volume="7", number="3", pages="e31149", keywords="digital health", keywords="eHealth", keywords="mHealth", keywords="telehealth", keywords="telemedicine", keywords="attitude", keywords="awareness", keywords="pharmacy interns", abstract="Background: Digital health technologies and apps are rapidly advancing in recent years. It is expected to have more roles in transforming the health care system in this era of digital services. However, limited research is available regarding delivering digital health education in pharmacy and the pharmacy students' perspectives on digital health. Objective: This study aims to assess pharmacy interns' awareness of digital health apps in Saudi Arabia and their views regarding the coverage of digital health in the education of pharmacists. In addition, we assessed the interns' perceptions and beliefs about the concepts, benefits, and implementation of digital health in practice settings. Methods: A cross-sectional study using a web-based survey was conducted among pharmacy interns at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. An invitation with a link to the web-based survey was sent to all interns registered at the college between January and March 2021. Results: A total of 68 out of 77 interns registered in the internship year participated in this study, giving a response rate of 88\%. The mean total score for pharmacy interns' awareness of digital health apps in Saudi Arabia was 5.66 (SD 1.74; maximum attainable score=7). The awareness with different apps ranged from 97\% (66/68) for the Tawakkalna app to 65\% (44/68) for the Ministry of Health 937 call center. The mean total score for attitude and beliefs toward concepts and benefits of telehealth and telemedicine apps was 58.25 (SD 10.44; maximum attainable score=75). In this regard, 84\% (57/68) of the interns believed that telehealth could enhance the quality of care, 71\% (48/68) believed that it could help effectively provide patient counseling, and 69\% (47/68) believed it could improve patients' adherence to therapy. In this study, 41\% (28/68) believed that the current coverage of digital health in the curriculum was average, whereas only 18\% (12/68) believed it was high or very high coverage. Moreover, only 38\% (26/68) attended additional educational activities related to digital health. Consequently, the majority (43/68, 63\%) were of the opinion that there is a high or very high need to educate and train pharmacists in the field of digital health. Conclusions: Overall, the interns showed good awareness of common digital health apps in Saudi Arabia. Moreover, the majority of the interns had positive perceptions and beliefs about the concepts, benefits, and implementation of digital health. However, the findings showed that there is still scope for improvement in some areas. Moreover, most interns indicated that there is a need for more education and training in the field of digital health. Consequently, early exposure to content related to digital health and pharmacy informatics is an important step to help in the wide use of these technologies in the graduates' future careers. ", doi="10.2196/31149", url="https://mededu.jmir.org/2021/3/e31149", url="http://www.ncbi.nlm.nih.gov/pubmed/34338649" } @Article{info:doi/10.2196/28245, author="Hettiachchi, Danula and Hayes, Lachie and Goncalves, Jorge and Kostakos, Vassilis", title="Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager", journal="JMIR Med Inform", year="2021", month="Aug", day="16", volume="9", number="8", pages="e28245", keywords="task assignment", keywords="smartphones", keywords="hospital communication", keywords="clinical workflows", keywords="mobile app", keywords="clinical platform", keywords="mHealth", abstract="Background: Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective: We seek to identify whether the structure of the collected communication data provides insights into hospitals' workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods: We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results: We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions: Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff. ", doi="10.2196/28245", url="https://medinform.jmir.org/2021/8/e28245", url="http://www.ncbi.nlm.nih.gov/pubmed/34398797" } @Article{info:doi/10.2196/17660, author="Grau-Corral, Inmaculada and Pantoja, Efrain Percy and Grajales III, J. Francisco and Kostov, Belchin and Aragunde, Valent{\'i}n and Puig-Soler, Marta and Roca, Daria and Couto, Elvira and Sis{\'o}-Almirall, Antoni", title="Assessing Apps for Health Care Workers Using the ISYScore-Pro Scale: Development and Validation Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jul", day="21", volume="9", number="7", pages="e17660", keywords="assessment", keywords="mobile app", keywords="mobile application", keywords="mHealth", keywords="health care professionals", keywords="mobile application rating scale", keywords="scale development", abstract="Background: The presence of mobile phone and smart devices has allowed for the use of mobile apps to support patient care. However, there is a paucity in our knowledge regarding recommendations for mobile apps specific to health care professionals. Objective: The aim of this study is to establish a validated instrument to assess mobile apps for health care providers and health systems. Our objective is to create and validate a tool that evaluates mobile health apps aimed at health care professionals based on a trust, utility, and interest scale. Methods: A five-step methodology framework guided our approach. The first step consisted of building a scale to evaluate apps for health care professionals based on a literature review. This was followed with expert panel validation through a Delphi method of (rated) web-based questionnaires to empirically evaluate the inclusion and weight of the indicators identified through the literature review. Repeated iterations were followed until a consensus greater than 75\% was reached. The scale was then tested using a pilot to assess reliability. Interrater agreement of the pilot was measured using a weighted Cohen kappa. Results: Using a literature review, a first draft of the scale was developed. This was followed with two Delphi rounds between the local research group and an external panel of experts. After consensus was reached, the resulting ISYScore-Pro 17-item scale was tested. A total of 280 apps were originally identified for potential testing (140 iOS apps and 140 Android apps). These were categorized using International Statistical Classification of Diseases, Tenth Revision. Once duplicates were removed and they were downloaded to confirm their specificity to the target audience (ie, health care professionals), 66 remained. Of these, only 18 met the final criteria for inclusion in validating the ISYScore-Pro scale (interrator reliabilty 92.2\%; kappa 0.840, 95\% CI 0.834-0.847; P<.001). Conclusions: We have developed a reproducible methodology to objectively evaluate mobile health apps targeted to health care professionals and providers, the ISYScore-Pro scale. Future research will be needed to adapt the scale to other languages and across other domains (eg, legal compliance or security). ", doi="10.2196/17660", url="https://mhealth.jmir.org/2021/7/e17660", url="http://www.ncbi.nlm.nih.gov/pubmed/34287216" } @Article{info:doi/10.2196/26582, author="Killian, Daniel and Gibson, Emma and Kachule, Mphatso and Palamountain, Kara and Bangoh, Bitilinyu Joseph and Deo, Sarang and Jonasson, Oddur Jonas", title="An Unstructured Supplementary Service Data System for Daily Tracking of Patient Samples and Diagnostic Results in a Diagnostic Network in Malawi: System Development and Field Trial", journal="J Med Internet Res", year="2021", month="Jul", day="6", volume="23", number="7", pages="e26582", keywords="diagnostic networks", keywords="mobile phone", keywords="sample transportation", keywords="sub-Saharan Africa", keywords="data collection", abstract="Background: Diagnostics in many low- and middle-income countries are conducted through centralized laboratory networks. Samples are collected from patients at remote point-of-care health facilities, and diagnostic tests are performed at centralized laboratories. Sample transportation systems that deliver diagnostic samples and test results are crucial for timely diagnosis and treatment in such diagnostic networks. However, they often lack the timely and accurate data (eg, the quantity and location of samples prepared for collection) required for efficient operation. Objective: This study aims to demonstrate the feasibility, adoption, and accuracy of a distributed data collection system that leverages basic mobile phone technology to gather reports on the quantity and location of patient samples and test results prepared for delivery in the diagnostic network of Malawi. Methods: We designed a system that leverages unstructured supplementary service data (USSD) technology to enable health workers to submit daily reports describing the quantity of transportation-ready diagnostic samples and test results at specific health care facilities, free of charge with any mobile phone, and aggregate these data for sample transportation administrators. We then conducted a year-long field trial of this system in 51 health facilities serving 3 districts in Malawi. Between July 2019 and July 2020, the participants submitted daily reports containing the number of patient samples or test results designated for viral load, early infant diagnosis, and tuberculosis testing at each facility. We monitored daily participation and compared the submitted USSD reports with program data to assess system feasibility, adoption, and accuracy. Results: The participating facilities submitted 37,771 reports over the duration of the field trial. Daily facility participation increased from an average of 50\% (26/51) in the first 2 weeks of the trial to approximately 80\% (41/51) by the midpoint of the trial and remained at or above 80\% (41/51) until the conclusion of the trial. On average, more than 80\% of the reports submitted by a facility for a specific type of sample matched the actual number of patient samples collected from that facility by a courier. Conclusions: Our findings suggest that a USSD-based system is a feasible, adoptable, and accurate solution to the challenges of untimely, inaccurate, or incomplete data in diagnostic networks. Certain design characteristics of our system, such as the use of USSD, and implementation characteristics, such as the supportive role of the field team, were necessary to ensure high participation and accuracy rates without any explicit financial incentives. ", doi="10.2196/26582", url="https://www.jmir.org/2021/7/e26582", url="http://www.ncbi.nlm.nih.gov/pubmed/34255690" } @Article{info:doi/10.2196/30621, author="Kim, S. Esther and Laird, Laura and Wilson, Carlee and Bieg, Till and Mildner, Philip and M{\"o}ller, Sebastian and Schatz, Raimund and Schwarz, Stephanie and Spang, Robert and Voigt-Antons, Jan-Niklas and Rochon, Elizabeth", title="Implementation and Effects of an Information Technology--Based Intervention to Support Speech and Language Therapy Among Stroke Patients With Aphasia: Protocol for a Virtual Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="2", volume="10", number="7", pages="e30621", keywords="aphasia", keywords="rehabilitation", keywords="speech-language pathology", keywords="app-based therapy", keywords="user-centered design", keywords="mHealth", keywords="adaptive software", abstract="Background: Mobile app--based therapies are increasingly being employed by speech-language pathologists in the rehabilitation of people with aphasia as adjuncts or substitutes for traditional in-person therapy approaches. These apps can increase the intensity of treatment and have resulted in meaningful outcomes across several domains. Objective: VoiceAdapt is a mobile therapy app designed with user and stakeholder feedback within a user-centered design framework. VoiceAdapt uses two evidence-based lexical retrieval treatments to help people with aphasia in improving their naming abilities through interactions with the app. The purpose of the randomized controlled trial (RCT) proposed here is to examine the feasibility and clinical efficacy of training with VoiceAdapt on the language and communication outcomes of people with aphasia. Methods: A multicenter RCT is being conducted at two locations within Canada. A total of 80 people with aphasia will be recruited to participate in a two-arm, waitlist-controlled, crossover group RCT. After baseline assessment, participants will be randomized into an intervention group or a waitlist control group. The intervention group participants will engage in 5 weeks of training with the app, followed by posttreatment and follow-up assessments after an additional 5 weeks. Those in the waitlist control group will have no training for 5 weeks; this is followed by pretreatment assessment, training for 5 weeks, and posttreatment assessment. All trial procedures are being conducted remotely given the COVID-19 pandemic. Results: Recruitment of participants started in September 2020, and the study is expected to be completed by March 2022. Publication of results is expected within 6 months of study completion. Conclusions: The results of the RCT will provide information on evidence-based practice using technology-based solutions to treat aphasia. If positive results are obtained from this RCT, the VoiceAdapt app can be recommended as an efficacious means of improving lexical retrieval and communicative functioning in people with aphasia in an easily accessible and a cost-effective manner. Moreover, the implementation of this RCT through remote assessment and delivery can provide information to therapists on telerehabilitation practices and monitoring of app-based home therapy programs. Trial Registration: ClinicalTrials.gov NCT04108364; https://clinicaltrials.gov/ct2/show/NCT04108364 International Registered Report Identifier (IRRID): DERR1-10.2196/30621 ", doi="10.2196/30621", url="https://www.researchprotocols.org/2021/7/e30621", url="http://www.ncbi.nlm.nih.gov/pubmed/34255727" } @Article{info:doi/10.2196/26262, author="Shen, Chunying and Jiang, Bin and Yang, Qilian and Wang, Chengnan and Lu, Z. Kevin and Gu, Meng and Yuan, Jing", title="Mobile Apps for Drug--Drug Interaction Checks in Chinese App Stores: Systematic Review and Content Analysis", journal="JMIR Mhealth Uhealth", year="2021", month="Jun", day="15", volume="9", number="6", pages="e26262", keywords="drug interaction", keywords="MARS", keywords="app", keywords="drug safety", keywords="drugs", keywords="mHealth", abstract="Background: As a computerized drug--drug interaction (DDI) alert system has not been widely implemented in China, health care providers are relying on mobile health (mHealth) apps as references for checking drug information, including DDIs. Objective: The main objective of this study was to evaluate the quality and content of mHealth apps supporting DDI checking in Chinese app stores. Methods: A systematic review was carried out in November 2020 to identify mHealth apps providing DDI checking in both Chinese iOS and Android platforms. We extracted the apps' general information (including the developer, operating system, costs, release date, size, number of downloads, and average rating), scientific or clinical basis, and accountability, based on a multidimensional framework for evaluation of apps. The quality of mHealth apps was evaluated by using the Mobile App Rating Scale (MARS). Descriptive statistics, including numbers and percentages, were calculated to describe the characteristics of the apps. For each app selected for evaluation, the section-specific MARS scores were calculated by taking the arithmetic mean, while the overall MARS score was described as the arithmetic mean of the section scores. In addition, the Cohen kappa ($\kappa$) statistic was used to evaluate the interrater agreement. Results: A total of 7 apps met the selection criteria, and only 3 included citations. The average rating score for Android apps was 3.5, with a minimum of 1.0 and a maximum of 4.9, while the average rating score for iOS apps was 4.7, with a minimum of 4.2 and a maximum of 4.9. The mean MARS score was 3.69 out of 5 (95\% CI 3.34-4.04), with the lowest score of 1.96 for Medication Guidelines and the highest score of 4.27 for MCDEX mobile. The greatest variation was observed in the information section, which ranged from 1.41 to 4.60. The functionality section showed the highest mean score of 4.05 (95\% CI 3.71-4.40), whereas the engagement section resulted in the lowest average score of 3.16 (95\% CI 2.81-3.51). For the information quality section, which was the focus of this analysis, the average score was 3.42, with the MCDEX mobile app having the highest score of 4.6 and the Medication Guidelines app having the lowest score of 1.9. For the overall MARS score, the Cohen interrater $\kappa$ was 0.354 (95\% CI 0.236-0.473), the Fleiss $\kappa$ was 0.353 (95\% CI, 0.234-0.472), and the Krippendorff $\alpha$ was 0.356 (95\% CI 0.237-0.475). Conclusions: This study systematically reviewed the mHealth apps in China with a DDI check feature. The majority of investigated apps demonstrated high quality with accurate and comprehensive information on DDIs. However, a few of the apps that had a massive number of downloads in the Chinese market provided incorrect information. Given these apps might be used by health care providers for checking potential DDIs, this creates a substantial threat to patient safety. ", doi="10.2196/26262", url="https://mhealth.jmir.org/2021/6/e26262", url="http://www.ncbi.nlm.nih.gov/pubmed/33962910" } @Article{info:doi/10.2196/28616, author="Milne-Ives, Madison and Lam, Ching and Rehman, Najib and Sharif, Raja and Meinert, Edward", title="Distributed Ledger Infrastructure to Verify Adverse Event Reporting (DeLIVER): Proposal for a Proof-of-Concept Study", journal="JMIR Res Protoc", year="2021", month="Jun", day="10", volume="10", number="6", pages="e28616", keywords="adverse drug reaction reporting systems", keywords="drug-related side effects and adverse reactions", keywords="blockchain", keywords="mobile applications", keywords="distributed ledger technology", abstract="Background: Adverse drug event reporting is critical for ensuring patient safety; however, numbers of reports have been declining. There is a need for a more user-friendly reporting system and for a means of verifying reports that have been filed. Objective: This project has 2 main objectives: (1) to identify the perceived benefits and barriers in the current reporting of adverse events by patients and health care providers and (2) to develop a distributed ledger infrastructure and user interface to collect and collate adverse event reports to create a comprehensive and interoperable database. Methods: A review of the literature will be conducted to identify the strengths and limitations of the current UK adverse event reporting system (the Yellow Card System). If insufficient information is found in this review, a survey will be created to collect data from system users. The results of these investigations will be incorporated into the development of a mobile and web app for adverse event reporting. A digital infrastructure will be built using distributed ledger technology to provide a means of linking reports with existing pharmaceutical tracking systems. Results: The key outputs of this project will be the development of a digital infrastructure, including a backend distributed ledger system and an app-based user interface. Conclusions: This infrastructure is expected to improve the accuracy and efficiency of adverse event reporting systems by enabling the monitoring of specific medicines or medical devices over their life course while protecting patients' personal health data. International Registered Report Identifier (IRRID): PRR1-10.2196/28616 ", doi="10.2196/28616", url="https://www.researchprotocols.org/2021/6/e28616", url="http://www.ncbi.nlm.nih.gov/pubmed/34110292" } @Article{info:doi/10.2196/14851, author="Rose, Christian and Nichols, Taylor and Hackner, Daniel and Chang, Julia and Straube, Steven and Jooste, Willem and Sawe, Hendry and Tenner, Andrea", title="Utilizing Lean Software Methods To Improve Acceptance of Global eHealth Initiatives: Results From the Implementation of the Basic Emergency Care App", journal="JMIR Form Res", year="2021", month="May", day="26", volume="5", number="5", pages="e14851", keywords="lean", keywords="eHealth", keywords="emergency", keywords="global health", keywords="app development", keywords="decision support", keywords="primary survey", keywords="mHealth", keywords="Africa", keywords="Tanzania", keywords="low- and middle income countries", keywords="LMIC", abstract="Background: Health systems in low- and middle-income countries face considerable challenges in providing high-quality accessible care. eHealth has had mounting interest as a possible solution given the unprecedented growth in mobile phone and internet technologies in these locations; however, few apps or software programs have, as of yet, gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to engage and meet local stakeholder needs and the high costs of software development. Objective: World Health Organization Basic Emergency Care course participants requested a mobile point-of-care adjunct to the primary course material. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees' reported needs and avoid some of the abovementioned failings. We aimed to use the well-described Lean software development strategy---given our familiarity with its elements and its ubiquitous use in medicine, global health, and software development---to complete this task efficiently and with maximal stakeholder involvement. Methods: From September 2016 through January 2017, the Basic Emergency Care app was designed and developed at the University of California San Francisco. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania---World Health Organization Basic Emergency Care partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of Basic Emergency Care course material. Results: Our user-centered mobile app was developed with an iterative participatory approach with its first version available within 6 months and with high acceptance---95\% of Basic Emergency Care Course participants felt that it was useful. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance and allows for efficient feedback and expansion. Conclusions: We believe that utilizing Lean software development strategies may help global health advocates and researchers build eHealth solutions with a process that is familiar and with buy-in across stakeholders that is responsive, rapid to deploy, and sustainable. ", doi="10.2196/14851", url="https://formative.jmir.org/2021/5/e14851", url="http://www.ncbi.nlm.nih.gov/pubmed/33882013" } @Article{info:doi/10.2196/29562, author="Clingan, A. Caroline and Dittakavi, Manasa and Rozwadowski, Michelle and Gilley, N. Kristen and Cislo, R. Christine and Barabas, Jenny and Sandford, Erin and Olesnavich, Mary and Flora, Christopher and Tyler, Jonathan and Mayer, Caleb and Stoneman, Emily and Braun, Thomas and Forger, B. Daniel and Tewari, Muneesh and Choi, Won Sung", title="Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study", journal="JMIR Res Protoc", year="2021", month="May", day="12", volume="10", number="5", pages="e29562", keywords="mobile health", keywords="app", keywords="mHealth", keywords="wearable", keywords="sensor", keywords="COVID-19", keywords="health care worker", keywords="frontline worker", keywords="smartphone", keywords="digital health", abstract="Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 ", doi="10.2196/29562", url="https://www.researchprotocols.org/2021/5/e29562", url="http://www.ncbi.nlm.nih.gov/pubmed/33945497" } @Article{info:doi/10.2196/25503, author="Sezgin, Emre and Noritz, Garey and Lin, Simon and Huang, Yungui", title="Feasibility of a Voice-Enabled Medical Diary App (SpeakHealth) for Caregivers of Children With Special Health Care Needs and Health Care Providers: Mixed Methods Study", journal="JMIR Form Res", year="2021", month="May", day="11", volume="5", number="5", pages="e25503", keywords="children with special health care needs", keywords="care management", keywords="care coordination", keywords="voice-enabled mobile app", keywords="health information technology", keywords="voice assistant", keywords="voice interaction", keywords="mobile phone", abstract="Background: Children with special health care needs (CSHCN) require more than the usual care management and coordination efforts from caregivers and health care providers (HCPs). Health information and communication technologies can potentially facilitate these efforts to increase the quality of care received by CSHCN. Objective: In this study, we aim to assess the feasibility of a voice-enabled medical diary app (SpeakHealth) by investigating its potential use among caregivers and HCPs. Methods: Following a mixed methods approach, caregivers of CSHCN were interviewed (n=10) and surveyed (n=86) about their care management and communication technology use. Only interviewed participants were introduced to the SpeakHealth app prototype, and they tested the app during the interview session. In addition, we interviewed complex care HCPs (n=15) to understand their perception of the value of a home medical diary such as the SpeakHealth app. Quantitative data were analyzed using descriptive statistics and correlational analyses. Theoretical thematic analysis was used to analyze qualitative data. Results: The survey results indicated a positive attitude toward voice-enabled technology and features; however, there was no strong correlation among the measured items. The caregivers identified communication, information sharing, tracking medication, and appointments as fairly and highly important features of the app. Qualitative analysis revealed the following two overarching themes: enablers and barriers in care communication and enablers and barriers in communication technologies. The subthemes included parent roles, care communication technologies, and challenges. HCPs found the SpeakHealth app to be a promising tool for timely information collection that could be available for sharing information with the health system. Overall, the findings demonstrated a variety of needs and challenges for caregivers of CSHCN and opportunities for voice-enabled, interactive medical diary apps in care management and coordination. Caregivers fundamentally look for better information sharing and communication with HCPs. Health care and communication technologies can potentially improve care communication and coordination in addressing the patient and caregiver needs. Conclusions: The perspectives of caregivers and providers suggested both benefits and challenges in using the SpeakHealth app for medical note-taking and tracking health events at home. Our findings could inform researchers and developers about the potential development and use of a voice-enabled medical diary app. ", doi="10.2196/25503", url="https://formative.jmir.org/2021/5/e25503", url="http://www.ncbi.nlm.nih.gov/pubmed/33865233" } @Article{info:doi/10.2196/21586, author="Noack, Maria Eva and Schulze, Jennifer and M{\"u}ller, Frank", title="Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process", journal="JMIR Mhealth Uhealth", year="2021", month="Apr", day="14", volume="9", number="4", pages="e21586", keywords="paramedic", keywords="interpreter", keywords="medical translation", keywords="application software", keywords="app", keywords="digital communication tool", keywords="foreign-language patients", keywords="language barrier", keywords="participatory design", keywords="prehospital emergency care", keywords="emergency medical service", abstract="Background: In emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented. Objective: We aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients. Methods: We actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field. Results: With input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history--taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive. Conclusions: The nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics' work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use. Trial Registration: German Clinical Trials Register DRKS00016719; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00016719 International Registered Report Identifier (IRRID): RR2-10.1186/s12913-020-05098-5 ", doi="10.2196/21586", url="https://mhealth.jmir.org/2021/4/e21586", url="http://www.ncbi.nlm.nih.gov/pubmed/33851933" } @Article{info:doi/10.2196/23450, author="North, Frederick and Nelson, M. Elissa and Majerus, J. Rebecca and Buss, J. Rebecca and Thompson, C. Matthew and Crum, A. Brian", title="Impact of Web-Based Self-Scheduling on Finalization of Well-Child Appointments in a Primary Care Setting: Retrospective Comparison Study", journal="JMIR Med Inform", year="2021", month="Mar", day="18", volume="9", number="3", pages="e23450", keywords="electronic health record", keywords="schedules", keywords="patient appointment", keywords="preventive health service", keywords="office visit", keywords="outpatient care", keywords="software tool", keywords="computer software application", keywords="mobile applications", keywords="child health", keywords="pediatric", keywords="preventive care", keywords="self", abstract="Background: Web-booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but self-scheduling of health care appointments on the web is not yet widely used. An electronic health record that integrates appointment scheduling and patient web-based access to medical records creates an opportunity for patient self-scheduling. The Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software-managed self-scheduling of well-child visits. Objective: This study aims to examine the use of a new self-scheduling appointment feature within POS in both web and mobile formats and determine the use characteristics, outcomes, and efficiency of self-scheduling compared with staff scheduling. Methods: Within a primary care setting, we collected 13 months of all appointment activity for the well-child visit for children aged 2-12 years. As these specific appointment types are for minors, self-scheduling is performed by parents or other proxies. We compared the appointment actions of scheduling and cancelling for both self-scheduled and staff-scheduled appointments. The frequency in which patients were using self-scheduling outside of normal business hours was quantified, and we compared no-show outcomes of finalized appointments. Results: Of the 1099 patients who performed any self-scheduling actions, 73.1\% (803/1099) exclusively used self-scheduling and self-cancelling software. For those with access to self-scheduling (patients registered with the Mayo Clinic POS), 4.92\% (1201/24,417) of all well-child appointment-scheduling actions were self-scheduled. Staff scheduling required more than a single appointment step (eg, schedule, cancel, reschedule) in 28.32\% (3729/13,168) compared with only 6.93\% (53/765) of self-scheduled appointments (P<.001). Self-scheduling appointment actions took place outside of regular business hours 29.5\% (354/1201) of the time. No-shows accounted for 3.07\% (28/912) of the self-scheduled finalized appointments compared with 4.12\% (693/16,828) of staff-scheduled appointments, which is a nonsignificant difference (P=.12). Staff-scheduled finalized appointments (that allowed for scheduling appointments for more than 12 weeks in the future) revealed a potential demand of 11.15\% (1876/16,828) for appointments with longer lead times. Conclusions: Self-scheduling can generate a significant number of finalized appointments, decreasing the need for staff scheduler time. We found that 29.5\% (354/1201) of the self-scheduling activity took place outside of the usual staff scheduler hours, adding convenience value to the scheduling process. For exclusive self-schedulers, 93.1\% (712/765) finalized the appointment in a single step. The no-show rates were not adversely affected by the self-scheduling. ", doi="10.2196/23450", url="https://medinform.jmir.org/2021/3/e23450", url="http://www.ncbi.nlm.nih.gov/pubmed/33734095" } @Article{info:doi/10.2196/24322, author="Almalki, Manal and Giannicchi, Anna", title="Health Apps for Combating COVID-19: Descriptive Review and Taxonomy", journal="JMIR Mhealth Uhealth", year="2021", month="Mar", day="2", volume="9", number="3", pages="e24322", keywords="app", keywords="COVID-19", keywords="corona", keywords="self-care", keywords="personal tracking", keywords="review", keywords="mHealth", keywords="track", keywords="surveillance", keywords="awareness", keywords="exposure", keywords="consumer health informatics", abstract="Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies' characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps' designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps' web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67\%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31\%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27\%), managing exposure to COVID-19 (6/29, 20\%), monitoring health by health care professionals (5/29, 17\%), and conducting research studies (1/29, 3.5\%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps' effectiveness and from governmental organizations to increase public awareness of these digital solutions. ", doi="10.2196/24322", url="https://mhealth.jmir.org/2021/3/e24322", url="http://www.ncbi.nlm.nih.gov/pubmed/33626017" } @Article{info:doi/10.2196/24452, author="Anyanwu, C. Emeka and Ward, Parker R. and Shah, Atman and Arora, Vineet and Umscheid, A. Craig", title="A Mobile App to Facilitate Socially Distanced Hospital Communication During COVID-19: Implementation Experience", journal="JMIR Mhealth Uhealth", year="2021", month="Feb", day="23", volume="9", number="2", pages="e24452", keywords="adoption", keywords="communication", keywords="COVID-19", keywords="hospital", keywords="inpatient", keywords="mHealth", keywords="mobile app", keywords="telemedicine", abstract="Background: COVID-19 has significantly altered health care delivery, requiring clinicians and hospitals to adapt to rapidly changing hospital policies and social distancing guidelines. At our large academic medical center, clinicians reported that existing information on distribution channels, including emails and hospital intranet posts, was inadequate to keep everyone abreast with these changes. To address these challenges, we adapted a mobile app developed in-house to communicate critical changes in hospital policies and enable direct telephonic communication between clinical team members and hospitalized patients, to support social distancing guidelines and remote rounding. Objective: This study aimed to describe the unique benefits and challenges of adapting an app developed in-house to facilitate communication and remote rounding during COVID-19. Methods: We adapted moblMD, a mobile app available on the iOS and Android platforms. In conjunction with our Hospital Incident Command System, resident advisory council, and health system innovation center, we identified critical, time-sensitive policies for app usage. A shared collaborative document was used to align app-based communication with more traditional communication channels. To minimize synchronization efforts, we particularly focused on high-yield policies, and the time of last review and the corresponding reviewer were noted for each protocol. To facilitate social distancing and remote patient rounding, the app was also populated with a searchable directory of numbers to patient bedside phones and hospital locations. We monitored anonymized user activity from February 1 to July 31, 2020. Results: On its first release, 1104 clinicians downloaded moblMD during the observation period, of which 46\% (n=508) of downloads occurred within 72 hours of initial release. COVID-19 policies in the app were reviewed most commonly during the first week (801 views). Users made sustained use of hospital phone dialing features, including weekly peaks of 2242 phone number dials, 1874 directory searches, and 277 patient room phone number searches through the last 2 weeks of the observation period. Furthermore, clinicians submitted 56 content- and phone number--related suggestions through moblMD. Conclusions: We rapidly developed and deployed a communication-focused mobile app early during COVID-19, which has demonstrated initial and sustained value among clinicians in communicating with in-patients and each other during social distancing. Our internal innovation benefited from our team's familiarity with institutional structures, short feedback loops, limited security and privacy implications, and a path toward sustainability provided by our innovation center. Challenges in content management were overcome through synchronization efforts and timestamping review. As COVID-19 continues to alter health care delivery, user activity metrics suggest that our solution will remain important in our efforts to continue providing safe and up-to-date clinical care. ", doi="10.2196/24452", url="https://mhealth.jmir.org/2021/2/e24452", url="http://www.ncbi.nlm.nih.gov/pubmed/33513562" } @Article{info:doi/10.2196/22135, author="de Batlle, Jordi and Massip, Mireia and Vargiu, Eloisa and Nadal, Nuria and Fuentes, Araceli and Ortega Bravo, Marta and Miralles, Felip and Barb{\'e}, Ferran and Torres, Gerard and ", title="Implementing Mobile Health--Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study", journal="JMIR Mhealth Uhealth", year="2021", month="Jan", day="14", volume="9", number="1", pages="e22135", keywords="chronic disease", keywords="cost-benefit analysis", keywords="delivery of health care, integrated", keywords="mHealth", keywords="eHealth", keywords="quality of life", abstract="Background: Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective: The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods: As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results: A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57\% less unplanned visits (P=.004) and 50\% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions: The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care. ", doi="10.2196/22135", url="https://mhealth.jmir.org/2021/1/e22135", url="http://www.ncbi.nlm.nih.gov/pubmed/33443486" } @Article{info:doi/10.2196/20482, author="Alon, Noy and Stern, Dora Ariel and Torous, John", title="Assessing the Food and Drug Administration's Risk-Based Framework for Software Precertification With Top Health Apps in the United States: Quality Improvement Study", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="26", volume="8", number="10", pages="e20482", keywords="mobile health", keywords="smartphone", keywords="Food and Drug Administration", keywords="software", keywords="mobile phone", abstract="Background: As the development of mobile health apps continues to accelerate, the need to implement a framework that can standardize the categorization of these apps to allow for efficient yet robust regulation is growing. However, regulators and researchers are faced with numerous challenges, as apps have a wide variety of features, constant updates, and fluid use cases for consumers. As past regulatory efforts have failed to match the rapid innovation of these apps, the US Food and Drug Administration (FDA) has proposed that the Software Precertification (Pre-Cert) Program and a new risk-based framework could be the solution. Objective: This study aims to determine whether the risk-based framework proposed by the FDA's Pre-Cert Program could standardize categorization of top health apps in the United States. Methods: In this quality improvement study during summer 2019, the top 10 apps for 6 disease conditions (addiction, anxiety, depression, diabetes, high blood pressure, and schizophrenia) in Apple iTunes and Android Google Play Store in the United States were classified using the FDA's risk-based framework. Data on the presence of well-defined app features, user engagement methods, popularity metrics, medical claims, and scientific backing were collected. Results: The FDA's risk-based framework classifies an app's risk by the disease condition it targets and what information that app provides. Of the 120 apps tested, 95 apps were categorized as targeting a nonserious health condition, whereas only 7 were categorized as targeting a serious condition and 18 were categorized as targeting a critical condition. As the majority of apps targeted a nonserious condition, their risk categorization was largely determined by the information they provided. The apps that were assessed as not requiring FDA review were more likely to be associated with the integration of external devices than those assessed as requiring FDA review (15/58, 26\% vs 5/62, 8\%; P=.03) and health information collection (24/58, 41\% vs 9/62, 15\%; P=.008). Apps exempt from the review were less likely to offer health information (25/58, 43\% vs 45/62, 72\%; P<.001), to connect users with professional care (7/58, 12\% vs 14/62, 23\%; P=.04), and to include an intervention (8/58, 14\% vs 35/62, 55\%; P<.001). Conclusions: The FDA's risk-based framework has the potential to improve the efficiency of the regulatory review process for health apps. However, we were unable to identify a standard measure that differentiated apps requiring regulatory review from those that would not. Apps exempt from the review also carried concerns regarding privacy and data security. Before the framework is used to assess the need for a formal review of digital health tools, further research and regulatory guidance are needed to ensure that the Pre-Cert Program operates in the greatest interest of public health. ", doi="10.2196/20482", url="http://mhealth.jmir.org/2020/10/e20482/", url="http://www.ncbi.nlm.nih.gov/pubmed/32927429" } @Article{info:doi/10.2196/16485, author="Crehan, Caroline and Kesler, Erin and Chikomoni, Angela Indira and Sun, Kristi and Dube, Queen and Lakhanpaul, Monica and Heys, Michelle", title="Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit", journal="JMIR Mhealth Uhealth", year="2020", month="Oct", day="21", volume="8", number="10", pages="e16485", keywords="infant, newborn", keywords="mHealth", keywords="data collection", keywords="clinical audit", keywords="digital health", keywords="low income population", keywords="mobile phone", abstract="Background: Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. Objective: This study aims to examine 1 month's data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. Methods: Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. Results: Of 191 total admissions, 134 (70.2\%) admissions were completed using NeoTree, and 129 (67.5\%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3\%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25\% (3/12), 58\% (7/12), and 8\% (1/12) of deaths, respectively. Data were more than 90\% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. Conclusions: This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings. ", doi="10.2196/16485", url="https://mhealth.jmir.org/2020/10/e16485", url="http://www.ncbi.nlm.nih.gov/pubmed/33084581" } @Article{info:doi/10.2196/21881, author="Wilson, Rozanne and Small, Jeff", title="Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study", journal="JMIR Nursing", year="2020", month="Sep", day="29", volume="3", number="1", pages="e21881", keywords="mobile apps", keywords="mobile phone", keywords="caregivers", keywords="dementia", keywords="communication", keywords="patient care", abstract="Background: Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents. Objective: This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents. Methods: This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays. Results: Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC. Conclusions: This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care. ", doi="10.2196/21881", url="https://nursing.jmir.org/2020/1/e21881/", url="http://www.ncbi.nlm.nih.gov/pubmed/34406973" } @Article{info:doi/10.2196/18414, author="Zaidi, Shehla and Kazi, Momin Abdul and Riaz, Atif and Ali, Ammarah and Najmi, Rabia and Jabeen, Rawshan and Khudadad, Umerdad and Sayani, Saleem", title="Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study", journal="J Med Internet Res", year="2020", month="Sep", day="17", volume="22", number="9", pages="e18414", keywords="mHealth", keywords="community health workers", keywords="usability", keywords="usefulness", keywords="task-technology fit", abstract="Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology. ", doi="10.2196/18414", url="http://www.jmir.org/2020/9/e18414/", url="http://www.ncbi.nlm.nih.gov/pubmed/32940612" } @Article{info:doi/10.2196/20848, author="Lee, Seohyun and Kim, Eunji and Desta, Birhane Tekaligne", title="Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="8", volume="8", number="9", pages="e20848", keywords="team communication", keywords="health extension workers", keywords="mobile communication", keywords="mobile data collection", keywords="Ethiopia", keywords="health worker", keywords="communication", keywords="data", abstract="Background: In Ethiopia, health extension workers (HEWs) are deployed across the country by the government to meet public health needs. Team communication is important for effective teamwork, but community health workers in low-resource settings like Ethiopia may face challenges in carrying out team meetings to compile service statistics. This is due to the nature of their outreach activities, which requires extensive travel. Objective: This study aimed to identify gaps in team communication about service statistics among HEWs in Ethiopia. Considering mobile communication and data collection as tools for bridging these gaps, we examined disparities in access to electricity, which has been identified as one of the major barriers to this approach. Methods: Data from the most recent Performance Monitoring and Accountability 2020 service delivery point survey were used for our analysis. Logistic regression analysis was performed to identify disparities in team communication on service statistics for family planning, which is a major component of the HEW's job. Disparities were examined across health facilities with different levels of HEW integration in their staffing structure (ie, no HEWs, at least one HEW, or only HEWs). Additionally, a chi-square test was conducted to examine disparities in access to electricity to explore the potential of mobile communication and data collection integration. Results: In total, 427 health facilities of four different types (ie, hospitals, health centers, health posts, and health clinics) were included in our analysis. At most health posts (84/95, 88\%), only HEWs were employed; none of the health clinics integrated the HEW model into their staffing structure. Among the 84 health posts, the odds of having team meetings on family planning service statistics in the past 12 months were 0.48 times the odds of those without HEWs (P=.02). No statistically significant differences were found between HEW-only facilities and facilities with at least one HEW. Most health facilities (69/83, 83.13\%) with HEWs as the only staff had no electricity at the time of the survey while 71.25\% (57/80) had intermittent access (ie, service disruption lasting 2 or more hours that day). There were statistically significant differences in electricity access among health facilities with different levels of HEW integration (P<.001). Conclusions: Facilities employing only HEWs were less likely to have regular team meetings to discuss service statistics. Since their responsibilities involve extensive outreach activities, travel, and paper-based recordkeeping, empowering HEWs with mobile communication and data collection can be a workable solution. The empirical evidence regarding disparities in electricity access also supports the need for and the feasibility of this approach. ", doi="10.2196/20848", url="http://mhealth.jmir.org/2020/9/e20848/", url="http://www.ncbi.nlm.nih.gov/pubmed/32897231" } @Article{info:doi/10.2196/20025, author="Windisch, Olivier and Zamberg, Ido and Zanella, Marie-C{\'e}line and Gayet-Ageron, Ang{\`e}le and Blondon, Katherine and Schiffer, Eduardo and Agoritsas, Thomas", title="Using mHealth to Increase the Reach of Local Guidance to Health Professionals as Part of an Institutional Response Plan to the COVID-19 Outbreak: Usage Analysis Study", journal="JMIR Mhealth Uhealth", year="2020", month="Aug", day="19", volume="8", number="8", pages="e20025", keywords="COVID-19", keywords="smartphone", keywords="mHealth", keywords="information dissemination", keywords="health professionals", keywords="health administration", keywords="health apps", abstract="Background: The ongoing coronavirus disease (COVID-19) pandemic forced health jurisdictions worldwide to significantly restructure and reorganize their medical activities. In response to the rapidly evolving body of evidence, a solid communication strategy is needed to increase the reach of and adherence to locally drafted and validated guidance to aide medical staff with COVID-19--related clinical decisions. Objective: We present a usage analysis of a dedicated mobile health (mHealth) platform as part of an institutional knowledge dissemination strategy of COVID-19--related guidance to all health care workers (HCWs) in a large academic hospital. Methods: A multidisciplinary team of experts drafted local guidance related to COVID-19. In total, 60 documents and 17 external links were made available through the platform. Documents were disseminated using a recently deployed mHealth platform for HCWs. Targeted dissemination of COVID-19--related content began on March 22, 2020. Using a third-party statistics tool, data concerning user activity and content use was anonymously collected. A quantitative analysis of user activity was performed over a 4-month period, separated into 3 periods: 2 months before (Period A), 2 weeks after (Period B), and 6 weeks following (Period C) targeted dissemination. Regional epidemiological data (daily new COVID-19 cases and total COVID-19--related hospitalizations) was extracted from an official registry. Results: During the study period, the platform was downloaded by 1233 new users. Consequently, the total number of users increased from 1766 users before Period A to a total of 2999 users at the end of Period C. We observed 27,046 document views, of which 12,728 (47.1\%) were COVID-19--related. The highest increase in activity occurred in Period B, rapidly following targeted dissemination, with 7740 COVID-19--related content views, representing 71.2\% of total content views within the abovementioned period and 550 daily views of COVID-19--related documents. Total documents consulted per day increased from 117 (IQR 74-160) to 657 (IQR 481-1051), P<.001. This increase in activity followed the epidemiological curbing of newly diagnosed COVID-19 cases, which peaked during Period B. Total active devices doubled from 684 to 1400, daily user activity increased fourfold, and the number of active devices rose from 53 (IQR 40-70) to 210 (IQR 167-297), P<.001. In addition, the number of sessions per day rose from 166 (IQR 110-246) to 704 (IQR 517-1028), P<.001. A persistent but reduced increase in total documents consulted per day (172 [IQR 131-251] versus 117 [IQR 74-160], P<.001) and active devices (71 [IQR 64-89] versus 53 [IQR 40-70]) was observed in Period C compared to Period A, while only 29.8\% of the content accessed was COVID-19--related. After targeted dissemination, an immediate increase in activity was observed after push notifications were sent to users. Conclusions: The use of an mHealth solution to disseminate time-sensitive medical knowledge seemed to be an effective solution to increase the reach of validated content to a targeted audience. ", doi="10.2196/20025", url="http://mhealth.jmir.org/2020/8/e20025/", url="http://www.ncbi.nlm.nih.gov/pubmed/32749996" } @Article{info:doi/10.2196/17447, author="Byambasuren, Oyungerel and Beller, Elaine and Hoffmann, Tammy and Glasziou, Paul", title="Barriers to and Facilitators of the Prescription of mHealth Apps in Australian General Practice: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="30", volume="8", number="7", pages="e17447", keywords="mobile apps", keywords="mHealth", keywords="apps", keywords="app prescription", keywords="general practice", abstract="Background: The ubiquity of smartphones and health apps make them a potential self-management tool for patients that could be prescribed by medical professionals. However, little is known about how Australian general practitioners and their patients view the possibility of prescribing mobile health (mHealth) apps as a nondrug intervention. Objective: This study aimed to determine barriers and facilitators to prescribing mHealth apps in Australian general practice from the perspective of general practitioners and their patients. Methods: We conducted semistructured interviews in Australian general practice settings with purposively sampled general practitioners and patients. The audio-recorded interviews were transcribed, coded, and thematically analyzed by two researchers. Results: Interview participants included 20 general practitioners and 15 adult patients. General practitioners' perceived barriers to prescribing apps included a generational difference in the digital propensity for providers and patients; lack of knowledge of prescribable apps and trustworthy sources to access them; the time commitment required of providers and patients to learn and use the apps; and concerns about privacy, safety, and trustworthiness of health apps. General practitioners perceived facilitators as trustworthy sources to access prescribable apps and information, and younger generation and widespread smartphone ownership. For patients, the main barriers were older age and usability of mHealth apps. Patients were not concerned about privacy and data safety issues regarding health app use. Facilitators for patients included the ubiquity of smartphones and apps, especially for the younger generation and recommendation of apps by doctors. We identified evidence of effectiveness as an independent theme from both the provider and patient perspectives. Conclusions: mHealth app prescription appears to be feasible in general practice. The barriers and facilitators identified by the providers and patients overlapped, though privacy was of less concern to patients. The involvement of health professionals and patients is vital for the successful integration of effective, evidence-based mHealth apps with clinical practice. ", doi="10.2196/17447", url="http://mhealth.jmir.org/2020/7/e17447/", url="http://www.ncbi.nlm.nih.gov/pubmed/32729839" } @Article{info:doi/10.2196/18413, author="Scherr, Foster Thomas and Moore, Paige Carson and Thuma, Philip and Wright, Wilson David", title="Evaluating Network Readiness for mHealth Interventions Using the Beacon Mobile Phone App: Application Development and Validation Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="28", volume="8", number="7", pages="e18413", keywords="mHealth", keywords="network readiness", keywords="network assessment", keywords="mobile network", abstract="Background: Mobile health (mHealth) interventions have the potential to transform the global health care landscape. The processing power of mobile devices continues to increase, and growth of mobile phone use has been observed worldwide. Uncertainty remains among key stakeholders and decision makers as to whether global health interventions can successfully tap into this trend. However, when correctly implemented, mHealth can reduce geographic, financial, and social barriers to quality health care. Objective: The aim of this study was to design and test Beacon, a mobile phone--based tool for evaluating mHealth readiness in global health interventions. Here, we present the results of an application validation study designed to understand the mobile network landscape in and around Macha, Zambia, in 2019. Methods: Beacon was developed as an automated mobile phone app that continually collects spatiotemporal data and measures indicators of network performance. Beacon was used in and around Macha, Zambia, in 2019. Results were collected, even in the absence of network connectivity, and asynchronously uploaded to a database for further analysis. Results: Beacon was used to evaluate three mobile phone networks around Macha. Carriers A and B completed 6820/7034 (97.0\%) and 6701/7034 (95.3\%) downloads and 1349/1608 (83.9\%) and 1431/1608 (89.0\%) uploads, respectively, while Carrier C completed only 62/1373 (4.5\%) file downloads and 0/1373 (0.0\%) file uploads. File downloads generally occurred within 4 to 12 seconds, and their maximum download speeds occurred between 2 AM and 5 AM. A decrease in network performance, demonstrated by increases in upload and download durations, was observed beginning at 5 PM and continued throughout the evening. Conclusions: Beacon was able to compare the performance of different cellular networks, show times of day when cellular networks experience heavy loads and slow down, and identify geographic ``dead zones'' with limited or no cellular service. Beacon is a ready-to-use tool that could be used by organizations that are considering implementing mHealth interventions in low- and middle-income countries but are questioning the feasibility of the interventions, including infrastructure and cost. It could also be used by organizations that are looking to optimize the delivery of an existing mHealth intervention with improved logistics management. ", doi="10.2196/18413", url="http://mhealth.jmir.org/2020/7/e18413/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720909" } @Article{info:doi/10.2196/11627, author="Kan, Wei-Chih and Kuo, Shu-Chun and Chien, Tsair-Wei and Lin, John Jui-Chung and Yeh, Yu-Tsen and Chou, Willy and Chou, Po-Hsin", title="Therapeutic Duplication in Taiwan Hospitals for Patients With High Blood Pressure, Sugar, and Lipids: Evaluation With a Mobile Health Mapping Tool", journal="JMIR Med Inform", year="2020", month="Jul", day="27", volume="8", number="7", pages="e11627", keywords="duplicate medication", keywords="mHealth", keywords="hypertension", keywords="high blood sugar", keywords="high blood lipid", abstract="Background: Cardiovascular disease causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids (hyperlipidemia) have attracted substantial attention regarding the abuse of health care resources and to implement preventive measures for such abuse. Duplicative prescriptions may occur by patients receiving redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient's wandering among hospitals. Objective: We evaluated the degree of duplicative prescriptions in Taiwanese hospitals for outpatients with three types of medications (antihypertension, antihyperglycemia, and antihyperlipidemia), and then used an online dashboard based on mobile health (mHealth) on a map to determine whether the situation has improved in the recent 25 fiscal quarters. Methods: Data on duplicate prescription rates of drugs for the three conditions were downloaded from the website of Taiwan's National Health Insurance Administration (TNHIA) from the third quarter of 2010 to the third quarter of 2016. Complete data on antihypertension, antihyperglycemia, and antihyperlipidemia prescriptions were obtained from 408, 414, and 359 hospitals, respectively. We used scale quality indicators to assess the attributes of the study data, created a dashboard that can be traced using mHealth, and selected the hospital type with the best performance regarding improvement on duplicate prescriptions for the three types of drugs using the weighted scores on an online dashboard. Kendall coefficient of concordance (W) was used to evaluate whether the performance rankings were unanimous. Results: The data quality was found to be acceptable and showed good reliability and construct validity. The online dashboard using mHealth on Google Maps allowed for easy and clear interpretation of duplicative prescriptions regarding hospital performance using multidisciplinary functionalities, and showed significant improvement in the reduction of duplicative prescriptions among all types of hospitals. Medical centers and regional hospitals showed better performance with improvement in the three types of duplicative prescriptions compared with the district hospitals. Kendall W was 0.78, indicating that the performance rankings were not unanimous (Chi square2=4.67, P=.10). Conclusions: This demonstration of a dashboard using mHealth on a map can inspire using the 42 other quality indicators of the TNHIA by hospitals in the future. ", doi="10.2196/11627", url="https://medinform.jmir.org/2020/7/e11627", url="http://www.ncbi.nlm.nih.gov/pubmed/32716306" } @Article{info:doi/10.2196/16971, author="McMahon, Joy Emma and Jaenke, Rachael and Brimblecombe, Julie", title="A Mobile App to Rapidly Appraise the In-Store Food Environment: Reliability, Utility, and Construct Validity Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e16971", keywords="mobile apps", keywords="reliability and validity", keywords="food", keywords="diet", keywords="environment and public health", abstract="Background: Consumer food environments are increasingly being recognized as influential determinants of food purchasing and subsequent intake and health. We developed a tool to enable efficient, but relatively comprehensive, appraisal of the in-store food environment. The Store Scout mobile app facilitates the evaluation of product (availability and range), placement (visibility, accessibility, proximity to high-traffic areas, and location relative to other products), price (price promotion), and promotion (displays and advertising) across 7 categories of food products, with appraisal given immediately as scores (0-100, where a higher score is more in line with best practice). Primary end users are public health nutritionists and nutritionists employed by store organizations; however, store managers and staff are also potential end users. Objective: This study aims to evaluate the reliability (interrater reliability and internal consistency), utility (distribution of scores), and construct validity (score by store type) of measurements using the Store Scout mobile app. Methods: The Store Scout mobile app was used independently by 2 surveyors to evaluate the store environment in 54 stores: 34 metropolitan stores (9 small and 11 large supermarkets, 10 convenience stores, and 4 petrol stations) in Brisbane, Australia, and 20 remote stores (19 small supermarkets and 1 petrol station) in Indigenous Australian communities in Northern Australia. The agreement between surveyors in the overall and category scores was evaluated using intraclass correlation coefficients (ICCs). Interrater reliability of measurement items was assessed using percentage agreement and the Gwet agreement coefficient (AC). Internal consistency was assessed by comparing the responses of items measuring similar aspects of the store environment. We examined the distribution of score values using boxplots and differences by store type using the Kruskal-Wallis test. Results: The median difference in the overall score between surveyors was 4.4 (range 0.0-11.1), with an ICC of 0.954 (95\% CI 0.914-0.975). Most measurement items had very good (n=74/196, 37.8\%) or good (n=81/196, 41.3\%) interrater reliability using the Gwet AC. A minimal inconsistency of measurement was found. Overall scores ranged from 19.2 to 81.6. There was a significant difference in score by store type (P<.001). Large Brisbane supermarkets scored highest (median 77.4, range 53.2-81.6), whereas small Brisbane supermarkets (median 63.9, range 41.0-71.3) and small remote supermarkets (median 63.8, range 56.5-74.9) scored significantly higher than Brisbane petrol stations (median 33.1, range 19.2-37.8) and convenience stores (median 39.0, range 22.4-63.8). Conclusions: These findings suggest good reliability and internal consistency of food environment measurements using the Store Scout mobile app. We identified specific aspects that can be improved to further increase the reliability of this tool. We found a good distribution of score values and evidence that scoring could capture differences by store type in line with previous evidence, which gives an indication of construct validity. The Store Scout mobile app shows promise in its capability to measure and track the health-enabling characteristics of store environments. ", doi="10.2196/16971", url="https://mhealth.jmir.org/2020/7/e16971", url="http://www.ncbi.nlm.nih.gov/pubmed/32706683" } @Article{info:doi/10.2196/21163, author="Echeverr{\'i}a, Patricia and Mas Bergas, Angel Miquel and Puig, Jordi and Isnard, Mar and Massot, Mireia and Vedia, Cristina and Peir{\'o}, Ricardo and Ordorica, Yolanda and Pablo, Sara and Ulldemolins, Mar{\'i}a and Iruela, Merc{\'e} and Balart, Dolors and Ruiz, Mar{\'i}a Jos{\'e} and Herms, Jordi and Clotet Sala, Bonaventura and Negredo, Eugenia", title="COVIDApp as an Innovative Strategy for the Management and Follow-Up of COVID-19 Cases in Long-Term Care Facilities in Catalonia: Implementation Study", journal="JMIR Public Health Surveill", year="2020", month="Jul", day="17", volume="6", number="3", pages="e21163", keywords="COVID-19", keywords="mobile health", keywords="app", keywords="COVIDApp", keywords="long-term care facilities", keywords="institutionalized individuals", keywords="mHealth", keywords="elderly", keywords="long-term", keywords="care", keywords="public health", keywords="management", keywords="surveillance", abstract="Background: The coronavirus disease (COVID-19) pandemic has caused an unprecedented worldwide public health crisis that requires new management approaches. COVIDApp is a mobile app that was adapted for the management of institutionalized individuals in long-term care facilities. Objective: The aim of this paper is to report the implementation of this innovative tool for the management of long-term care facility residents as a high-risk population, specifically for early identification and self-isolation of suspected cases, remote monitoring of mild cases, and real-time monitoring of the progression of the infection. Methods: COVIDApp was implemented in 196 care centers in collaboration with 64 primary care teams. The following parameters of COVID-19 were reported daily: signs/symptoms; diagnosis by reverse transcriptase--polymerase chain reaction; absence of symptoms for ?14 days; total deaths; and number of health care workers isolated with suspected COVID-19. The number of at-risk centers was also described. Results: Data were recorded from 10,347 institutionalized individuals and up to 4000 health care workers between April 1 and 30, 2020. A rapid increase in suspected cases was seen until day 6 but decreased during the last two weeks (from 1084 to 282 cases). The number of confirmed cases increased from 419 (day 6) to 1293 (day 22) and remained stable during the last week. Of the 10,347 institutionalized individuals, 5,090 (49,2\%) remained asymptomatic for ?14 days. A total of 854/10,347 deaths (8.3\%) were reported; 383 of these deaths (44.8\%) were suspected/confirmed cases. The number of isolated health care workers remained high over the 30 days, while the number of suspected cases decreased during the last 2 weeks. The number of high-risk long-term care facilities decreased from 19/196 (9.5\%) to 3/196 (1.5\%). Conclusions: COVIDApp can help clinicians rapidly detect and remotely monitor suspected and confirmed cases of COVID-19 among institutionalized individuals, thus limiting the risk of spreading the virus. The platform shows the progression of infection in real time and can aid in designing new monitoring strategies. ", doi="10.2196/21163", url="http://publichealth.jmir.org/2020/3/e21163/", url="http://www.ncbi.nlm.nih.gov/pubmed/32629425" } @Article{info:doi/10.2196/14795, author="Ramdani, Boumediene and Duan, Binheng and Berrou, Ilhem", title="Exploring the Determinants of Mobile Health Adoption by Hospitals in China: Empirical Study", journal="JMIR Med Inform", year="2020", month="Jul", day="14", volume="8", number="7", pages="e14795", keywords="mHealth", keywords="mobile phone", keywords="adoption", keywords="hospitals", keywords="TOE", keywords="China", abstract="Background: Although mobile health (mHealth) has the potential to transform health care by delivering better outcomes at a much lower cost than traditional health care services, little is known about mHealth adoption by hospitals. Objective: This study aims to explore the determinants of mHealth adoption by hospitals using the technology-organization-environment (TOE) framework. Methods: We conducted an interviewer-administered survey with 87 managers in Chinese public hospitals and analyzed the data using logistic regression. Results: The results of our survey indicate that perceived ease of use ($\beta$=.692; P<.002), system security ($\beta$=.473; P<.05), top management support ($\beta$=1.466; P<.002), hospital size ($\beta$=1.069; P<.004), and external pressure ($\beta$=.703; P<.005) are significantly related to hospitals' adoption of mHealth. However, information technology infrastructure ($\beta$=.574; P<.02), system reliability ($\beta$=?1.291; P<.01), and government policy ($\beta$=2.010; P<.04) are significant but negatively related to hospitals' adoption of mHealth. Conclusions: We found that TOE model works in the context of mHealth adoption by hospitals. In addition to technological predictors, organizational and environmental predictors are critical for explaining mHealth adoption by Chinese hospitals. ", doi="10.2196/14795", url="https://medinform.jmir.org/2020/7/e14795", url="http://www.ncbi.nlm.nih.gov/pubmed/32459630" } @Article{info:doi/10.2196/17982, author="KC, Bhuvan and Lim, Dorothy and Low, Chia Chia and Chew, Connie and Blebil, Qais Ali and Dujaili, Abdulelah Juman and Alrasheedy, A. Alian", title="Positioning and Utilization of Information and Communication Technology in Community Pharmacies of Selangor, Malaysia: Cross-Sectional Study", journal="JMIR Med Inform", year="2020", month="Jul", day="8", volume="8", number="7", pages="e17982", keywords="information and communication technology", keywords="community pharmacy", keywords="Malaysia", keywords="pharmacy services", abstract="Background: Information and communication technology (ICT) is an essential element of modern ``smart'' cities. These smart cities have integrated housing, marketplace, public amenities, services, business, and transportation via ICT. ICT is also now widely used in urban health care delivery. Objective: The aim of this study was to determine the positioning and roles of ICT in community pharmacies in the state of Selangor, Malaysia. Methods: A cross-sectional study was conducted from November 2018 to January 2019 across 9 different subdistricts in the state of Selangor, including Subang Jaya, Cheras, Puchong, Port Klang, Kota Kemuning, Selayang, Chow Kit, Ampang, and Seri Kembangan. A total of 90 community pharmacists were approached from the 9 subdistricts and invited to participate in the study. Results: Of the 90 community pharmacies approached, 60 agreed to participate in the study, representing a response rate of 67\%. The majority (36/60, 60\%) of the respondents were women, and more than half (32/60, 53\%) of the community pharmacies were run by young adults (ie, 30 years old and younger). More than three-quarters of the community pharmacies (46/60, 77\%) used electronic health records. Half of the community pharmacies used online social media platforms for advertising and promoting their pharmacies. The vast majority of the community pharmacies (55/60, 92\%) were using modern electronic payment systems, and some were also using other new electronic payment methods. Moreover, most of the community pharmacies (41/60, 68\%) were using software and programs for accounting and logistics purposes. In addition, 47/60 (78\%) of the community pharmacies used a barcode reading system for medicines/health products, and 16/60 (27\%) of the pharmacies had online stores, and consumers could buy medicines and health products from these pharmacies via their online portal. In addition, 20/60 (33\%) of the community pharmacies used at least one of the common online business platforms available in Southeast Asia to sell products/medicines. The telephone was the most commonly used means of communication with patients, although some pharmacies also used email, WhatsApp, SMS text messaging, and other communication platforms. Conclusions: This study showed that the majority of community pharmacies in Selangor, Malaysia are using ICT for different purposes. However, there is still limited use of mobile apps to provide health services. Overall, community pharmacies have been adopting ICT apps for pharmacy services but the rate of adoption is relatively slower than that in other sectors of Malaysia. ", doi="10.2196/17982", url="https://medinform.jmir.org/2020/7/e17982", url="http://www.ncbi.nlm.nih.gov/pubmed/32463787" } @Article{info:doi/10.2196/16345, author="Rono, Hillary and Bastawrous, Andrew and Macleod, David and Bunywera, Cosmas and Mamboleo, Ronald and Wanjala, Emmanuel and Burton, Matthew", title="Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="19", volume="8", number="6", pages="e16345", keywords="visual impairment", keywords="algorithms", keywords="mobile phone", keywords="screening", keywords="mHealth", keywords="sensitivity", keywords="specificity", abstract="Background: The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective: This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods: We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs' referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results: The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9\% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0\%; 95\% CI 87.7\%-93.7\%) of the cases and correctly identified 153 of 196 (specificity 78.1\%; 95\% CI 71.6\%-83.6\%) cases as not having a referable eye problem. The positive predictive value was 88.9\% (95\% CI 85.3\%-91.8\%), and the negative predictive value was 81.8\% (95\% CI 75.5\%-87.1\%). Conclusions: Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context. ", doi="10.2196/16345", url="https://mhealth.jmir.org/2020/6/e16345", url="http://www.ncbi.nlm.nih.gov/pubmed/32558656" } @Article{info:doi/10.2196/17272, author="Lupi{\'a}{\~n}ez-Villanueva, Francisco and Folkvord, Frans and Vanden Abeele, Mariek", title="Influence of the Business Revenue, Recommendation, and Provider Models on Mobile Health App Adoption: Three-Country Experimental Vignette Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="4", volume="8", number="6", pages="e17272", keywords="mHealth adoption", keywords="experiment", keywords="mobile apps", keywords="self-monitoring", keywords="privacy paradox", keywords="business model", keywords="data protection", keywords="recommendation", keywords="health consciousness", keywords="health information orientation", keywords="eHealth literacy", abstract="Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits of mHealth for patients and health care providers, scientific research examining factors explaining the adoption level of mHealth tools remains scarce. Objective: We performed an experimental vignette study to investigate how four factors related to the business model of an mHealth app affect its adoption and users' willingness to pay: (1) the revenue model (ie, sharing data with third parties vs accepting advertisements); (2) the data protection model (General Data Protection Regulation [GDPR]-compliant data handling vs nonGDPR-compliant data handling); (3) the recommendation model (ie, doctor vs patient recommendation); and (4) the provider model (ie, pharmaceutical vs medical association provider). In addition, health consciousness, health information orientation, and electronic health literacy were explored as intrapersonal predictors of adoption. Methods: We conducted an experimental study in three countries, Spain (N=800), Germany (N=800), and the Netherlands (N=416), to assess the influence of multiple business models and intrapersonal characteristics on the willingness to pay and intention to download a health app. Results: The revenue model did not affect willingness to pay or intentions to download the app in all three countries. In the Netherlands, data protection increased willingness to pay for the health app (P<.001). Moreover, in all three countries, data protection increased the likelihood of downloading the app (P<.001). In Germany (P=.04) and the Netherlands (P=.007), a doctor recommendation increased both willingness to pay and intention to download the health app. For all three countries, apps manufactured in association with a medical organization were more likely to be downloaded (P<.001). Finally, in all three countries, men, younger individuals, those with higher levels of education, and people with a health information orientation were willing to pay more for adoption of the health app and had a higher intention to download the app. Conclusions: The finding that people want their data protected by legislation but are not willing to pay more for data protection suggests that in the context of mHealth, app privacy protection cannot be leveraged as a selling point. However, people do value a doctor recommendation and apps manufactured by a medical association, which particularly influence their intention to download an mHealth app. ", doi="10.2196/17272", url="https://mhealth.jmir.org/2020/6/e17272", url="http://www.ncbi.nlm.nih.gov/pubmed/32496204" } @Article{info:doi/10.2196/16980, author="Ritchie, Jordon and Welch, Brandon", title="Categorization of Third-Party Apps in Electronic Health Record App Marketplaces: Systematic Search and Analysis", journal="JMIR Med Inform", year="2020", month="May", day="29", volume="8", number="5", pages="e16980", keywords="electronic health records", keywords="medical informatics", keywords="software", keywords="interoperability", keywords="apps", keywords="app marketplace", abstract="Background: Third-party electronic health record (EHR) apps allow health care organizations to extend the capabilities and features of their EHR system. Given the widespread utilization of EHRs and the emergence of third-party apps in EHR marketplaces, it has become necessary to conduct a systematic review and analysis of apps in EHR app marketplaces. Objective: The goal of this review is to organize, categorize, and characterize the availability of third-party apps in EHR marketplaces. Methods: Two informaticists (authors JR and BW) used grounded theory principles to review and categorize EHR apps listed in top EHR vendors' public-facing marketplaces. Results: We categorized a total of 471 EHR apps into a taxonomy consisting of 3 primary categories, 15 secondary categories, and 55 tertiary categories. The three primary categories were administrative (n=203, 43.1\%), provider support (n=159, 33.8\%), and patient care (n=109, 23.1\%). Within administrative apps, we split the apps into four secondary categories: front office (n=77, 37.9\%), financial (n=53, 26.1\%), office administration (n=49, 24.1\%), and office device integration (n=17, 8.4\%). Within the provider support primary classification, we split the apps into eight secondary categories: documentation (n=34, 21.3\%), records management (n=27, 17.0\%), care coordination (n=23, 14.4\%), population health (n=18, 11.3\%), EHR efficiency (n=16, 10.1\%), ordering and prescribing (n=15, 9.4\%), medical device integration (n=13, 8.2\%), and specialty EHR (n=12, 7.5\%). Within the patient care primary classification, we split the apps into three secondary categories: patient engagement (n=50, 45.9\%), clinical decision support (n=40, 36.7\%), and remote care (n=18, 16.5\%). Total app counts varied substantially across EHR vendors. Overall, the distribution of apps across primary categories were relatively similar, with a few exceptions. Conclusions: We characterized and organized a diverse and rich set of third-party EHR apps. This work provides an important reference for developers, researchers, and EHR customers to more easily search, review, and compare apps in EHR app marketplaces. ", doi="10.2196/16980", url="http://medinform.jmir.org/2020/5/e16980/", url="http://www.ncbi.nlm.nih.gov/pubmed/32469324" } @Article{info:doi/10.2196/16527, author="Ngo, Victoria and Matsumoto, G. Cynthia and Joseph, G. Jill and Bell, F. Janice and Bold, J. Richard and Davis, Andra and Reed, C. Sarah and Kim, K. Katherine", title="The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial", journal="JMIR Mhealth Uhealth", year="2020", month="May", day="26", volume="8", number="5", pages="e16527", keywords="care coordination, continuity of patient care", keywords="oncology", keywords="chemotherapy", keywords="patient-centered care", keywords="mobile health", keywords="technology adoption", abstract="Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)---a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. ", doi="10.2196/16527", url="http://mhealth.jmir.org/2020/5/e16527/", url="http://www.ncbi.nlm.nih.gov/pubmed/32452814" } @Article{info:doi/10.2196/18668, author="Zamberg, Ido and Manzano, Sergio and Posfay-Barbe, Klara and Windisch, Olivier and Agoritsas, Thomas and Schiffer, Eduardo", title="A Mobile Health Platform to Disseminate Validated Institutional Measurements During the COVID-19 Outbreak: Utilization-Focused Evaluation Study", journal="JMIR Public Health Surveill", year="2020", month="Apr", day="14", volume="6", number="2", pages="e18668", keywords="covid-19", keywords="novel coronavirus", keywords="smartphone", keywords="SARS-COV-2", keywords="mHealth", keywords="knowledge", keywords="information", keywords="dissemination", keywords="health policy", keywords="infectious disease", keywords="outbreak", keywords="public health", keywords="preparation", abstract="Background: As part of the response plans for the current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), authorities are drafting and implementing containment measures across jurisdictions worldwide in the effort to slow down transmission and reduce the infection rate. A solid communication strategy is needed to increase the reach of valid information to health professionals, reduce misinformation, and efficiently implement recommended measures. Objective: The aim of this paper is to describe the utilization of a dedicated mobile health (mHealth) platform to disseminate up-to-date and validated information about SARS-CoV-2 to all medical staff of the Children's Hospital at the University Hospitals of Geneva. Methods: Three documents containing institutional information concerning screening, local containment procedures, and frequently asked questions and answers for parents were made available to the staff through a mobile app developed in the University of Geneva, Switzerland. Using a third-party statistics tool, we anonymously monitored user activity as well as content utilization patterns since the diagnosis of the first case of SARS-CoV-2 in Switzerland on February 25, 2020. Results: From February 25, 2020, to March 13, 2020 (18 days), information documents on SARS-CoV-2 were viewed 859 times, which accounted for 35.6\% of the total content views (total views=332). User activity increased significantly with 50.8 (SD 14.4) users per day in this period as compared to the previous weeks (mean 26.4, SD 9.8; P<.001). In addition, session numbers per day more than doubled during the aforementioned period (P<.001). In a survey, medical staff found the information easy to find within the app. On a 10-point Likert scale, the ability of the app to reassure staff in clinical practice was rated as 7.6 (SD 2.1), time-saving ability was rated as 8.5 (SD 2.1), and the need to look for information from other sources was rated as 5.9 (SD 3.3). Conclusions: The use of an mHealth solution to disseminate novel coronavirus--related information seemed to be an effective and time-saving communication channel within our institution during the SARS-CoV-2 outbreak. Medical staff felt reassured and informed in daily practice. More research should be done on the clinical impact and outcomes of the integration of mHealth solutions as a communication channel of validated information within health institutions. ", doi="10.2196/18668", url="http://publichealth.jmir.org/2020/2/e18668/", url="http://www.ncbi.nlm.nih.gov/pubmed/32250958" } @Article{info:doi/10.2196/16030, author="Li, Chunyan and Xiong, Yuan and Sit, Fong Hao and Tang, Weiming and Hall, J. Brian and Muessig, E. Kathryn and Wei, Chongyi and Bao, Huanyu and Wei, Shufang and Zhang, Dapeng and Mi, Guodong and Yu, Fei and Tucker, D. Joseph", title="A Men Who Have Sex With Men--Friendly Doctor Finder Hackathon in Guangzhou, China: Development of a Mobile Health Intervention to Enhance Health Care Utilization", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="27", volume="8", number="2", pages="e16030", keywords="mobile health", keywords="hackathon", keywords="crowdsourcing", keywords="men who have sex with men", keywords="MSM-friendly", keywords="health care utilization", abstract="Background: Mobile health (mHeath)--based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. Objective: A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. Methods: The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. Results: We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one's location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. Conclusions: This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings. ", doi="10.2196/16030", url="http://mhealth.jmir.org/2020/2/e16030/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130189" } @Article{info:doi/10.2196/16063, author="Chiang, Ting-Wei and Chen, Si-Yu and Pan, Yuan-Chien and Lin, Yu-Hsuan", title="Automatic Work-Hours Recorder for Medical Staff (Staff Hours): Mobile App Development", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="25", volume="8", number="2", pages="e16063", keywords="smartphone", keywords="mobile apps", keywords="medical staff", keywords="global positioning system", keywords="shift work schedule", abstract="Background: There are numerous mobile apps for tracking work hours, but only a few of them record work hours automatically instead of relying on manual logging. No apps have been customized for medical staff, whose work schedules are highly complicated as they have both regular hours and on-call duties. Objective: The specific aims of this study were to (1) identify the Staff Hours app users' GPS-defined work hours, (2) examine the overtime work hours from the app-recorded total work hours and the participants' self-reported scheduled work hours, and (3) compare these app-recorded total work hours among different occupations. Methods: We developed an app, Staff Hours, to automatically calculate a user's work hours via GPS background data. Users can enter their scheduled hours, including regular hours and on-call duties. The app automatically generates overtime reports by comparing the app-recorded total work hours with the user-defined scheduled hours. A total of 183 volunteers (60 females and 123 males; mean age 32.98 years, SD 6.74) were included in this study. Most of the participants (162/183, 88.5\%) were medical staff, and their positions were resident physicians (n=89), visiting staff (n=38), medical students (n=10), registered nurses (n=25), and non--health care professionals (non-HCPs; n=21). Results: The total work hours (mean 55.69 hours, SD 21.34) of the 183 participants were significantly higher than their scheduled work hours (mean 50.67 hours, SD 21.44; P=.01). Medical staff had significantly longer total work hours (mean 57.01 hours, SD 21.20) than non-HCPs (mean 45.48 hours, SD 20.08; P=.02). Residents (mean 60.38 hours, SD 18.67) had significantly longer work hours than visiting staff (mean 51.42 hours, SD 20.33; P=.03) and non-HCPs (mean 45.48 hours, SD 20.08; P=.004). Conclusions: Staff Hours is the first automatic GPS location--based app designed for medical staff to track work hours and calculate overtime. For medical staff, this app could keep complete and accurate records of work hours in real time, reduce bias, and allow for better complying with labor regulations. ", doi="10.2196/16063", url="http://mhealth.jmir.org/2020/2/e16063/", url="http://www.ncbi.nlm.nih.gov/pubmed/32130165" } @Article{info:doi/10.2196/16220, author="Uhrig Castonguay, J. Breana and Cressman, E. Andrew and Kuo, Irene and Patrick, Rudy and Trezza, Claudia and Cates, Alice and Olsen, Halli and Peterson, James and Kurth, Ann and Bazerman, B. Lauri and Beckwith, G. Curt", title="The Implementation of a Text Messaging Intervention to Improve HIV Continuum of Care Outcomes Among Persons Recently Released From Correctional Facilities: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="13", volume="8", number="2", pages="e16220", keywords="criminal justice", keywords="incarcerated populations", keywords="HIV", keywords="acquired immunodeficiency syndrome", keywords="mHealth", keywords="anti-HIV agents", keywords="medication adherence", keywords="retention in care", keywords="implementation science", abstract="Background: Previously incarcerated individuals have suboptimal linkage and engagement in community HIV care. Mobile health (mHealth) interventions have been shown to be effective in addressing these gaps. In Washington, District of Columbia (DC), we conducted a randomized trial of an SMS text messaging--based mHealth intervention (CARE+ Corrections) to increase linkage to community HIV care and antiretroviral treatment adherence among HIV-infected persons involved in the criminal justice system. Objective: This study aimed to describe the SMS text messaging--based intervention, participant use of the intervention, and barriers and facilitators of implementation. Methods: From August 2013 to April 2015, HIV-positive incarcerated individuals were recruited within the DC Department of Corrections, and persons released in the past 6 months were recruited within the community via street-based recruitment, community partnerships, and referrals. Participants were followed for 6 months and received weekly or daily SMS text messages. Formative research resulted in the development of the content of the messages in 4 categories: HIV Appointment Reminders, Medication Adherence, Prevention Reminders, and Barriers to Care following release from jail. Participants could customize the timing, frequency, and message content throughout the study period. Results: Of the 112 participants enrolled, 57 (50.9\%) were randomized to the intervention group and 55 (49.1\%) to the control group; 2 control participants did not complete the baseline visit, and were dropped from the study, leaving a total of 110 participants who contributed to the analyses. Study retention was similar across both study arms. Median age was 42 years (IQR 30-50), 86\% (49/57) were black or African American, 58\% (33/57) were male, 25\% (14/57) were female, and 18\% (10/57) were transgender. Median length of last incarceration was 4 months (IQR 1.7-9.0), and median lifetime number of times incarcerated was 6.5 (IQR 3.5-14.0). Most participants (32/54, 59\%) had a baseline viral load of <200 copies/mL. Nearly all participants (52/57, 91\%) chose to use a cell phone provided by the study. The most preferred Appointment Reminder message was Hey how you feeling? Don't forget to give a call and make your appointment (19/57, 33\%). The most preferred Medication Adherence message was Don't forget your skittles! (31/57, 54\%), and 63\% (36/57) of participants chose to receive daily (vs weekly) messages from this category at baseline. The most preferred Prevention Reminder message was Stay strong. Stay clean (18/57, 32\%). The most preferred Barriers to Care message was Holla at your case manager, they're here to help (12/57, 22\%). Minor message preference differences were observed among participants enrolled in the jail versus those from the community. Conclusions: Participants' ability to customize their SMS text message plan proved helpful. Further large-scale research on mHealth platforms is needed to assess its efficacy among HIV-infected persons with a history of incarceration. Trial Registration: ClinicalTrials.gov?NCT01721226;?https://clinicaltrials.gov/ct2/show/NCT01721226 ", doi="10.2196/16220", url="https://mhealth.jmir.org/2020/2/e16220", url="http://www.ncbi.nlm.nih.gov/pubmed/32053119" } @Article{info:doi/10.2196/16081, author="Zaidi, Shehla and Shaikh, Ali Saqib and Sayani, Saleem and Kazi, Momin Abdul and Khoja, Adeel and Hussain, Shahzad Syed and Najmi, Rabia", title="Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants", journal="JMIR Mhealth Uhealth", year="2020", month="Feb", day="13", volume="8", number="2", pages="e16081", keywords="mHealth", keywords="immunization", keywords="digital technology", keywords="experience", keywords="health workers", abstract="Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers. ", doi="10.2196/16081", url="https://mhealth.jmir.org/2020/2/e16081", url="http://www.ncbi.nlm.nih.gov/pubmed/32053115" } @Article{info:doi/10.2196/16247, author="Grau-Corral, Inmaculada and Jans{\`a}, Margarida and Gascon, Pau and Lozano-Rub{\'i}, Raimundo and Pantoja, Efrain Percy and Roca, Daria and Aragunde Miguens, Valent{\'i}n and Hidalgo-Mazzei, Diego and Escarrabill, Joan", title="Mobile Health Projects in a High-Complexity Reference Hospital: Case Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="31", volume="8", number="1", pages="e16247", keywords="mobile health", keywords="observational study", abstract="Background: The widespread adoption of mobile and wearable devices and apps makes it essential to assess their possible impact on the management of health and diseases. Health care providers (HCPs) find themselves faced with a new situation in their setting with the proliferation of mobile health (mHealth) intervention tests. Few studies have addressed the development of mHealth and the methodologies to manage these apps in a tertiary hospital. Objective: The aim of this study was to evaluate the mHealth projects implemented in the Hospital Cl{\'i}nic of Barcelona to increase awareness of the context in which they are used and to develop policies for the development of good practice in mHealth innovation. Methods: A prospective, descriptive cross-sectional study was conducted in a highly specialized university hospital with 850 beds for adults and a reference population of 520,000 inhabitants. A specific questionnaire was developed based on the Mobile Health 5 Dimensions European (MOHE 5D-EU) theoretical model to find mHealth projects. Apps, telemedicine, and wearable devices were included in the systematic search. For that purpose, a vertical (top-down) email-based snowball process was conducted. Data were collected from February to December 2018 by conducting personal interviews with HCPs using a structured questionnaire. Results: During the study period, 45 interviews were conducted; 35 mHealth initiatives were found, with 25 targeted to patients and 10 to health professionals. Most mHealth initiatives (34/35, 97\%) were related to the software field (apps and telemedicine initiatives), and one was related to wearable devices. Among the projects, 68\% (24/35) were classified as medical devices or developments at the edge (developments susceptible to limitations depending on the intended use). In relation to data protection, 27 initiatives managing personal data (27/35, 77\%) considered data protection legislation. Only 9\% (3/35) of the initiatives had foreseen the use of interconnectivity standards. Most of the initiatives were funded by grants (14/35, 40\%), sponsorships (5/35, 14\%), or the hospital itself (5/35, 14\%). In terms of clinical management, most projects were developed in the field of research, followed by professional tools, clinical information, and therapeutic education. Only 6 projects were involved with health care; all were led by either the industry or small and medium enterprises. Conclusions: This study helped create the design of a map of the mHealth projects conducted in our hospital that showed the stages of development of the different ongoing projects. This will allow monitoring of mHealth projects and construction of tools to reinforce areas with detected deficiencies. Our theoretical approach using a modified MOHE 5D-EU model was found to be useful for analyzing the characteristics of mHealth projects. ", doi="10.2196/16247", url="http://mhealth.jmir.org/2020/1/e16247/", url="http://www.ncbi.nlm.nih.gov/pubmed/32012092" } @Article{info:doi/10.2196/14213, author="Alanezi, Fahad and Alanzi, Turki", title="A Gig mHealth Economy Framework: Scoping Review of Internet Publications", journal="JMIR Mhealth Uhealth", year="2020", month="Jan", day="15", volume="8", number="1", pages="e14213", keywords="gig economy", keywords="gigs", keywords="mHealth", keywords="sharing economy", keywords="gig mHealth", abstract="Background: The gig economy (characterized by short-term contracts rather than being a full-time employee in an organization) is one of the most recent and important tendencies that have expanded through the global economic market thanks to advances in internet and communication technologies. Similarly, mobile health (mHealth) technologies have also evolved rapidly with the development of the internet and mobile apps, attracting attention globally for their health care benefits. Objective: This study aimed to propose an integration of mHealth within the framework of the gig economy that leads to a new dimension of health care services and the proposal of a new term: gig mHealth. Methods: A review and systematic search of articles, books, and opinions that allowed for answering the research questions were executed through the internet. In this sense, the concept of the gig economy and examples, advantages and disadvantages, were reviewed. Similarly, the general characteristics of mHealth technologies were revised. In addition, the role of technology in supporting the development of the gig economy and mHealth technologies and the interactions between them were investigated. Results: The findings suggested that the gig economy is characterized by its flexibility in working hours, on-demand work, free agents, freelancing, freedom in the choice of work, and independent contracts. In addition, an analysis of an mHealth system indicated that it was composed of patients, specialists, nurses, and database administrators. In this system, patients and specialists or nurses are connected to cloud services for the transmission of data and medical information through a mobile app. Here, the administrators update the database and app features, among other technical tasks. Conversely, a general structure of an integrated gig mHealth system was developed. In this structure, the mHealth care services and the mHealth care activities were incorporated into a gig economy model. In addition, a practical example of an integrated view of a gig economy app in mHealth that illustrates the interaction between the patients (consumers) and providers (partners) of mHealth care services, mHealth care activities, health care professionals, and individual contractors was presented. The consumers and providers were interconnected with the health care company, brand, or firm through digital means using a mobile app or Windows platforms. Conclusions: The analysis carried out in this study suggested the possibility of integrating mHealth within the framework of the gig economy enhancing health care service delivery and the management of health care activities. The following 4 major areas of apps proposed in the mHealth framework that can catalyze the operations using the features of the gig economy were sharing/renting medical and diagnostic equipment and resources, on-demand appointments/self-health management, on-demand health care services, and assigning health care activities/gigs to individual contractors. This integration leads to a new dimension for health care services and the proposal of a new term: gig mHealth. ", doi="10.2196/14213", url="https://mhealth.jmir.org/2020/1/e14213", url="http://www.ncbi.nlm.nih.gov/pubmed/31939745" } @Article{info:doi/10.2196/17040, author="Bautista, Robert John and Lin, C. Trisha T. and Theng, Yin-Leng", title="Influence of Organizational Issues on Nurse Administrators' Support to Staff Nurses' Use of Smartphones for Work Purposes in the Philippines: Focus Group Study", journal="JMIR Nursing", year="2020", month="Jan", day="10", volume="3", number="1", pages="e17040", keywords="BYOD", keywords="IT consumerization", keywords="nurse administrators", keywords="organizational support", keywords="Philippines", keywords="smartphone", abstract="Background: Studies show that nurses use their own smartphones for work purposes, and there are several organizational issues related to this. However, it is unclear what these organizational issues are in the Philippines and the influence they have on nurse administrators' (ie, superiors) support to staff nurses' (ie, subordinates) use of smartphones for work purposes. Objective: Drawing from the Organizational Support Theory (OST), this study aimed to identify organizational issues that influence nurse administrators' support to staff nurses' use of smartphones for work purposes. Methods: Between June and July 2017, 9 focus groups with 43 nurse administrators (ie, head nurses, nurse supervisors, and nurse managers) were conducted in 9 tertiary-level general hospitals in Metro Manila, the Philippines. Drawing from OST, issues were classified as those that encouraged or inhibited nurse administrators to support nurses' use of smartphones for work purposes. Results: Nurse administrators were encouraged to support nurses' use of smartphones for work purposes when (1) personal smartphones are superior to workplace technologies, (2) personal smartphones resolve unit phone problems, and (3) policy is unrealistic to implement. Conversely, issues that inhibited nurse administrators to support nurses' use of smartphones for work purposes include (1) smartphone use for nonwork purposes and (2) misinterpretation by patients. Conclusions: Nurse administrators in the Philippines faced several organizational issues that encouraged or inhibited support to staff nurses' use of smartphones for work purposes. Following OST, the extent of their support can influence staff nurses' perceived organizational support on the use of smartphones for work purposes, Overall, the findings highlight the role and implication of organizational support in the context of smartphone consumerization in hospital settings, especially in developing countries. ", doi="10.2196/17040", url="https://nursing.jmir.org/2020/1/e17040", url="http://www.ncbi.nlm.nih.gov/pubmed/34345781" } @Article{info:doi/10.2196/16391, author="Yang, E. William and Spaulding, M. Erin and Lumelsky, David and Hung, George and Huynh, Phuong Pauline and Knowles, Kellen and Marvel, A. Francoise and Vilarino, Valerie and Wang, Jane and Shah, M. Lochan and Xun, Helen and Shan, Rongzi and Wongvibulsin, Shannon and Martin, S. Seth", title="Strategies for the Successful Implementation of a Novel iPhone Loaner System (iShare) in mHealth Interventions: Prospective Study", journal="JMIR Mhealth Uhealth", year="2019", month="Dec", day="16", volume="7", number="12", pages="e16391", keywords="mHealth", keywords="digital health", keywords="innovation", keywords="myocardial infarction", keywords="health care disparities", keywords="smartphone", keywords="mobile phone", keywords="smart technology", keywords="loaner device", keywords="telemedicine", abstract="Background: As smartphone ownership continues to rise, health care systems and technology companies are driven to develop mobile health (mHealth) interventions as both diagnostic and therapeutic tools. An important consideration during mHealth intervention development is how to achieve health equity despite demographic differences in smartphone ownership. One solution is through the recirculation of loaner smartphones; however, best practices for implementing such programs to optimize security, privacy, scalability, and convenience for participants are not well defined. Objective: In this tutorial, we describe how we implemented our novel Corrie iShare program, a 30-day loaner iPhone and smartwatch recirculation program, as part of a multi-center mHealth intervention to improve recovery and access to guideline-directed therapy following acute myocardial infarction. Methods: We conducted a prospective study utilizing a smartphone app and leveraged iOS enterprise features as well as cellular data service to automate recirculation. Results: Our configuration protocol was shortened from 1 hour to 10 minutes. Of 200 participants, 92 (46.0\%) did not own an iPhone and would have been excluded from the study without iShare. Among iShare participants, 72\% (66/92) returned their loaned smartphones. Conclusions: The Corrie iShare program demonstrates the potential for a sustainable and scalable mHealth loaner program, enabling broader population reach while optimizing user experience. Implementation may face institutional constraints and software limitations. Consideration should be given to optimizing loaner returns. ", doi="10.2196/16391", url="https://mhealth.jmir.org/2019/12/e16391", url="http://www.ncbi.nlm.nih.gov/pubmed/31841115" } @Article{info:doi/10.2196/15313, author="Xie, Wanhua and Cao, Xiaojun and Dong, Hongwei and Liu, Yu", title="The Use of Smartphone-Based Triage to Reduce the Rate of Outpatient Error Registration: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="11", volume="7", number="11", pages="e15313", keywords="smartphone", keywords="triage", keywords="outpatients", keywords="personal satisfaction", abstract="Background: In many clinics, patients now have the option to make Web-based appointments but doing so according to their own judgment may lead to wrong registration and delayed medical services. We hypothesized that smartphone-based triage in outpatient services is superior to Web-based self-appointment registration guided by the medical staff. Objective: This study aimed to investigate smartphone-based triage in outpatient services compared with Web-based self-appointment registration and to provide a reference for improving outpatient care under appointment registration. Methods: The following parameters in Guangzhou Women and Children's Medical Center were analyzed: wrong registration rate, the degree of patient satisfaction, outpatient visits 6 months before and after smartphone-based triage, queries after smartphone-based triage, number of successful registrations, inquiry content, and top 10 recommended diseases and top 10 recommended departments after queries. Results: Smartphone-based triage showed significant effects on average daily queries, which accounted for 16.15\% (1956/12,112) to 29.46\% (3643/12,366) of daily outpatient visits. The average daily successful registration after queries accounted for 56.14\% (1101/1961) to 60.92\% (1437/2359) of daily queries and 9.33\% (1130/12,112) to 16.83\% (2081/12,366) of daily outpatient visits. The wrong registration rate after smartphone-based triage was reduced from 0.68\% (12,810/1,895,829) to 0.12\% (2379/2,017,921) (P<.001), and the degree of patient satisfaction was improved. Monthly outpatient visits were increased by 0.98\% (3192/325,710) to 13.09\% (42,939/328,032) compared with the same period the preceding year (P=.02). Conclusions: Smartphone-based triage significantly reduces the wrong registration rate caused by patient Web-based appointment registration and improves the degree of patient satisfaction. Thus, it is worth promoting. ", doi="10.2196/15313", url="http://mhealth.jmir.org/2019/11/e15313/", url="http://www.ncbi.nlm.nih.gov/pubmed/31710300" } @Article{info:doi/10.2196/15301, author="Zawati, H. Ma'n and Lang, Michael", title="Mind the App: Considerations for the Future of Mobile Health in Canada", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="4", volume="7", number="11", pages="e15301", keywords="smartphone", keywords="mobile phone", keywords="regulation", keywords="patients", keywords="physicians", doi="10.2196/15301", url="https://mhealth.jmir.org/2019/11/e15301", url="http://www.ncbi.nlm.nih.gov/pubmed/31682580" } @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/10.2196/14558, author="Gill, Kaur Roopan and Ogilvie, Gina and Norman, V. Wendy and Fitzsimmons, Brian and Maher, Ciana and Renner, Regina", title="Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care (The FACTS Study Phase II) After Surgical Abortion: User-Centered Design", journal="JMIR Hum Factors", year="2019", month="Oct", day="10", volume="6", number="4", pages="e14558", keywords="mHealth", keywords="abortion", keywords="digital health", keywords="human centered design", keywords="knowledge translation", keywords="women's health", keywords="sexual health", abstract="Background: Human-centered design is a methodology that applies an iterative participatory process that engages the end-user for whom an innovation or intervention is designed for from start to end. There is general evidence to support the use of human-centered design for development of tools to affect health behavior, but specifically for family planning provision. This study is part two of a three-phase study that uses a user-centered design methodology which uses the findings from Phase I to design, develop, and test a digital health solution to support follow-up after an induced surgical abortion. Objective: The objectives for this study were to: (1) develop a Web-based intervention based on preferences and experiences of women who underwent an abortion as measured in the formative phase of the Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care Study; (2) conduct usability testing of the intervention to determine user-friendliness and appropriateness of the intervention; and (3) finalize a beta version of the Web-based intervention for pilot testing. Methods: The study design was based on the ``development-evaluation-implementation'' process from the Medical Research Council Framework for Complex Medical Interventions. This study is in Phase II of III and is based on user-centered design methodology. Phase I findings demonstrated that women engage with technology to assist in clinical care and they preferred a comprehensive website with email or text notifications to support follow-up care. In Phase II we collaborated with family planning experts and key stakeholders to synthesize evidence from Phase I. With them and a development partner we built a prototype. Usability testing was completed with 9 participants using a validated System Usability Scale. This was then used to refine the intervention for Phase III pilot study. This study was approved by the local Ethics board. Results: We developed a comprehensive Web-based tool called myPostCare.ca, which includes: Post-Procedure Care, Emotional Well-Being Tool, Contraception Explorer, Sexual Health, Book an Appointment, and Other Resources. Additionally, over the course of a month after the procedure, automatic email notifications were sent to women as a form of virtual follow-up support, directing them to myPostCare.ca resources. The Web-based tool was refined based on usability testing results. Conclusions: This study demonstrated that user-centered design is a useful methodology to build programs and interventions that are women-centered, specifically for abortion care. ", doi="10.2196/14558", url="https://humanfactors.jmir.org/2019/4/e14558", url="http://www.ncbi.nlm.nih.gov/pubmed/31603429" } @Article{info:doi/10.2196/13516, author="Kehe, Kai and Girgensohn, Roland and Swoboda, Walter and Bieler, Dan and Franke, Axel and Helm, Matthias and Kulla, Martin and Luepke, Kerstin and Morwinsky, Thomas and Bl{\"a}tzinger, Markus and Rossmann, Katalyn", title="Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis", journal="JMIR Mhealth Uhealth", year="2019", month="Aug", day="19", volume="7", number="8", pages="e13516", keywords="digital documentation", keywords="digital pen", keywords="digital paper", keywords="refugee camp", keywords="refugee crisis", keywords="Europe", keywords="Germany", keywords="epidemiology", abstract="Background: The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases. Objective: The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp. Methods: DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation. Results: For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed. Conclusions: We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps. ", doi="10.2196/13516", url="http://mhealth.jmir.org/2019/8/e13516/", url="http://www.ncbi.nlm.nih.gov/pubmed/31429420" } @Article{info:doi/10.2196/medinform.9510, author="Dusseljee-Peute, W. Linda and Van der Togt, Remko and Jansen, Bas and Jaspers, W. Monique", title="The Value of Radio Frequency Identification in Quality Management of the Blood Transfusion Chain in an Academic Hospital Setting", journal="JMIR Med Inform", year="2019", month="Aug", day="05", volume="7", number="3", pages="e9510", keywords="radio waves", keywords="automatic data processing", keywords="blood transfusion", keywords="geographic information systems", keywords="temperature", keywords="technology", keywords="guideline adherence", abstract="Background: A complex process like the blood transfusion chain could benefit from modern technologies such as radio frequency identification (RFID). RFID could, for example, play an important role in generating logistic and temperature data of blood products, which are important in assessing the quality of the logistic process of blood transfusions and the product itself. Objective: This study aimed to evaluate whether location, time stamp, and temperature data generated in real time by an active RFID system containing temperature sensors attached to red blood cell (RBC) products can be used to assess the compliance of the management of RBCs to 4 intrahospital European and Dutch guidelines prescribing logistic and temperature constraints in an academic hospital setting. Methods: An RFID infrastructure supported the tracking and tracing of 243 tagged RBCs in a clinical setting inside the hospital at the blood transfusion laboratory, the operating room complex, and the intensive care unit within the Academic Medical Center, a large academic hospital in Amsterdam, the Netherlands. The compliance of the management of 182 out of the 243 tagged RBCs could be assessed on their adherence to the following guidelines on intrahospital storage, transport, and distribution: (1) RBCs must be preserved within an environment with a temperature between 2{\textdegree}C and 6{\textdegree}C; (2) RBCs have to be transfused within 1 hour after they have left a validated cooling system; (3) RBCs that have reached a temperature above 10{\textdegree}C must not be restored or must be transfused within 24 hours or else be destroyed; (4) unused RBCs are to be returned to the BTL within 24 hours after they left the transfusion laboratory. Results: In total, 4 blood products (4/182 compliant; 2.2\%) complied to all applicable guidelines. Moreover, 15 blood products (15/182 not compliant to 1 out of several guidelines; 8.2\%) were not compliant to one of the guidelines of either 2 or 3 relevant guidelines. Finally, 148 blood products (148/182 not compliant to 2 guidelines; 81.3\%) were not compliant to 2 out of the 3 relevant guidelines. Conclusions: The results point out the possibilities of using RFID technology to assess the quality of the blood transfusion chain itself inside a hospital setting in reference to intrahospital guidelines concerning the storage, transport, and distribution conditions of RBCs. This study shows the potentials of RFID in identifying potential bottlenecks in hospital organizations' processes by use of objective data, which are to be tackled in process redesign efforts. The effect of these efforts can subsequently be evaluated by the use of RFID again. As such, RFID can play a significant role in optimization of the quality of the blood transfusion chain. ", doi="10.2196/medinform.9510", url="https://medinform.jmir.org/2019/3/e9510/", url="http://www.ncbi.nlm.nih.gov/pubmed/31381503" } @Article{info:doi/10.2196/14779, author="Vorakulpipat, Chalee and Rattanalerdnusorn, Ekkachan and Sirapaisan, Soontorn and Savangsuk, Visut and Kasisopha, Natsuda", title="A Mobile-Based Patient-Centric Passive System for Guiding Patients Through the Hospital Workflow: Design and Development", journal="JMIR Mhealth Uhealth", year="2019", month="Jul", day="22", volume="7", number="7", pages="e14779", keywords="user-centered design", keywords="health care informatics", keywords="mobile computing", keywords="data analytics", keywords="mhealth", abstract="Background: A hospital is an unfamiliar place to patients because of its style, atmosphere, and procedures. These hospital characteristics cause patients to become confused about responding to protocols, which slows down the procedural flows. Some additional information technology infrastructure facilities and human resources may be needed to solve these problems. However, this solution needs high investment and cannot guarantee an accuracy of information sent to patients. To handle this limitation, EasyHos has been developed to help patients recognize their status (for example, ``waiting for an appointment at 11am``) during their stay in a hospital using all existing infrastructure and hospital data and without changing existing hospital's process. Objective: The objective of this study was to provide a design of the EasyHos system and the case study in hospitals in Thailand. The design is usable and repeatable for small- and medium-sized hospitals where internet infrastructure is in place. Methods: The EasyHos system has been designed based on existing infrastructure, hospital data and hospital processes. The main components include mobile devices, existing hospital data, wireless communication network. The EasyHos was deployed at 2 hospitals in Thailand, one small and the other with a medium size. The experimental process was focused on solving the problem of unfamiliarity in the hospital. The criteria and pretest conditions regarding the unexpected problem have been defined before the experiment. Results: The results are presented in terms of criteria, pretest conditions, posttest conditions in the hospitals. The posttest conditions show the experimental results and impact of the system on users such as hospital nurses/staff and patients. For example, the questions from patients were reduced by 83.3\% after using EasyHos system while nurses/hospital staff had 5 min more to do their routine work each day. In addition, another impact is that hospitals can create new information values from existing data, which now can be visible and valuable to patients. Conclusions: Hospitals' unexpected problems have been reduced by the EasyHos system. The EasyHos system has been developed with self-service and patient-centered concepts to assist patients with necessary information. The system makes interaction easier for nurses/hospital staff members and patients working or waiting in the hospital. The nurses/hospital staff members would have more time to do their routine works. Hospitals can easily set up the EasyHos system, which will have a low or nearly zero implementation cost. ", doi="10.2196/14779", url="http://mhealth.jmir.org/2019/7/e14779/", url="http://www.ncbi.nlm.nih.gov/pubmed/31333195" } @Article{info:doi/10.2196/13964, author="Zhao, Beiqun and Tai-Seale, Ming and Longhurst, Christopher and Clay, Brian", title="Utilization of Hospital Room Hospitality Features on Patient-Controlled Tablet Computers: Cohort Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jun", day="20", volume="7", number="6", pages="e13964", keywords="inpatients", keywords="electronic health records", keywords="patient satisfaction", keywords="patients' rooms", abstract="Background: Patient portals tethered to electronic health records can improve patient experience, activation, and outcomes. However, adoption of inpatient portals has been challenging. One way to potentially increase inpatient portal usage is to integrate it with a room control (RC) app on a common tablet computer. Objective: The aim of this study was to perform a retrospective analysis of patient usage of an RC app provided on tablet computers in patient rooms of our new inpatient tower. Methods: We identified all patients who were admitted for >24 hours to our new inpatient tower over a 90-day period from September 1 to November 30, 2017. After excluding newborn patients from our analysis, we then identified patients who used the RC app at least one time during their admission. We linked these data to patient demographics (including age, sex, and race) and admitting service. We then performed univariable and multivariable logistic regression to assess patterns of RC app usage. Results: A total of 3411 patients were admitted over the course of the study period; 2242/3411 (65.73\%) used the RC app during their hospitalization. Compared with white patients, other/mixed/unknown race and Asian, Hawaiian, Pacific Islander, American Indian race were significantly associated with increased use of the RC app in a multivariable analysis. Increasing age was significantly associated with increased usage of the RC app. Usage of the RC app also varied by admitting services. Compared with general medicine, bone marrow transplant and general surgery patients had increased usage of the RC app. Conversely, critical care, medical specialties, neurology, surgical subspecialties, and obstetrics/gynecology were all associated with decreased usage of the RC app. Conclusions: Our study shows that one-third of patients are not using the RC app for critical room functions. Future initiatives to increase RC usage should take these populations into consideration. Contrary to common belief, older patients may use tablet-enabled RCs just as often, if not more often, than younger patients. Certain admitting services, such as neurology and surgical subspecialties, may have had lower usage rates owing to accessibility issues. Our study allows hospitals to tailor support for specific patient populations to increase RC app usage. ", doi="10.2196/13964", url="http://mhealth.jmir.org/2019/6/e13964/", url="http://www.ncbi.nlm.nih.gov/pubmed/31223118" } @Article{info:doi/10.2196/13588, author="Chai, R. Peter and Zhang, Haipeng and Jambaulikar, D. Guruprasad and Boyer, W. Edward and Shrestha, Labina and Kitmitto, Loay and Wickner, G. Paige and Salmasian, Hojjat and Landman, B. Adam", title="An Internet of Things Buttons to Measure and Respond to Restroom Cleanliness in a Hospital Setting: Descriptive Study", journal="J Med Internet Res", year="2019", month="Jun", day="19", volume="21", number="6", pages="e13588", keywords="operations research", keywords="wireless technology", keywords="hygiene", keywords="toilet facilities", keywords="workflow", abstract="Background: Restroom cleanliness is an important factor in hospital quality. Due to its dynamic process, it can be difficult to detect the presence of dirty restrooms that need to be cleaned. Using an Internet of Things (IoT) button can permit users to designate restrooms that need cleaning and in turn, allow prompt response from housekeeping to maintain real-time restroom cleanliness. Objective: This study aimed to describe the deployment of an IoT button--based notification system to measure hospital restroom cleanliness reporting system usage and qualitative feedback from housekeeping staff on IoT button use. Methods: We deployed IoT buttons in 16 hospital restrooms. Over an 8-month period, housekeeping staff received real-time notifications and responded to button presses for restroom cleaning. All button presses were recorded. We reported average button usage by hospital area, time of day, and day of week. We also conducted interviews with housekeeping supervisors and staff to understand their acceptance of and experience with the system. Results: Over 8 months, 1920 requests to clean restrooms in the main hospital lobby and satellite buildings were received. The hospital lobby IoT buttons received over half (N=1055, 55\%) of requests for cleaning. Most requests occurred in afternoon hours from 3 PM to midnight. Requests for cleaning remained stable throughout the work week with fewer requests occurring over weekends. IoT button use was sustained throughout the study period. Interviews with housekeeping supervisors and staff demonstrated acceptance of the IoT buttons; actual use was centered around asynchronous communication between supervisors and staff in response to requests to clean restrooms. Conclusions: An IoT button system is a feasible method to generate on-demand request for restroom cleaning that is easy to deploy and that users will consistently engage with. Data from this system have the potential to enable responsive scheduling for restroom service and anticipate periods of high restroom utilization in a hospital. ", doi="10.2196/13588", url="http://www.jmir.org/2019/6/e13588/", url="http://www.ncbi.nlm.nih.gov/pubmed/31219046" } @Article{info:doi/10.2196/14094, author="Balakrishnan, S. Ashwin and Nguyen, G. Hao and Shinohara, Katsuto and Au Yeung, Reuben and Carroll, R. Peter and Odisho, Y. Anobel", title="A Mobile Health Intervention for Prostate Biopsy Patients Reduces Appointment Cancellations: Cohort Study", journal="J Med Internet Res", year="2019", month="Jun", day="2", volume="21", number="6", pages="e14094", keywords="text messaging", keywords="appointments and schedules", keywords="mHealth", keywords="quality improvement", keywords="urology", keywords="prostate neoplasm", abstract="Background: Inadequate patient education and preparation for office-based procedures often leads to delayed care, poor patient satisfaction, and increased costs to the health care system. We developed and deployed a mobile health (mHealth) reminder and education program for patients scheduled for transrectal prostate biopsy. Objective: We aimed to evaluate the impact of an mHealth reminder and education program on appointment cancellation rates, communication frequency, and patient satisfaction. Methods: We developed a text message (SMS, short message service)--based program with seven reminders containing links to Web-based content and surveys sent over an 18-day period (14 days before through 3 days after prostate biopsy). Messages contained educational content, reminders, and readiness questionnaires. Demographic information, appointment cancellations or change data, and patient/provider communication events were collected for 6 months before and after launching the intervention. Patient satisfaction was evaluated in the postintervention cohort. Results: The preintervention (n=473) and postintervention (n=359) cohorts were composed of men of similar median age and racial/ethnic distribution living a similar distance from clinic. The postintervention cohort had significantly fewer canceled or rescheduled appointments (33.8\% vs 21.2\%, P<.001) and fewer same-day cancellations (3.8\% vs 0.5\%, P<.001). There was a significant increase in preprocedural telephone calls (0.6 vs 0.8 calls per patient, P=.02) in the postintervention cohort, but not a detectable change in postprocedural calls. The mean satisfaction with the program was 4.5 out of 5 (SD 0.9). Conclusions: An mHealth periprocedural outreach program significantly lowered appointment cancellation and rescheduling and was associated with high patient satisfaction scores with a slight increase in preprocedural telephone calls. This led to fewer underused procedure appointments and high patient satisfaction. ", doi="10.2196/14094", url="https://www.jmir.org/2019/6/e14094/", url="http://www.ncbi.nlm.nih.gov/pubmed/31199294" } @Article{info:doi/10.2196/10299, author="Lv, Qing and Jiang, Yutong and Qi, Jun and Zhang, Yanli and Zhang, Xi and Fang, Linkai and Tu, Liudan and Yang, Mingcan and Liao, Zetao and Zhao, Minjing and Guo, Xinghua and Qiu, Minli and Gu, Jieruo and Lin, Zhiming", title="Using Mobile Apps for Health Management: A New Health Care Mode in China", journal="JMIR Mhealth Uhealth", year="2019", month="Jun", day="03", volume="7", number="6", pages="e10299", keywords="mHealth", keywords="internet", keywords="health care", keywords="medical informatics", abstract="Background: China has a large population; however, medical resources are unevenly distributed and extremely limited, and more medical services are needed. With the development and ever-increasing popularity of mobile internet communication, China has created a mode of mobile health (mHealth) care to resolve this problem. Objective: The aim of this study was (1) to describe the problems associated with China's medical care practice, (2) explore the need for and the feasibility of internet-based medical care in China, and (3) analyze the functionality of and services offered by internet-based health care platforms for the management of chronic diseases. Methods: Data search was performed by searching national websites, the popular search engine Baidu, the App Store, and websites of internet medical care institutions, using search terms like ``mobile health,'' ``Internet health,'' ``mobile medical,'' ``Internet medical,'' ``digital medical,'' ``digital health,'' and ``online doctor.'' A total of 6 mobile apps and websites with the biggest enrollment targeting doctors and end users with chronic diseases in China were selected. Results: We recognized the limitations of medical and health care providers and unequal distribution of medical resources in China. An mHealth care platform is a novel and efficient way for doctors and patients to follow up and manage chronic diseases. Services offered by these platforms include reservation and payment, medical consultation, medical education assessment, pharmaceutical and medical instruments sales, electronic medical records, and chronic disease management. China's health policies are now strongly promoting the implementation of mHealth solutions, particularly in response to the increasing burden of chronic diseases and aging in the population. Conclusions: China's internet-based medical and health care mode can benefit the populace by providing people with high-quality medical resources. This can help other countries and regions with high population density and unevenly distributed medical resources manage their health care concerns. ", doi="10.2196/10299", url="https://mhealth.jmir.org/2019/6/e10299/", url="http://www.ncbi.nlm.nih.gov/pubmed/31162131" } @Article{info:doi/10.2196/13963, author="Kawakyu, Nami and Nduati, Ruth and Munguambe, Kh{\'a}tia and Coutinho, Joana and Mburu, Nancy and DeCastro, Georgina and Inguane, Celso and Zunt, Andrew and Abburi, Neil and Sherr, Kenneth and Gimbel, Sarah", title="Development and Implementation of a Mobile Phone--Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique", journal="JMIR Mhealth Uhealth", year="2019", month="May", day="13", volume="7", number="5", pages="e13963", keywords="mHealth", keywords="quality improvement", keywords="engineering", keywords="HIV", keywords="mother to child transmission", keywords="implementation science", abstract="Background: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses' clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone--based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. Objective: The objective of this study was to understand and improve the mPCAT's core usability factors and assess the health workers' experience with using the mPCAT. Methods: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT's core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. Results: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff---critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. Conclusions: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements. ", doi="10.2196/13963", url="http://mhealth.jmir.org/2019/5/e13963/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094351" } @Article{info:doi/10.2196/11497, author="Opoku, Daniel and Busse, Reinhard and Quentin, Wilm", title="Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana", journal="JMIR Mhealth Uhealth", year="2019", month="May", day="03", volume="7", number="5", pages="e11497", keywords="implementation science", keywords="mHealth", keywords="eHealth", keywords="noncommunicable diseases", keywords="disease management", keywords="sub-Saharan Africa", keywords="qualitative research", keywords="health policy", abstract="Background: A growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. Objective: This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Methods: Members of the technical working group responsible for Ghana's national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. Results: A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework's categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. Conclusions: The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions. ", doi="10.2196/11497", url="https://mhealth.jmir.org/2019/5/e11497/", url="http://www.ncbi.nlm.nih.gov/pubmed/31066706" } @Article{info:doi/10.2196/12251, author="Ozella, Laura and Gauvin, Laetitia and Carenzo, Luca and Quaggiotto, Marco and Ingrassia, Luigi Pier and Tizzoni, Michele and Panisson, Andr{\'e} and Colombo, Davide and Sapienza, Anna and Kalimeri, Kyriaki and Della Corte, Francesco and Cattuto, Ciro", title="Wearable Proximity Sensors for Monitoring a Mass Casualty Incident Exercise: Feasibility Study", journal="J Med Internet Res", year="2019", month="Apr", day="26", volume="21", number="4", pages="e12251", keywords="contact patterns", keywords="contact networks", keywords="wearable proximity sensors", keywords="mass casualty incident", keywords="simulation", keywords="medical staff -- patient interaction", keywords="patients' flow", abstract="Background: Over the past several decades, naturally occurring and man-made mass casualty incidents (MCIs) have increased in frequency and number worldwide. To test the impact of such events on medical resources, simulations can provide a safe, controlled setting while replicating the chaotic environment typical of an actual disaster. A standardized method to collect and analyze data from mass casualty exercises is needed to assess preparedness and performance of the health care staff involved. Objective: In this study, we aimed to assess the feasibility of using wearable proximity sensors to measure proximity events during an MCI simulation. In the first instance, our objective was to demonstrate how proximity sensors can collect spatial and temporal information about the interactions between medical staff and patients during an MCI exercise in a quasi-autonomous way. In addition, we assessed how the deployment of this technology could help improve future simulations by analyzing the flow of patients in the hospital. Methods: Data were obtained and collected through the deployment of wearable proximity sensors during an MCI functional exercise. The scenario included 2 areas: the accident site and the Advanced Medical Post, and the exercise lasted 3 hours. A total of 238 participants were involved in the exercise and classified in categories according to their role: 14 medical doctors, 16 nurses, 134 victims, 47 Emergency Medical Services staff members, and 27 health care assistants and other hospital support staff. Each victim was assigned a score related to the severity of his/her injury. Each participant wore a proximity sensor, and in addition, 30 fixed devices were placed in the field hospital. Results: The contact networks show a heterogeneous distribution of the cumulative time spent in proximity by the participants. We obtained contact matrices based on the cumulative time spent in proximity between the victims and rescuers. Our results showed that the time spent in proximity by the health care teams with the victims is related to the severity of the patient's injury. The analysis of patients' flow showed that the presence of patients in the rooms of the hospital is consistent with the triage code and diagnosis, and no obvious bottlenecks were found. Conclusions: Our study shows the feasibility of the use of wearable sensors for tracking close contacts among individuals during an MCI simulation. It represents, to our knowledge, the first example of unsupervised data collection---ie, without the need for the involvement of observers, which could compromise the realism of the exercise---of face-to-face contacts during an MCI exercise. Moreover, by permitting detailed data collection about the simulation, such as data related to the flow of patients in the hospital, such deployment provides highly relevant input for the improvement of MCI resource allocation and management. ", doi="10.2196/12251", url="http://www.jmir.org/2019/4/e12251/", url="http://www.ncbi.nlm.nih.gov/pubmed/31025944" } @Article{info:doi/10.2196/11316, author="Panayiotou, Anita and Gardner, Anastasia and Williams, Sue and Zucchi, Emiliano and Mascitti-Meuter, Monita and Goh, MY Anita and You, Emily and Chong, WH Terence and Logiudice, Dina and Lin, Xiaoping and Haralambous, Betty and Batchelor, Frances", title="Language Translation Apps in Health Care Settings: Expert Opinion", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="09", volume="7", number="4", pages="e11316", keywords="health care", keywords="communication", keywords="language", keywords="technology", abstract="Background: Currently, over 300 languages are spoken in Australian homes. People without proficient English from non-English speaking countries may not receive equitable care if their health care workers do not speak their primary language. Use of professional interpreters is considered the gold standard; however, for a variety of reasons, it is often limited to key aspects of care such as diagnosis and consent. With the emergence of mobile technologies, health care workers are increasingly using digital translation tools to fill this gap. However, many of these technologies have not been developed for health care settings and their use has not been evaluated. Objective: This study aimed to evaluate iPad-compatible language translation apps to determine their suitability for enabling everyday conversations in health care settings. Methods: Translation apps were identified by searching the Apple iTunes Store and published and grey literature. Criteria for inclusion were that the apps were available at no cost, able to translate at least one of the top 10 languages spoken in Australia, and available for use on iPad. Apps that met inclusion criteria were reviewed in 2 stages. Stage 1 was the feature analysis conducted by 2 independent researchers, where apps were evaluated for offline use, input and output methods, and number of languages. Stage 2 was the analysis of suitability for everyday communication in the health care setting, conducted by 2 independent professionals with expertise in translation and cross-cultural communication. Apps that enabled key aspects of care normally within the realm of professional interpreters, such as assessment, treatment and discharge planning, and seeking consent for medical treatments, were considered unsuitable. Results: In total, 15 apps were evaluated. Of these, 8 apps contained voice-to-voice and voice-to-text translation options. In addition, 6 apps were restricted to using preset health phrases, whereas 1 app used a combination of free input and preset phrases. However, 5 apps were excluded before stage 2. In addition, 6 of the 10 remaining apps reviewed in stage 2 were specifically designed for health care translation purposes. Of these, 2 apps were rated as suitable for everyday communication in the health care setting---culturally and linguistically diverse Assist and Talk To Me. Both apps contained simple and appropriate preset health phrases and did not contain conversations that are normally within the realm of professional interpreters. Conclusions: All iPad-compatible translation apps require a degree of caution and consideration when used in health care settings, and none should replace professional interpreters. However, some apps may be suitable for everyday conversations, such as those that enable preset phrases to be translated on subject matters that do not require a professional interpreter. Further research into the use of translation technology for these types of conversations is needed. ", doi="10.2196/11316", url="https://mhealth.jmir.org/2019/4/e11316/", url="http://www.ncbi.nlm.nih.gov/pubmed/30964446" } @Article{info:doi/10.2196/11166, author="Leavens, Schneider Eleanor Ladd and Stevens, Marie Elise and Brett, Irene Emma and Molina, Neil and Leffingwell, Ryan Thad and Wagener, Lee Theodore", title="Use of Rideshare Services to Increase Participant Recruitment and Retention in Research: Participant Perspectives", journal="J Med Internet Res", year="2019", month="Apr", day="08", volume="21", number="4", pages="e11166", keywords="rideshare service", keywords="recruitment", keywords="retention", keywords="attrition", keywords="transportation", abstract="Background: Recruitment and retention of participants are important factors in empirical studies. Methods that increase recruitment and retention can reduce costs and burden on researchers related to the need for over-recruitment because of attrition. Rideshare services such as Uber and Lyft are a potential means for decreasing this burden. Objective: This study aimed to understand the role rideshare utilization plays in participant recruitment and retention in research trials. Methods: Data are presented for a study (N=42) in which rideshare services were utilized for participant transportation to and from study visits during a 2-session, in-laboratory research study. Results: Retention at visit 2 was greater than 95\% (42/44) in the initial study. In a follow-up survey of the participants from the original trial, participants (N=32) reported that the rideshare service was an important reason they returned for all study visits. Participants reported whether they would prefer differing levels of additional monetary compensation or a ride from a rideshare service. When the additional compensation was less than US \$15, participants reported a preference for the rideshare service. Conclusions: Rideshare services may represent a relatively low cost means for increasing study retention. Specifically, findings indicate that rideshare services may not be crucial for initial participant recruitment but for their retention in multi-visit studies. ", doi="10.2196/11166", url="https://www.jmir.org/2019/4/e11166/", url="http://www.ncbi.nlm.nih.gov/pubmed/30958268" } @Article{info:doi/10.2196/11472, author="Jeon, Byoungjun and Jeong, Boseong and Jee, Seunghoon and Huang, Yan and Kim, Youngmin and Park, Ho Gee and Kim, Jungah and Wufuer, Maierdanjiang and Jin, Xian and Kim, Wha Sang and Choi, Hyun Tae", title="A Facial Recognition Mobile App for Patient Safety and Biometric Identification: Design, Development, and Validation", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="08", volume="7", number="4", pages="e11472", keywords="facial recognition", keywords="patient identification systems", keywords="biometric identification", keywords="patient safety", keywords="smartphone", keywords="mobile applications", abstract="Background: Patient verification by unique identification is an important procedure in health care settings. Risks to patient safety occur throughout health care settings by failure to correctly identify patients, resulting in the incorrect patient, incorrect site procedure, incorrect medication, and other errors. To avoid medical malpractice, radio-frequency identification (RFID), fingerprint scanners, iris scanners, and other technologies have been implemented in care settings. The drawbacks of these technologies include the possibility to lose the RFID bracelet, infection transmission, and impracticality when the patient is unconscious. Objective: The purpose of this study was to develop a mobile health app for patient identification to overcome the limitations of current patient identification alternatives. The development of this app is expected to provide an easy-to-use alternative method for patient identification. Methods: We have developed a facial recognition mobile app for improved patient verification. As an evaluation purpose, a total of 62 pediatric patients, including both outpatient and inpatient, were registered for the facial recognition test and tracked throughout the facilities for patient verification purpose. Results: The app was developed to contain 5 main parts: registration, medical records, examinations, prescriptions, and appointments. Among 62 patients, 30 were outpatients visiting plastic surgery department and 32 were inpatients reserved for surgery. Whether patients were under anesthesia or unconscious, facial recognition verified all patients with 99\% accuracy even after a surgery. Conclusions: It is possible to correctly identify both outpatients and inpatients and also reduce the unnecessary cost of patient verification by using the mobile facial recognition app with great accuracy. Our mobile app can provide valuable aid to patient verification, including when the patient is unconscious, as an alternative identification method. ", doi="10.2196/11472", url="https://mhealth.jmir.org/2019/4/e11472/", url="http://www.ncbi.nlm.nih.gov/pubmed/30958275" } @Article{info:doi/10.2196/12652, author="Venter, Francois Willem Daniel and Fischer, Alex and Lalla-Edward, Tresha Samanta and Coleman, Jesse and Lau Chan, Vincent and Shubber, Zara and Phatsoane, Mothepane and Gorgens, Marelize and Stewart-Isherwood, Lynsey and Carmona, Sergio and Fraser-Hurt, Nicole", title="Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="02", volume="7", number="4", pages="e12652", keywords="cell phones", keywords="HIV", keywords="app", keywords="Africa", keywords="linkage to care", keywords="patient information", abstract="Background: South Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71\% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade. Objective: SmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners. Methods: This study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation. Results: A total of 345 participants were recruited into the study; 64.9\% (224/345) of the participants were female and 44.1\% (152/345) were aged less than 30 years. In addition, 46.7\% (161/345) were employed full time, 95.9\% (331/345) had at least secondary school education, and 35.9\% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6\% (88/181) in the intervention arm versus 45.1\% (74/164) in the control (P=.52) and increased to 64.1\% (116/181) and 61.0\% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20\% increase in linkage to care for the intervention group. Conclusions: Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care. Trial Registration: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW) ", doi="10.2196/12652", url="https://mhealth.jmir.org/2019/4/e12652/", url="http://www.ncbi.nlm.nih.gov/pubmed/30938681" } @Article{info:doi/10.2196/formative.9922, author="Ng, Denise and McMurray, Josephine and Wallace, James and Morita, Plinio", title="What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys", journal="JMIR Form Res", year="2019", month="Mar", day="18", volume="3", number="1", pages="e9922", keywords="quality of healthcare", keywords="surveys and questionnaires", keywords="patient satisfaction", keywords="data collection", keywords="smartphone", keywords="mobile phone", keywords="risk", keywords="privacy", abstract="Background: Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy. Objective: This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences. Methods: We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys. Results: Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients' adoption of smart surveys. Conclusions: On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies. ", doi="10.2196/formative.9922", url="http://formative.jmir.org/2019/1/e9922/", url="http://www.ncbi.nlm.nih.gov/pubmed/30882354" } @Article{info:doi/10.2196/mhealth.9990, author="Somers, Camilla and Grieve, Eleanor and Lennon, Marilyn and Bouamrane, Matt-Mouley and Mair, S. Frances and McIntosh, Emma", title="Valuing Mobile Health: An Open-Ended Contingent Valuation Survey of a National Digital Health Program", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="17", volume="7", number="1", pages="e3", keywords="mHealth", keywords="public health", keywords="delivery of health care", keywords="public health systems research", abstract="Background: Changing population demographics and technology developments have resulted in growing interest in the potential of consumer-facing digital health. In the United Kingdom, a {\textsterling}37 million (US \$49 million) national digital health program delivering assisted living lifestyles at scale (dallas) aimed to deploy such technologies at scale. However, little is known about how consumers value such digital health opportunities. Objective: This study explored consumers' perspectives on the potential value of digital health technologies, particularly mobile health (mHealth), to promote well-being by examining their willingness-to-pay (WTP) for such health solutions. Methods: A contingent valuation study involving a UK-wide survey that asked participants to report open-ended absolute and marginal WTP or willingness-to-accept for the gain or loss of a hypothetical mHealth app, Healthy Connections. Results: A UK-representative cohort (n=1697) and a dallas-like (representative of dallas intervention communities) cohort (n=305) were surveyed. Positive absolute and marginal WTP valuations of the app were identified across both cohorts (absolute WTP: UK-representative cohort {\textsterling}196 or US \$258 and dallas-like cohort {\textsterling}162 or US \$214; marginal WTP: UK-representative cohort {\textsterling}160 or US \$211 and dallas-like cohort {\textsterling}151 or US \$199). Among both cohorts, there was a high prevalence of zeros for both the absolute WTP (UK-representative cohort: 467/1697, 27.52\% and dallas-like cohort: 95/305, 31.15\%) and marginal WTP (UK-representative cohort: 487/1697, 28.70\% and dallas-like cohort: 99/305, 32.5\%). In both cohorts, better general health, previous amount spent on health apps (UK-representative cohort 0.64, 95\% CI 0.27 to 1.01; dallas-like cohort: 1.27, 95\% CI 0.32 to 2.23), and age had a significant (P>.00) association with WTP (UK-representative cohort: ?0.1, 95\% CI ?0.02 to ?0.01; dallas-like cohort: ?0.02, 95\% CI ?0.03 to ?0.01), with younger participants willing to pay more for the app. In the UK-representative cohort, as expected, higher WTP was positively associated with income up to {\textsterling}30,000 or US \$39,642 (0.21, 95\% CI 0.14 to 0.4) and increased spending on existing phone and internet services (0.52, 95\% CI 0.30 to 0.74). The amount spent on existing health apps was shown to be a positive indicator of WTP across cohorts, although the effect was marginal (UK-representative cohort 0.01, 95\% CI 0.01 to 0.01; dallas-like cohort 0.01, 95\% CI 0.01 to 0.02). Conclusions: This study demonstrates that consumers value mHealth solutions that promote well-being, social connectivity, and health care control, but it is not universally embraced. For mHealth to achieve its potential, apps need to be tailored to user accessibility and health needs, and more understanding of what hinders frequent users of digital technologies and those with long-term conditions is required. This novel application of WTP in a digital health context demonstrates an economic argument for investing in upskilling the population to promote access and expedite uptake and utilization of such digital health and well-being apps. ", doi="10.2196/mhealth.9990", url="http://mhealth.jmir.org/2019/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/30664488" } @Article{info:doi/10.2196/12232, author="George, Doris and Hassali, Azmi Mohamed and HSS, Amar-Singh", title="Usability Testing of a Mobile App to Report Medication Errors Anonymously: Mixed-Methods Approach", journal="JMIR Hum Factors", year="2018", month="Dec", day="21", volume="5", number="4", pages="e12232", keywords="mobile app", keywords="usability", keywords="medication error reporting", keywords="anonymous", abstract="Background: Reporting of medication errors is one of the essential mechanisms to identify risky health care systems and practices that lead to medication errors. Unreported medication errors are a real issue; one of the identified causes is a burdensome medication error reporting system. An anonymous and user-friendly mobile app for reporting medication errors could be an alternative method of reporting medication error in busy health care settings. Objective: The objective of this paper is to report usability testing of the Medication Error Reporting App (MERA), a mobile app for reporting medication errors anonymously. Methods: Quantitative and qualitative methods were employed involving 45 different testers (pharmacists, doctors, and nurses) from a large tertiary hospital in Malaysia. Quantitative data was retrieved using task performance and rating of MERA and qualitative data were retrieved through focus group discussions. Three sessions, with 15 testers each session, were conducted from January to March 2018. Results: The majority of testers were pharmacists (23/45, 51\%), female (35/45, 78\%), and the mean age was 36 (SD 9) years. A total of 135 complete reports were successfully submitted by the testers (three reports per tester) and 79.2\% (107/135) of the reports were correct. There was significant improvement in mean System Usability Scale scores in each session of the development process (P<.001) and mean time to report medication errors using the app was not significantly different between each session (P=.70) with an overall mean time of 6.7 (SD 2.4) minutes. Testers found the app easy to use, but doctors and nurses were unfamiliar with terms used especially medication process at which error occurred and type of error. Although, testers agreed the app can be used in the future for reporting, they were apprehensive about security, validation, and abuse of feedback featured in the app. Conclusions: MERA can be used to report medication errors easily by various health care personnel and it has the capacity to provide feedback on reporting. However, education on medication error reporting should be provided to doctors and nurses in Malaysia and the security of the app needs to be established to boost reporting by this method. ", doi="10.2196/12232", url="http://humanfactors.jmir.org/2018/4/e12232/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578216" } @Article{info:doi/10.2196/12261, author="Weber, J. Summer and Dawson, Daniela and Greene, Haley and Hull, C. Pamela", title="Mobile Phone Apps for Low-Income Participants in a Public Health Nutrition Program for Women, Infants, and Children (WIC): Review and Analysis of Features", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="19", volume="6", number="11", pages="e12261", keywords="WIC", keywords="low-income", keywords="mobile phone", keywords="mHealth", abstract="Background: Since 1972, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been proven to improve the health of participating low-income women and children in the United States. Despite positive nutritional outcomes associated with WIC, the program needs updated tools to help future generations. Improving technology in federal nutrition programs is crucial for keeping nutrition resources accessible and easy for low-income families to use. Objective: This review aimed to analyze the main features of publicly available mobile phone apps for WIC participants. Methods: Keyword searches were performed in the app stores for the 2 most commonly used mobile phone operating systems between December 2017 and June 2018. Apps were included if they were relevant to WIC and excluded if the target users were not WIC participants. App features were reviewed and classified according to type and function. User reviews from the app stores were examined, including ratings and categorization of user review comments. Results: A total of 17 apps met selection criteria. Most apps (n=12) contained features that required verified access available only to WIC participants. Apps features were classified into categories: (1) shopping management (eg, finding and redeeming food benefits), (2) clinic appointment management (eg, appointment reminders and scheduling), (3) informational resources (eg, recipes, general food list, tips about how to use WIC, links to other resources), (4) WIC-required nutrition education modules, and (5) other user input. Positive user reviews indicated that apps with shopping management features were very useful. Conclusions: WIC apps are becoming increasingly prevalent, especially in states that have implemented electronic benefits transfer for WIC. This review offers new contributions to the literature and practice, as practitioners, software developers, and health researchers seek to improve and expand technology in the program. ", doi="10.2196/12261", url="http://mhealth.jmir.org/2018/11/e12261/", url="http://www.ncbi.nlm.nih.gov/pubmed/30455172" } @Article{info:doi/10.2196/10360, author="Furberg, D. Robert and Raspa, Melissa and Wheeler, C. Anne and McCormack, A. Lauren and Bailey, B. Donald", title="A Digital Health App to Assess Decisional Capacity to Provide Informed Consent: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2018", month="Nov", day="19", volume="7", number="11", pages="e10360", keywords="clinical trial", keywords="decision support techniques", keywords="digital health", keywords="ethics", keywords="informed consent", keywords="fragile X syndrome", abstract="Background: Any study with human subjects must have a robust consent process to ensure that participants understand the study and can decide whether they want to be involved. Investigators must determine whether a potential study participant is able to make an informed decision and what modifications or supports are needed to maximize participation in decision making. A variety of approaches have been used to modify consent forms and the consent process to increase the research participants' decisional capacity. This protocol describes a randomized controlled trial (RCT) of a digital health app to support decision making among individuals contemplating providing consent to participate in a clinical trial. Objective: The objective of this RCT will be to determine if the use of a tablet-based app facilitates greater participation in and satisfaction with the consent process compared with standard practice and identify which individual factors are associated with better response to the decision aid. We hypothesize that the tablet-based version of the consent process will promote more informed decision making, including decisions that are more consistent with individual preferences and values expressed during qualitative data collection. Methods: A two-arm RCT will be conducted in a sample of approximately 100 individuals with fragile X syndrome in their homes across the United States. Results: Data analysis will be completed by late 2018. Conclusions: By developing and testing a novel consent decision aid, we will have a better understanding of whether and how technological support can optimize the fit between the decisional capacity and the decisional process. Trial Registration: ClinicalTrials.gov NCT02465931; https://clinicaltrials.gov/ct2/show/NCT02465931 (Archived by WebCite at http://www.webcitation.org/72Q3xJQAw) International Registered Report Identifier (IRRID): PRR1-10.2196/10360 ", doi="10.2196/10360", url="https://www.researchprotocols.org/2018/11/e10360/", url="http://www.ncbi.nlm.nih.gov/pubmed/30455171" } @Article{info:doi/10.2196/publichealth.9015, author="Tom-Aba, Daniel and Nguku, Mboya Patrick and Arinze, Chukwujekwu Chinedu and Krause, Gerard", title="Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review", journal="JMIR Public Health Surveill", year="2018", month="Oct", day="29", volume="4", number="4", pages="e68", keywords="case management", keywords="contact tracing", keywords="Ebola virus disease", keywords="eHealth", keywords="mHealth", keywords="systematic review", keywords="West Africa", abstract="Background: The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language using the search strategy: (``outbreak'' OR ``epidemic'') AND (``mobile phone'' OR ``smartphone'' OR ``smart phone'' OR ``mobile phone'' OR ``tablet'' OR ``mHealth'') AND (``Ebola'' OR ''EVD'' OR ``VHF'' OR ``Ebola virus disease'' OR ``viral hemorrhagic fever'') AND (``2014'' OR ``2015''). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools' functionalities. Results: We identified 1220 publications through the search strategy, of which 6.31\% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62\% (34/55) offered functionalities for surveillance, 22\% (10/45) for case management, 18\% (7/38) for contact tracing, and 6\% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities. Conclusions: Among the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development. ", doi="10.2196/publichealth.9015", url="http://publichealth.jmir.org/2018/4/e68/", url="http://www.ncbi.nlm.nih.gov/pubmed/30373727" } @Article{info:doi/10.2196/11440, author="Bassi, Abhinav and John, Oommen and Praveen, Devarsetty and Maulik, K. Pallab and Panda, Rajmohan and Jha, Vivekanand", title="Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Oct", day="26", volume="6", number="10", pages="e11440", keywords="mHealth", keywords="telemedicine", keywords="health care system", keywords="India", abstract="Background: With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. Objective: We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. Methods: A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. Results: The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease--focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6\% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0\%, 45/125) or 2 (45.6\%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2\% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. Conclusions: In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes. ", doi="10.2196/11440", url="http://mhealth.jmir.org/2018/10/e11440/", url="http://www.ncbi.nlm.nih.gov/pubmed/30368435" } @Article{info:doi/10.2196/11203, author="Nsabimana, Placide Alain and Uzabakiriho, Bernard and Kagabo, M. Daniel and Nduwayo, Jerome and Fu, Qinyouen and Eng, Allison and Hughes, Joshua and Sia, K. Samuel", title="Bringing Real-Time Geospatial Precision to HIV Surveillance Through Smartphones: Feasibility Study", journal="JMIR Public Health Surveill", year="2018", month="Aug", day="07", volume="4", number="3", pages="e11203", keywords="HIV surveillance", keywords="smartphones", keywords="mobile phones", keywords="geospatial data", abstract="Background: Precise measurements of HIV incidences at community level can help mount a more effective public health response, but the most reliable methods currently require labor-intensive population surveys. Novel mobile phone technologies are being tested for adherence to medical appointments and antiretroviral therapy, but using them to track HIV test results with automatically generated geospatial coordinates has not been widely tested. Objective: We customized a portable reader for interpreting the results of HIV lateral flow tests and developed a mobile phone app to track HIV test results in urban and rural locations in Rwanda. The objective was to assess the feasibility of this technology to collect front line HIV test results in real time and with geospatial context to help measure HIV incidences and improve epidemiological surveillance. Methods: Twenty health care workers used the technology to track the test results of 2190 patients across 3 hospital sites (2 urban sites in Kigali and a rural site in the Western Province of Rwanda). Mobile phones for less than US \$70 each were used. The mobile phone app to record HIV test results could take place without internet connectivity with uploading of results to the cloud taking place later with internet. Results: A total of 91.51\% (2004/2190) of HIV test results could be tracked in real time on an online dashboard with geographical resolution down to street level. Out of the 20 health care workers, 14 (70\%) would recommend the lateral flow reader, and 100\% would recommend the mobile phone app. Conclusions: Smartphones have the potential to simplify the input of HIV test results with geospatial context and in real time to improve public health surveillance of HIV. ", doi="10.2196/11203", url="http://publichealth.jmir.org/2018/3/e11203/", url="http://www.ncbi.nlm.nih.gov/pubmed/30087088" } @Article{info:doi/10.2196/mhealth.9896, author="Cervera Peris, Mercedes and Alonso Ror{\'i}s, Manuel V{\'i}ctor and Santos Gago, Manuel Juan and {\'A}lvarez Sabucedo, Luis and Wanden-Berghe, Carmina and Sanz-Valero, Javier", title="Management of the General Process of Parenteral Nutrition Using mHealth Technologies: Evaluation and Validation Study", journal="JMIR Mhealth Uhealth", year="2018", month="Apr", day="03", volume="6", number="4", pages="e79", keywords="parenteral nutrition", keywords="mobile apps", keywords="quality control", keywords="validation software", abstract="Background: Any system applied to the control of parenteral nutrition (PN) ought to prove that the process meets the established requirements and include a repository of records to allow evaluation of the information about PN processes at any time. Objective: The goal of the research was to evaluate the mobile health (mHealth) app and validate its effectiveness in monitoring the management of the PN process. Methods: We studied the evaluation and validation of the general process of PN using an mHealth app. The units of analysis were the PN bags prepared and administered at the Son Espases University Hospital, Palma, Spain, from June 1 to September 6, 2016. For the evaluation of the app, we used the Poststudy System Usability Questionnaire and subsequent analysis with the Cronbach alpha coefficient. Validation was performed by checking the compliance of control for all operations on each of the stages (validation and transcription of the prescription, preparation, conservation, and administration) and by monitoring the operative control points and critical control points. Results: The results obtained from 387 bags were analyzed, with 30 interruptions of administration. The fulfillment of stages was 100\%, including noncritical nonconformities in the storage control. The average deviation in the weight of the bags was less than 5\%, and the infusion time did not present deviations greater than 1 hour. Conclusions: The developed app successfully passed the evaluation and validation tests and was implemented to perform the monitoring procedures for the overall PN process. A new mobile solution to manage the quality and traceability of sensitive medicines such as blood-derivative drugs and hazardous drugs derived from this project is currently being deployed. ", doi="10.2196/mhealth.9896", url="http://mhealth.jmir.org/2018/4/e79/", url="http://www.ncbi.nlm.nih.gov/pubmed/29615389" } @Article{info:doi/10.2196/mhealth.6335, author="de Korte, Marieke Elsbeth and Wiezer, Noortje and Janssen, H. Joris and Vink, Peter and Kraaij, Wessel", title="Evaluating an mHealth App for Health and Well-Being at Work: Mixed-Method Qualitative Study", journal="JMIR Mhealth Uhealth", year="2018", month="Mar", day="28", volume="6", number="3", pages="e72", keywords="mHealth", keywords="work", keywords="qualitative research methods", keywords="interview", keywords="focus group", keywords="technology acceptance", keywords="user satisfaction", keywords="usability", keywords="well-being", keywords="prevention", abstract="Background: To improve workers' health and well-being, workplace interventions have been developed, but utilization and reach are unsatisfactory, and effects are small. In recent years, new approaches such as mobile health (mHealth) apps are being developed, but the evidence base is poor. Research is needed to examine its potential and to assess when, where, and for whom mHealth is efficacious in the occupational setting. To develop interventions for workers that actually will be adopted, insight into user satisfaction and technology acceptance is necessary. For this purpose, various qualitative evaluation methods are available. Objective: The objectives of this study were to gain insight into (1) the opinions and experiences of employees and experts on drivers and barriers using an mHealth app in the working context and (2) the added value of three different qualitative methods that are available to evaluate mHealth apps in a working context: interviews with employees, focus groups with employees, and a focus group with experts. Methods: Employees of a high-tech company and experts were asked to use an mHealth app for at least 3 weeks before participating in a qualitative evaluation. Twenty-two employees participated in interviews, 15 employees participated in three focus groups, and 6 experts participated in one focus group. Two researchers independently coded, categorized, and analyzed all quotes yielded from these evaluation methods with a codebook using constructs from user satisfaction and technology acceptance theories. Results: Interviewing employees yielded 785 quotes, focus groups with employees yielded 266 quotes, and the focus group with experts yielded 132 quotes. Overall, participants muted enthusiasm about the app. Combined results from the three evaluation methods showed drivers and barriers for technology, user characteristics, context, privacy, and autonomy. A comparison between the three qualitative methods showed that issues revealed by experts only slightly overlapped with those expressed by employees. In addition, it was seen that the type of evaluation yielded different results. Conclusions: Findings from this study provide the following recommendations for organizations that are planning to provide mHealth apps to their workers and for developers of mHealth apps: (1) system performance influences adoption and adherence, (2) relevancy and benefits of the mHealth app should be clear to the user and should address users' characteristics, (3) app should take into account the work context, and (4) employees should be alerted to their right to privacy and use of personal data. Furthermore, a qualitative evaluation of mHealth apps in a work setting might benefit from combining more than one method. Factors to consider when selecting a qualitative research method are the design, development stage, and implementation of the app; the working context in which it is being used; employees' mental models; practicability; resources; and skills required of experts and users. ", doi="10.2196/mhealth.6335", url="http://mhealth.jmir.org/2018/3/e72/", url="http://www.ncbi.nlm.nih.gov/pubmed/29592846" } @Article{info:doi/10.2196/humanfactors.8319, author="Dijkstra, Elske Nienke and Sino, Maria Carolina Geertruida and Heerdink, Rob Eibert and Schuurmans, Joanna Marieke", title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study", journal="JMIR Hum Factors", year="2018", month="Mar", day="07", volume="5", number="1", pages="e10", keywords="primary care", keywords="home care", keywords="eHealth", keywords="mHealth", abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ", doi="10.2196/humanfactors.8319", url="http://humanfactors.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29514771" } @Article{info:doi/10.2196/mhealth.8636, author="Liu, Hao-Yen and Lee, Wui-Chiang and Sun, Ying-Chou and Fen, Jun-Jeng and Chen, Tzeng-Ji and Chou, Li-Fang and Hwang, Shinn-Jang", title="Hospital-Owned Apps in Taiwan: Nationwide Survey", journal="JMIR Mhealth Uhealth", year="2018", month="Jan", day="16", volume="6", number="1", pages="e22", keywords="hospitals", keywords="telemedicine", keywords="mobile apps", keywords="Taiwan", keywords="mHealth", abstract="Background: Over the last decade, the use of mobile phone apps in the health care industry has grown rapidly. Owing to the high penetration rate of Internet use in Taiwan, hospitals are eager to provide their own apps to improve the accessibility of medical care for patients. Objective: The aims of this study were to provide an overview of the currently available hospital-owned apps in Taiwan and to conduct a cross-hospital comparison of app features. Methods: In May 2017, the availability of apps from all 414 hospitals in Taiwan was surveyed from the hospital home pages and the Google Play app store. The features of the downloaded apps were then examined in detail and, for each app, the release date of the last update, download frequency, and rating score were obtained from Google Play. Results: Among all the 414 hospitals in Taiwan, 150 (36.2\%) owned Android apps that had been made available for public use, including 95\% (18/19) of the academic medical centers, 77\% (63/82) of the regional hospitals, and 22.0\% (69/313) of the local community hospitals. Among the 13 different functionalities made available by the various hospital-owned apps, the most common were the doctor search (100\%, 150/150), real-time queue monitoring (100\%, 150/150), and online appointment scheduling (94.7\%, 142/150) functionalities. The majority of apps (57.3\%, 86/150) had a rating greater than 4 out of 5, 49.3\% (74/150) had been updated at some point in 2017, and 36.0\% (54/150) had been downloaded 10,000 to 50,000 times. Conclusions: More than one-third of the hospitals owned apps intended to increase patient access to health care. The most common app features might reflect the health care situation in Taiwan, where the overcrowded outpatient departments of hospitals operate in an open-access mode without any strict referral system. Further research should focus on the effectiveness and safety of these apps. ", doi="10.2196/mhealth.8636", url="http://mhealth.jmir.org/2018/1/e22/", url="http://www.ncbi.nlm.nih.gov/pubmed/29339347" } @Article{info:doi/10.2196/mhealth.9061, author="Nilsson, Ulrica and Dahlberg, Karuna and Jaensson, Maria", title="The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study", journal="JMIR Mhealth Uhealth", year="2017", month="Dec", day="3", volume="5", number="12", pages="e188", keywords="psychometric evaluation", keywords="postoperative recovery", keywords="Web version", keywords="evaluation studies", keywords="mobile application", keywords="Quality of Recovery scale", abstract="Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP. Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR. Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ?18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14. Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95\% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1\%. An exploratory factor analysis found 5 components explaining 57.8\% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect. Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients' postoperative recovery. ", doi="10.2196/mhealth.9061", url="http://mhealth.jmir.org/2017/12/e188/", url="http://www.ncbi.nlm.nih.gov/pubmed/29229590" } @Article{info:doi/10.2196/mhealth.8296, author="Katayama, Yusuke and Kitamura, Tetsuhisa and Kiyohara, Kosuke and Iwami, Taku and Kawamura, Takashi and Izawa, Junichi and Gibo, Koichiro and Komukai, Sho and Hayashida, Sumito and Kiguchi, Takeyuki and Ohnishi, Mitsuo and Ogura, Hiroshi and Shimazu, Takeshi", title="Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan", journal="JMIR Mhealth Uhealth", year="2017", month="Sep", day="11", volume="5", number="9", pages="e134", keywords="emergency medicine", keywords="emergency medical services", keywords="mobile health", keywords="telemedicine", keywords="public health", abstract="Background: Recently, the number of ambulance dispatches has been increasing in Japan, and it is therefore difficult for hospitals to accept emergency patients smoothly and appropriately because of the limited hospital capacity. To facilitate the process of requesting patient transport and hospital acceptance, an emergency information system using information technology (IT) has been built and introduced in various communities. However, its effectiveness has not been thoroughly revealed. We introduced a smartphone app system in 2013 that enables emergency medical service (EMS) personnel to share information among themselves regarding on-scene ambulances and the hospital situation. Objective: The aim of this study was to assess the effects of introducing this smartphone app on the EMS system in Osaka City, Japan. Methods: This retrospective study analyzed the population-based ambulance records of Osaka Municipal Fire Department. The study period was 6 years, from January 1, 2010 to December 31, 2015. We enrolled emergency patients for whom on-scene EMS personnel conducted hospital selection. The main endpoint was the difficulty experienced in gaining hospital acceptance at the scene. The definition of difficulty was making ?5 phone calls by EMS personnel at the scene to hospitals until a decision to transport was determined. The smartphone app was introduced in January 2013, and we compared the patients treated from 2010 to 2012 (control group) with those treated from 2013 to 2015 (smartphone app group) using an interrupted time-series analysis to assess the effects of introducing this smartphone app. Results: A total of 600,526 emergency patients for whom EMS personnel selected hospitals were eligible for our analysis. There were 300,131 emergency patients in the control group (50.00\%, 300,313/600,526) from 2010 to 2012 and 300,395 emergency patients in the smartphone app group (50.00\%, 300,395/600,526) from 2013 to 2015. The rate of difficulty in hospital acceptance was 14.19\% (42,585/300,131) in the control group and 10.93\% (32,819/300,395) in the smartphone app group. No change over time in the number of difficulties in hospital acceptance was found before the introduction of the smartphone app (regression coefficient: ?2.43, 95\% CI ?5.49 to 0.64), but after its introduction, the number of difficulties in hospital acceptance gradually decreased by month (regression coefficient: ?11.61, 95\% CI ?14.57 to ?8.65). Conclusions: Sharing information between an ambulance and a hospital by using the smartphone app at the scene was associated with decreased difficulty in obtaining hospital acceptance. Our app and findings may be worth considering in other areas of the world where emergency medical information systems with IT are needed. ", doi="10.2196/mhealth.8296", url="http://mhealth.jmir.org/2017/9/e134/", url="http://www.ncbi.nlm.nih.gov/pubmed/28893725" } @Article{info:doi/10.2196/mhealth.6889, author="Tian, Maoyi and Zhang, Jing and Luo, Rong and Chen, Shi and Petrovic, Djordje and Redfern, Julie and Xu, Roman Dong and Patel, Anushka", title="mHealth Interventions for Health System Strengthening in China: A Systematic Review", journal="JMIR Mhealth Uhealth", year="2017", month="Mar", day="16", volume="5", number="3", pages="e32", keywords="mHealth", keywords="China", keywords="health care systems", abstract="Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective: The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods: We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results: A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. ", doi="10.2196/mhealth.6889", url="http://mhealth.jmir.org/2017/3/e32/", url="http://www.ncbi.nlm.nih.gov/pubmed/28302597" } @Article{info:doi/10.2196/mhealth.5796, author="Mira, Joaqu{\'i}n Jos{\'e} and Carrillo, Irene and Fernandez, Cesar and Vicente, Asuncion Maria and Guilabert, Mercedes", title="Design and Testing of the Safety Agenda Mobile App for Managing Health Care Managers' Patient Safety Responsibilities", journal="JMIR Mhealth Uhealth", year="2016", month="Dec", day="08", volume="4", number="4", pages="e131", keywords="patient safety", keywords="mobile apps", keywords="administrators", keywords="health service", abstract="Background: Adverse events are a reality in clinical practice. Reducing the prevalence of preventable adverse events by stemming their causes requires health managers' engagement. Objective: The objective of our study was to develop an app for mobile phones and tablets that would provide managers with an overview of their responsibilities in matters of patient safety and would help them manage interventions that are expected to be carried out throughout the year. Methods: The Safety Agenda Mobile App (SAMA) was designed based on standardized regulations and reviews of studies about health managers' roles in patient safety. A total of 7 managers used a beta version of SAMA for 2 months and then they assessed and proposed improvements in its design. Their experience permitted redesigning SAMA, improving functions and navigation. A total of 74 Spanish health managers tried out the revised version of SAMA. After 4 months, their assessment was requested in a voluntary and anonymous manner. Results: SAMA is an iOS app that includes 37 predefined tasks that are the responsibility of health managers. Health managers can adapt these tasks to their schedule, add new ones, and share them with their team. SAMA menus are structured in 4 main areas: information, registry, task list, and settings. Of the 74 users who tested SAMA, 64 (86\%) users provided a positive assessment of SAMA characteristics and utility. Over an 11-month period, 238 users downloaded SAMA. This mobile app has obtained the AppSaludable (HealthyApp) Quality Seal. Conclusions: SAMA includes a set of activities that are expected to be carried out by health managers in matters of patient safety and contributes toward improving the awareness of their responsibilities in matters of safety. ", doi="10.2196/mhealth.5796", url="http://mhealth.jmir.org/2016/4/e131/", url="http://www.ncbi.nlm.nih.gov/pubmed/27932315" } @Article{info:doi/10.2196/publichealth.3381, author="Kaphle, Sangya and Matheke-Fischer, Michael and Lesh, Neal", title="Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2016", month="Dec", day="07", volume="2", number="2", pages="e169", keywords="community health workers", keywords="performance feedback", keywords="motivation", keywords="supportive supervision", keywords="mHealth apps", abstract="Background: Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective: The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods: In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results: We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass's delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass's delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. ", doi="10.2196/publichealth.3381", url="http://publichealth.jmir.org/2016/2/e169/", url="http://www.ncbi.nlm.nih.gov/pubmed/27927607" } @Article{info:doi/10.2196/mhealth.2654, author="Zhong, Daidi and Kirwan, J. Michael and Duan, Xiaolian", title="Regulatory Barriers Blocking Standardization of Interoperability", journal="JMIR Mhealth Uhealth", year="2013", month="Jul", day="12", volume="1", number="2", pages="e13", keywords="medical device regulation", keywords="device interoperability", keywords="personal health device", keywords="standardization", doi="10.2196/mhealth.2654", url="http://mhealth.jmir.org/2013/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/25098204" }