@Article{info:doi/10.2196/mhealth.5659,
author="Davis, Latham Teaniese
and DiClemente, Ralph
and Prietula, Michael",
title="Taking mHealth Forward: Examining the Core Characteristics",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="10",
volume="4",
number="3",
pages="e97",
keywords="mobile health",
keywords="eHealth",
keywords="mHealth",
keywords="health policy",
keywords="health technology",
keywords="text messaging",
keywords="public health informatics",
keywords="telehealth",
doi="10.2196/mhealth.5659",
url="http://mhealth.jmir.org/2016/3/e97/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27511612"
}


@Article{info:doi/10.2196/mhealth.5341,
author="Koldijk, Saskia
and Kraaij, Wessel
and Neerincx, A. Mark",
title="Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="05",
volume="4",
number="3",
pages="e79",
keywords="psychological stress",
keywords="professional burn-out",
keywords="behavioral symptoms",
keywords="self-management",
keywords="health technology",
keywords="early medical intervention",
abstract="Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate ``engagement and burn-out'' to ``stress'', and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. ",
doi="10.2196/mhealth.5341",
url="http://mhealth.jmir.org/2016/3/e79/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27380749"
}


@Article{info:doi/10.2196/mhealth.5855,
author="Fanning, Jason
and Mackenzie, Michael
and Roberts, Sarah
and Crato, Ines
and Ehlers, Diane
and McAuley, Edward",
title="Physical Activity, Mind Wandering, Affect, and Sleep: An Ecological Momentary Assessment",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="31",
volume="4",
number="3",
pages="e104",
keywords="physical activity",
keywords="mHealth",
keywords="attention",
keywords="sleep",
keywords="affect",
abstract="Background: A considerable portion of daily thought is spent in mind wandering. This behavior has been related to positive (eg, future planning, problem solving) and negative (eg, unhappiness, impaired cognitive performance) outcomes. Objective: Based on previous research suggesting future-oriented (ie, prospective) mind wandering may support autobiographical planning and self-regulation, this study examined associations between hourly mind wandering and moderate-to-vigorous physical activity (MVPA), and the impact of affect and daily sleep on these relations. Methods: College-aged adults (N=33) participated in a mobile phone-delivered ecological momentary assessment study for 1 week. Sixteen hourly prompts assessing mind wandering and affect were delivered daily via participants' mobile phones. Perceived sleep quality and duration was assessed during the first prompt each day, and participants wore an ActiGraph accelerometer during waking hours throughout the study week. Results: Study findings suggest present-moment mind wandering was positively associated with future MVPA (P=.03), and this relationship was moderated by affective state (P=.04). Moreover, excessive sleep the previous evening was related to less MVPA across the following day (P=.007). Further, mind wandering was positively related to activity only among those who did not oversleep (P=.007). Conclusions: Together, these results have implications for multiple health behavior interventions targeting physical activity, affect, and sleep. Researchers may also build on this work by studying these relationships in the context of other important behaviors and psychosocial factors (eg, tobacco use, depression, loneliness). ",
doi="10.2196/mhealth.5855",
url="http://mhealth.jmir.org/2016/3/e104/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27580673"
}


@Article{info:doi/10.2196/mhealth.5716,
author="Huerta-Ramos, Elena
and Escobar-Villegas, Soledad Maria
and Rubinstein, Katya
and Unoka, Szabolcs Zsolt
and Grasa, Eva
and Hospedales, Margarita
and J{\"a}{\"a}skel{\"a}inen, Erika
and Rubio-Abadal, Elena
and Caspi, Asaf
and Bitter, Istv{\'a}n
and Berdun, Jesus
and Sepp{\"a}l{\"a}, Jussi
and Ochoa, Susana
and Fazekas, Kata
and 
and Corripio, Iluminada
and Usall, Judith",
title="Measuring Users' Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="28",
volume="4",
number="3",
pages="e112",
keywords="mHealth solution",
keywords="treatment-resistant schizophrenia",
keywords="intervention model",
keywords="qualitative research",
keywords="needs assessment",
abstract="Background: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact. ",
doi="10.2196/mhealth.5716",
url="http://mhealth.jmir.org/2016/3/e112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27682896"
}


@Article{info:doi/10.2196/mhealth.6023,
author="Gunter, Rebecca
and Fernandes-Taylor, Sara
and Mahnke, Andrea
and Awoyinka, Lola
and Schroeder, Chad
and Wiseman, Jason
and Sullivan, Sarah
and Bennett, Kyla
and Greenberg, Caprice
and Kent, Craig K.",
title="Evaluating Patient Usability of an Image-Based Mobile Health Platform for Postoperative Wound Monitoring",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="28",
volume="4",
number="3",
pages="e113",
keywords="telemedicine",
keywords="smartphone",
keywords="surgical site infection",
keywords="postoperative wound infection",
abstract="Background: Surgical patients are increasingly using mobile health (mHealth) platforms to monitor recovery and communicate with their providers in the postdischarge period. Despite widespread enthusiasm for mHealth, few studies evaluate the usability or user experience of these platforms. Objective: Our objectives were to (1) develop a novel image-based smartphone app for postdischarge surgical wound monitoring, and (2) rigorously user test it with a representative population of vascular and general surgery patients. Methods: A total of 9 vascular and general surgery inpatients undertook usability testing of an internally developed smartphone app that allows patients to take digital images of their wound and answer a survey about their recovery. We followed the International Organization for Standardization (ISO) 9241-11 guidelines, focusing on effectiveness, efficiency, and user satisfaction. An accompanying training module was developed by applying tenets of adult learning. Sessions were audio-recorded, and the smartphone screen was mirrored onto a study computer. Digital image quality was evaluated by a physician panel to determine usefulness for clinical decision making. Results: The mean length of time spent was 4.7 (2.1-12.8) minutes on the training session and 5.0 (1.4-16.6) minutes on app completion. 55.5\% (5/9) of patients were able to complete the app independently with the most difficulty experienced in taking digital images of surgical wounds. Novice patients who were older, obese, or had groin wounds had the most difficulty. 81.8\% of images were sufficient for diagnostic purposes. User satisfaction was high, with an average usability score of 83.3 out of 100. Conclusion: Surgical patients can learn to use a smartphone app for postoperative wound monitoring with high user satisfaction. We identified design features and training approaches that can facilitate ease of use. This protocol illustrates an important, often overlooked, aspect of mHealth development to improve surgical care. ",
doi="10.2196/mhealth.6023",
url="http://mhealth.jmir.org/2016/3/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27683059"
}


@Article{info:doi/10.2196/mhealth.5921,
author="Alwashmi, Meshari
and Hawboldt, John
and Davis, Erin
and Marra, Carlo
and Gamble, John-Michael
and Abu Ashour, Waseem",
title="The Effect of Smartphone Interventions on Patients With Chronic Obstructive Pulmonary Disease Exacerbations: A Systematic Review and Meta-Analysis",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="01",
volume="4",
number="3",
pages="e105",
keywords="pulmonary disease, chronic obstructive",
keywords="telemedicine",
keywords="smartphone",
keywords="self care",
keywords="disease progression",
keywords="review",
keywords="meta-analysis",
abstract="Background: The prevalence and mortality rates of chronic obstructive pulmonary disease (COPD) are increasing worldwide. Therefore, COPD remains a major public health problem. There is a growing interest in the use of smartphone technology for health promotion and disease management interventions. However, the effectiveness of smartphones in reducing the number of patients having a COPD exacerbation is poorly understood. Objective: To summarize and quantify the association between smartphone interventions and COPD exacerbations through a comprehensive systematic review and meta-analysis. Methods: A comprehensive search strategy was conducted across relevant databases (PubMed, Embase, Cochrane, CINHA, PsycINFO, and the Cochrane Library Medline) from inception to October 2015. We included studies that assessed the use of smartphone interventions in the reduction of COPD exacerbations compared with usual care. Full-text studies were excluded if the investigators did not use a smartphone device or did not report on COPD exacerbations. Observational studies, abstracts, and reviews were also excluded. Two reviewers extracted the data and conducted a risk of bias assessment using the US Preventive Services Task Force quality rating criteria. A random effects model was used to meta-analyze the results from included studies. Pooled odds ratios were used to measure the effectiveness of smartphone interventions on COPD exacerbations. Heterogeneity was measured using the I2statistic. Results: Of the 245 unique citations screened, 6 studies were included in the qualitative synthesis. Studies were relatively small with less than 100 participants in each study (range 30 to 99) and follow-up ranged from 4-9 months. The mean age was 70.5 years (SD 5.6) and 74\% (281/380) were male. The studies varied in terms of country, type of smartphone intervention, frequency of data collection from the participants, and the feedback strategy. Three studies were included in the meta-analysis. The overall assessment of potential bias of the studies that were included in the meta-analysis was ``Good'' for one study and ``Fair'' for 2 studies. The pooled random effects odds ratio of patients having an exacerbation was 0.20 in patients using a smartphone intervention (95\% CI 0.07-0.62), a reduction of 80\% for smartphone interventions compared with usual care. However, there was moderate heterogeneity across the included studies (I2=59\%). Conclusion: Although current literature on the role of smartphones in reducing COPD exacerbations is limited, findings from our review suggest that smartphones are useful in reducing the number of patients having a COPD exacerbation. Nevertheless, using smartphones require synergistic strategies to achieve the desired outcome. These results should be interpreted with caution due to the heterogeneity among the studies. Researchers should focus on conducting rigorous studies with adequately powered sample sizes to determine the validity and clinical utility of smartphone interventions in the management of COPD. ",
doi="10.2196/mhealth.5921",
url="http://mhealth.jmir.org/2016/3/e105/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27589898"
}


@Article{info:doi/10.2196/mhealth.6187,
author="Lyles, R. Courtney
and Altschuler, Andrea
and Chawla, Neetu
and Kowalski, Christine
and McQuillan, Deanna
and Bayliss, Elizabeth
and Heisler, Michele
and Grant, W. Richard",
title="User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="14",
volume="4",
number="3",
pages="e108",
keywords="primary health care",
keywords="chronic disease",
keywords="computers, handheld",
keywords="mobile applications",
keywords="medical informatics",
keywords="health communication",
abstract="Background: Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits. Objective: Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization. Methods: We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool. In this paper, we present the significant changes made to the tablet tool at each phase of this design work. Results: Patient feedback emphasized the need to make the tablet tool accessible for patients who lacked technical proficiency and to reduce the quantity and complexity of text presentation. Both patients and their providers identified specific content choices based on their personal experiences (eg, the ability to raise private or sensitive concerns) and recommended targeting new patients. Stakeholder groups provided essential input on the need to augment text with video and to create different versions of the videos to match sex and race/ethnicity of the actors with patients. Conclusions: User-centered design in collaboration with patients, providers, and key health stakeholders led to marked evolution in the initial content, layout, and target audience for a tablet waiting room tool intended to assist complex patients with setting visit discussion priorities. ",
doi="10.2196/mhealth.6187",
url="http://mhealth.jmir.org/2016/3/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27627965"
}


@Article{info:doi/10.2196/mhealth.5284,
author="Cheng, Ferrer Paula Glenda
and Ramos, Munoz Roann
and Bitsch, {\'A}gila J{\'o}
and Jonas, Michael Stephan
and Ix, Tim
and See, Quetulio Portia Lynn
and Wehrle, Klaus",
title="Psychologist in a Pocket: Lexicon Development and Content Validation of a Mobile-Based App for Depression Screening",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="20",
volume="4",
number="3",
pages="e88",
keywords="depression",
keywords="Psychologist in a Pocket",
keywords="lexicon development",
keywords="text analysis",
abstract="Background: Language reflects the state of one's mental health and personal characteristics. It also reveals preoccupations with a particular schema, thus possibly providing insights into psychological conditions. Using text or lexical analysis in exploring depression, negative schemas and self-focusing tendencies may be depicted. As mobile technology has become highly integrated in daily routine, mobile devices have the capacity for ecological momentary assessment (EMA), specifically the experience sampling method (ESM), where behavior is captured in real-time or closer in time to experience in one's natural environment. Extending mobile technology to psychological health could augment initial clinical assessment, particularly of mood disturbances, such as depression and analyze daily activities, such as language use in communication. Here, we present the process of lexicon generation and development and the initial validation of Psychologist in a Pocket (PiaP), a mobile app designed to screen signs of depression through text analysis. Objective: The main objectives of the study are (1) to generate and develop a depressive lexicon that can be used for screening text-input in mobile apps to be used in the PiaP; and (2) to conduct content validation as initial validation. Methods: The first phase of our research focused on lexicon development. Words related to depression and its symptoms based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and in the ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines classification systems were gathered from focus group discussions with Filipino college students, interviews with mental health professionals, and the review of established scales for depression and other related constructs. Results: The lexicon development phase yielded a database consisting of 13 categories based on the criteria depressive symptoms in the DSM-5 and ICD-10. For the draft of the depression lexicon for PiaP, we were able to gather 1762 main keywords and 9655 derivatives of main keywords. In addition, we compiled 823,869 spelling variations. Keywords included negatively-valenced words like ``sad'', ``unworthy'', or ``tired'' which are almost always accompanied by personal pronouns, such as ``I'', ``I'm'' or ``my'' and in Filipino, ``ako'' or ``ko''. For the content validation, only keywords with CVR equal to or more than 0.75 were included in the depression lexicon test-run version. The mean of all CVRs yielded a high overall CVI of 0.90. A total of 1498 main keywords, 8911 derivatives of main keywords, and 783,140 spelling variations, with a total of 793, 553 keywords now comprise the test-run version. Conclusions: The generation of the depression lexicon is relatively exhaustive. The breadth of keywords used in text analysis incorporates the characteristic expressions of depression and its related constructs by a particular culture and age group. A content-validated mobile health app, PiaP may help augment a more effective and early detection of depressive symptoms. ",
doi="10.2196/mhealth.5284",
url="http://mhealth.jmir.org/2016/3/e88/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27439444"
}


@Article{info:doi/10.2196/mhealth.5960,
author="Wahle, Fabian
and Kowatsch, Tobias
and Fleisch, Elgar
and Rufer, Michael
and Weidt, Steffi",
title="Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="21",
volume="4",
number="3",
pages="e111",
keywords="depression",
keywords="mHealth",
keywords="?activities of daily living",
keywords="classification",
keywords="context awareness",
keywords="cognitive behavioral therapy",
abstract="Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject's preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results: A total of 36 subjects used MOSS for ?2 weeks. For subjects with clinical depression (PHQ-9?11) at baseline and adherence ?8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=?.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9?11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1\% and 59.1\% accuracy, respectively. Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states. ",
doi="10.2196/mhealth.5960",
url="http://mhealth.jmir.org/2016/3/e111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27655245"
}


@Article{info:doi/10.2196/mhealth.5406,
author="Zaidan, Sarah
and Roehrer, Erin",
title="Popular Mobile Phone Apps for Diet and Weight Loss: A Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="11",
volume="4",
number="3",
pages="e80",
keywords="applications",
keywords="diet",
keywords="monitoring",
keywords="obesity",
keywords="weight loss",
abstract="Background: A review of the literature has revealed that the rates of overweight and obesity have been increasing in Australia over the last two decades and that wellness mobile phone apps play a significant role in monitoring and managing individuals' weight. Although mobile phone app markets (iTunes and Google Play) list thousands of mobile phone health apps, it is not always clear whether those apps are supported by credible sources. Likewise, despite the prevailing use of mobile phone apps to aid with weight management, the usability features of these apps are not well characterized. Objective: The research explored how usability taxonomy could inform the popularity of downloaded, socially focused wellness mobile phone apps, in particular weight loss and diet apps. The aim of the study was to investigate the Australian mobile phone app stores (iTunes and Google Play) in order to examine the usability features of the most popular (ie, most downloaded) wellness apps. Methods: The design of this study comprises 3 main stages: stage 1, identifying apps; stage 2, development of weight loss and diet evaluation framework; and stage 3, application of the evaluation framework. Each stage includes specific data collection, analysis tools, and techniques. Results: The study has resulted in the development of a justified evaluation framework for weight loss and diet mobile phone apps. Applying the evaluation framework to the identified apps has shown that the most downloaded iTunes and Google Play apps are not necessarily the most usable or effective. In addition, the research found that search algorithms for iTunes and Google Play are biased toward apps' titles and keywords that do not accurately define the real functionality of the app. Moreover, the study has also analyzed the apps' user reviews, which served as justification for the developed evaluation framework. Conclusions: The analysis has shown that ease of use, reminder, bar code scanning, motivation, usable for all, and synchronization are significant attributes that should be included in weight loss and diet mobile phone apps and ultimately in potential weight loss and diet evaluation frameworks. ",
doi="10.2196/mhealth.5406",
url="http://mhealth.jmir.org/2016/3/e80/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27400806"
}


@Article{info:doi/10.2196/mhealth.5115,
author="Rivera, Jordan
and McPherson, Amy
and Hamilton, Jill
and Birken, Catherine
and Coons, Michael
and Iyer, Sindoora
and Agarwal, Arnav
and Lalloo, Chitra
and Stinson, Jennifer",
title="Mobile Apps for Weight Management: A Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="26",
volume="4",
number="3",
pages="e87",
keywords="weight loss",
keywords="obesity",
keywords="mobile apps",
keywords="smartphones",
keywords="mHealth",
abstract="Background: Obesity remains a major public health concern. Mobile apps for weight loss/management are found to be effective for improving health outcomes in adults and adolescents, and are pursued as a cost-effective and scalable intervention for combating overweight and obesity. In recent years, the commercial market for `weight loss apps' has expanded at rapid pace, yet little is known regarding the evidence-based quality of these tools for weight control. Objective: To characterize the inclusion of evidence-based strategies, health care expert involvement, and scientific evaluation of commercial mobile apps for weight loss/management. Methods: An electronic search was conducted between July 2014 and July 2015 of the official app stores for four major mobile operating systems. Three raters independently identified apps with a stated goal of weight loss/management, as well as weight loss/management apps targeted to pediatric users. All discrepancies regarding selection were resolved through discussion with a fourth rater. Metadata from all included apps were abstracted into a standard assessment criteria form and the evidence-based strategies, health care expert involvement, and scientific evaluation of included apps was assessed. Evidence-based strategies included: self-monitoring, goal-setting, physical activity support, healthy eating support, weight and/or health assessment, personalized feedback, motivational strategies, and social support. Results: A total of 393 apps were included in this review. Self-monitoring was most common (139/393, 35.3\%), followed by physical activity support (108/393, 27.5\%), weight assessment (100/393, 25.4\%), healthy eating support (91/393, 23.2\%), goal-setting (84/393, 21.4\%), motivational strategies (28/393, 7.1\%), social support (21/393, 5.3\%), and personalized feedback (7/393, 1.8\%). Of apps, 0.8\% (3/393) underwent scientific evaluation and 0.3\% (1/393) reported health care expert involvement. No apps were comprehensive in the assessment criteria, with the majority of apps meeting less than two criteria. Conclusions: Commercial mobile apps for weight loss/management lack important evidence-based features, do not involve health care experts in their development process, and have not undergone rigorous scientific testing. This calls into question the validity of apps' claims regarding their effectiveness and safety, at a time when the availability and growth in adoption of these tools is rapidly increasing. Collaborative efforts between developers, researchers, clinicians, and patients are needed to develop and test high-quality, evidence-based mobile apps for weight loss/management before they are widely disseminated in commercial markets. ",
doi="10.2196/mhealth.5115",
url="http://mhealth.jmir.org/2016/3/e87/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27460502"
}


@Article{info:doi/10.2196/mhealth.5241,
author="Mattila, Elina
and Lappalainen, Raimo
and V{\"a}lkkynen, Pasi
and Sairanen, Essi
and Lappalainen, P{\"a}ivi
and Karhunen, Leila
and Peuhkuri, Katri
and Korpela, Riitta
and Kolehmainen, Marjukka
and Ermes, Miikka",
title="Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="28",
volume="4",
number="3",
pages="e90",
keywords="mobile apps",
keywords="Acceptance and Commitment Therapy",
keywords="retrospective study",
keywords="adherence",
abstract="Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86\%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95\% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=?0.10, P=.01), usage days (B=?0.17, P=.008), and usage weeks (B=?0.73, P=.02), the number of exercises performed (B=?0.02, P=.03), and the total duration of use (B=?0.30, P=.04). Also, higher usage of Acceptance related exercises (B=?0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration: ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) ",
doi="10.2196/mhealth.5241",
url="http://mhealth.jmir.org/2016/3/e90/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27468653"
}


@Article{info:doi/10.2196/mhealth.5418,
author="Segovia-Siapco, Gina
and Sabat{\'e}, Joan",
title="Using Personal Mobile Phones to Assess Dietary Intake in Free-Living Adolescents: Comparison of Face-to-Face Versus Telephone Training",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="29",
volume="4",
number="3",
pages="e91",
keywords="adolescents",
keywords="dietary assessment",
keywords="dietary records",
keywords="digital images",
keywords="follow-up",
keywords="mobile phones",
keywords="real-time support",
keywords="technology",
abstract="Background: Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data. Objective: Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up). Methods: Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an ``end'' text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups. Results: All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95\% vs 43\%, P<.001), had complete information for each meal in their food record (95\% vs 71\%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51. Conclusions: Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents. ",
doi="10.2196/mhealth.5418",
url="http://mhealth.jmir.org/2016/3/e91/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27473291"
}


@Article{info:doi/10.2196/mhealth.5700,
author="Svensson, {\AA}sa
and Magnusson, Maria
and Larsson, Christel",
title="Overcoming Barriers: Adolescents' Experiences Using a Mobile Phone Dietary Assessment App",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="29",
volume="4",
number="3",
pages="e92",
keywords="adolescents",
keywords="content analysis",
keywords="dietary assessment",
keywords="Self Determination Theory",
keywords="mobile phone app",
abstract="Background: The use of new technology has the potential to increase participation rates in dietary studies and improve the validity of collected dietary data. However, to evaluate the usability of developed dietary methods, qualitative studies of participants' experiences and perceptions are needed. Objective: To explore adolescents' experiences using a newly developed mobile phone dietary assessment app, with a focus on factors that could affect their recording of dietary intake. Methods: Focus group interviews were conducted with 75 participants who had used a newly developed mobile phone dietary assessment app in a quantitative evaluation study. The interviews were analyzed using qualitative content analysis and the theoretical framework of Self Determination Theory was applied. Results: The adolescents' use of the mobile phone dietary assessment app was characterized by their struggle to overcome several perceived barriers. Facilitators that helped adolescents complete the method were also identified. Motivation was found to be an important facilitator, and intrinsically motivated participants completed the method because they found it fun to use. The autonomous extrinsically motivated participants completed the method for the greater good, in order to contribute to the study. The controlled extrinsically motivated participants completed the method to get a reward or avoid punishment. Amotivated participants did not complete the method. More motivated participants were assumed to be more able to overcome barriers and needed less facilitators. Conclusions: Future studies that examine the recording of food intake should include systematic efforts that aim to minimize identified barriers and promote identified facilitators. Further research should specifically aim at studying methods for (and effects of) increasing intrinsic motivation by supporting autonomy, competence, and relatedness among adolescents asked to participate in dietary studies. ",
doi="10.2196/mhealth.5700",
url="http://mhealth.jmir.org/2016/3/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27473462"
}


@Article{info:doi/10.2196/mhealth.4878,
author="Hartin, J. Phillip
and Nugent, D. Chris
and McClean, I. Sally
and Cleland, Ian
and Tschanz, T. JoAnn
and Clark, J. Christine
and Norton, C. Maria",
title="The Empowering Role of Mobile Apps in Behavior Change Interventions: The Gray Matters Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="02",
volume="4",
number="3",
pages="e93",
keywords="behavior",
keywords="health behavior",
keywords="behavior change",
keywords="motivation",
keywords="Alzheimer disease",
keywords="smartphone",
abstract="Background: Health education and behavior change programs targeting specific risk factors have demonstrated their effectiveness in reducing the development of future diseases. Alzheimer disease (AD) shares many of the same risk factors, most of which can be addressed via behavior change. It is therefore theorized that a behavior change intervention targeting these risk factors would likely result in favorable rates of AD prevention. Objective: The objective of this study was to reduce the future risk of developing AD, while in the short term promoting vascular health, through behavior change. Methods: The study was an interventional randomized controlled trial consisting of subjects who were randomly assigned into either treatment (n=102) or control group (n=42). Outcome measures included various blood-based biomarkers, anthropometric measures, and behaviors related to AD risk. The treatment group was provided with a bespoke ``Gray Matters'' mobile phone app designed to encourage and facilitate behavior change. The app presented evidence-based educational material relating to AD risk and prevention strategies, facilitated self-reporting of behaviors across 6 behavioral domains, and presented feedback on the user's performance, calculated from reported behaviors against recommended guidelines. Results: This paper explores the rationale for a mobile phone--led intervention and details the app's effect on behavior change and subsequent clinical outcomes. Via the app, the average participant submitted 7.3 (SD 3.2) behavioral logs/day (n=122,719). Analysis of these logs against primary outcome measures revealed that participants who improved their high-density lipoprotein cholesterol levels during the study duration answered a statistically significant higher number of questions per day (mean 8.30, SD 2.29) than those with no improvement (mean 6.52, SD 3.612), t97.74=?3.051, P=.003. Participants who decreased their body mass index (BMI) performed significantly better in attaining their recommended daily goals (mean 56.21 SD 30.4\%) than those who increased their BMI (mean 40.12 SD 29.1\%), t80 = ?2.449, P=.017. In total, 69.2\% (n=18) of those who achieved a mean performance percentage of 60\% or higher, across all domains, reduced their BMI during the study, whereas 60.7\% (n=34) who did not, increased their BMI. One-way analysis of variance of systolic blood pressure category changes showed a significant correlation between reported efforts to reduce stress and category change as a whole, P=.035. An exit survey highlighted that respondents (n=83) reported that the app motivated them to perform physical activity (85.4\%) and make healthier food choices (87.5\%). Conclusions: In this study, the ubiquitous nature of the mobile phone excelled as a delivery platform for the intervention, enabling the dissemination of educational intervention material while simultaneously monitoring and encouraging positive behavior change, resulting in desirable clinical effects. Sustained effort to maintain the achieved behaviors is expected to mitigate future AD risk. Trial Registration: ClinicalTrails.gov NCT02290912; https://clinicaltrials.gov/ct2/show/NCT02290912 (Archived by WebCite at http://www.webcitation.org/6ictUEwnm) ",
doi="10.2196/mhealth.4878",
url="http://mhealth.jmir.org/2016/3/e93/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27485822"
}


@Article{info:doi/10.2196/mhealth.6002,
author="McClure, B. Jennifer
and Anderson, L. Melissa
and Bradley, Katharine
and An, C. Lawrence
and Catz, L. Sheryl",
title="Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="03",
volume="4",
number="3",
pages="e94",
keywords="tobacco use cessation",
keywords="smoking",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="secure messaging",
keywords="varenicline",
abstract="Background: Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. Objective: To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning. Methods: Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes. Results: Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92\%) and consistently take their stop-smoking medication (17/22, 97\%) and would recommend the program to others (20/23, 87\%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36\% in the experimental arm versus 24\% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67\%) of experimental participants and three-quarters (25/33, 76\%) of controls prematurely discontinued their varenicline use (P=.29). Conclusions: The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program's effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. ClinicalTrial: ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj) ",
doi="10.2196/mhealth.6002",
url="http://mhealth.jmir.org/2016/3/e94/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27489247"
}


@Article{info:doi/10.2196/mhealth.5742,
author="Hartzler, Lisabeth Andrea
and BlueSpruce, June
and Catz, L. Sheryl
and McClure, B. Jennifer",
title="Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers' Perspectives",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="05",
volume="4",
number="3",
pages="e95",
keywords="mobile health",
keywords="human-centered design",
keywords="human-computer interaction",
keywords="smartphone",
keywords="smoking cessation",
keywords="telemedicine",
keywords="software design",
abstract="Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers' preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers' preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a ``blue-sky'' brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one's progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers' needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. ",
doi="10.2196/mhealth.5742",
url="http://mhealth.jmir.org/2016/3/e95/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27496593"
}


@Article{info:doi/10.2196/mhealth.5873,
author="Painter, Stefanie
and Ditsch, Gary
and Ahmed, Rezwan
and Hanson, Buck Nicholas
and Kachin, Kevin
and Berger, Jan",
title="Retrofit Weight-Loss Outcomes at 6, 12, and 24 Months and Characteristics of 12-Month High Performers: A Retrospective Analysis",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="22",
volume="4",
number="3",
pages="e101",
keywords="behavior",
keywords="body mass index",
keywords="BMI",
keywords="engagement",
keywords="fitness",
keywords="self-monitoring",
keywords="obesity",
keywords="overweight",
keywords="weight loss",
abstract="Background: Obesity is the leading cause of preventable death costing the health care system billions of dollars. Combining self-monitoring technology with personalized behavior change strategies results in clinically significant weight loss. However, there is a lack of real-world outcomes in commercial weight-loss program research. Objective: Retrofit is a personalized weight management and disease-prevention solution. This study aimed to report Retrofit's weight-loss outcomes at 6, 12, and 24 months and characterize behaviors, age, and sex of high-performing participants who achieved weight loss of 10\% or greater at 12 months. Methods: A retrospective analysis was performed from 2011 to 2014 using 2720 participants enrolled in a Retrofit weight-loss program. Participants had a starting body mass index (BMI) of >25 kg/m{\texttwosuperior} and were at least 18 years of age. Weight measurements were assessed at 6, 12, and 24 months in the program to evaluate change in body weight, BMI, and percentage of participants who achieved 5\% or greater weight loss. A secondary analysis characterized high-performing participants who lost ?10\% of their starting weight (n=238). Characterized behaviors were evaluated, including self-monitoring through weigh-ins, number of days wearing an activity tracker, daily step count average, and engagement through coaching conversations via Web-based messages, and number of coaching sessions attended. Results: Average weight loss at 6 months was ?5.55\% for male and ?4.86\% for female participants. Male and female participants had an average weight loss of ?6.28\% and ?5.37\% at 12 months, respectively. Average weight loss at 24 months was ?5.03\% and ?3.15\% for males and females, respectively. Behaviors of high-performing participants were assessed at 12 months. Number of weigh-ins were greater in high-performing male (197.3 times vs 165.4 times, P=.001) and female participants (222 times vs 167 times, P<.001) compared with remaining participants. Total activity tracker days and average steps per day were greater in high-performing females (304.7 vs 266.6 days, P<.001; 8380.9 vs 7059.7 steps, P<.001, respectively) and males (297.1 vs 255.3 days, P<.001; 9099.3 vs 8251.4 steps, P=.008, respectively). High-performing female participants had significantly more coaching conversations via Web-based messages than remaining female participants (341.4 vs 301.1, P=.03), as well as more days with at least one such electronic message (118 vs 108 days, P=.03). High-performing male participants displayed similar behavior. Conclusions: Participants on the Retrofit program lost an average of ?5.21\% at 6 months, ?5.83\% at 12 months, and ?4.09\% at 24 months. High-performing participants show greater adherence to self-monitoring behaviors of weighing in, number of days wearing an activity tracker, and average number of steps per day. Female high performers have higher coaching engagement through conversation days and total number of coaching conversations. ",
doi="10.2196/mhealth.5873",
url="http://mhealth.jmir.org/2016/3/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27549134"
}


@Article{info:doi/10.2196/mhealth.6034,
author="Jensen, D. Chad
and Duncombe, M. Kristina
and Lott, A. Mark
and Hunsaker, L. Sanita
and Duraccio, M. Kara
and Woolford, J. Susan",
title="An Evaluation of a Smartphone--Assisted Behavioral Weight Control Intervention for Adolescents: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="23",
volume="4",
number="3",
pages="e102",
keywords="obesity",
keywords="adolescence",
keywords="weight control",
keywords="electronic intervention",
keywords="self-monitoring",
abstract="Background: The efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring. Objective: To examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention. Methods: A total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention. Results: On average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20\% of electronic-only intervention days. Conclusions: Smartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions. ",
doi="10.2196/mhealth.6034",
url="http://mhealth.jmir.org/2016/3/e102/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27554704"
}


@Article{info:doi/10.2196/mhealth.5437,
author="Batink, Tim
and Bakker, Jindra
and Vaessen, Thomas
and Kasanova, Zuzana
and Collip, Dina
and van Os, Jim
and Wichers, Marieke
and Germeys, Inez
and Peeters, Frenk",
title="Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="15",
volume="4",
number="3",
pages="e103",
keywords="mHealth",
keywords="behavior change",
keywords="daily life intervention",
keywords="acceptance and commitment therapy",
keywords="experience sampling",
abstract="Background: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist's office and the ``real world.'' The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. Objectives: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL.  Methods: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life).  Results: More than three-quarters of the participants (76\%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). Conclusions: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects. ",
doi="10.2196/mhealth.5437",
url="http://mhealth.jmir.org/2016/3/e103/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27634747"
}


@Article{info:doi/10.2196/mhealth.5787,
author="Naughton, Felix
and Hopewell, Sarah
and Lathia, Neal
and Schalbroeck, Rik
and Brown, Chlo{\"e}
and Mascolo, Cecilia
and McEwen, Andy
and Sutton, Stephen",
title="A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="16",
volume="4",
number="3",
pages="e106",
keywords="mobile phone app",
keywords="smoking cessation",
keywords="context sensing",
keywords="tailoring",
keywords="geofence",
keywords="just-in-time adaptive intervention",
keywords="JITAI",
keywords="ecological momentary intervention",
keywords="craving",
abstract="Background: A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective: We sought to (1) assess smokers' compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods: An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results: Out of 15 participants, 3 (20\%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2\% of days. Geolocation was collected in 97.0\% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56\%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0\% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2\% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app's identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions: User-initiated self-report is feasible for training a cessation app about an individual's smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants. ",
doi="10.2196/mhealth.5787",
url="http://mhealth.jmir.org/2016/3/e106/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27637405"
}


@Article{info:doi/10.2196/mhealth.5227,
author="Walsh, C. Jane
and Corbett, Teresa
and Hogan, Michael
and Duggan, Jim
and McNamara, Abra",
title="An mHealth Intervention Using a Smartphone App to Increase Walking Behavior in Young Adults: A Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="22",
volume="4",
number="3",
pages="e109",
keywords="mHealth",
keywords="physical activity",
keywords="mobile phone app",
keywords="intervention",
keywords="health behavior change",
keywords="feasibility study",
abstract="Background: Physical inactivity is a growing concern for society and is a risk factor for cardiovascular disease, obesity, and other chronic diseases. Objective: This study aimed to determine the efficacy of the Accupedo-Pro Pedometer mobile phone app intervention, with the goal of increasing daily step counts in young adults. Methods: Mobile phone users (n=58) between 17-26 years of age were randomized to one of two conditions (experimental and control). Both groups downloaded an app that recorded their daily step counts. Baseline data were recorded and followed-up at 5 weeks. Both groups were given a daily walking goal of 30 minutes, but the experimental group participants were told the equivalent goal in steps taken, via feedback from the app. The primary outcome was daily step count between baseline and follow-up. Results: A significant time x group interaction effect was observed for daily step counts (P=.04). Both the experimental (P<.001) and control group (P=.03) demonstrated a significant increase in daily step counts, with the experimental group walking an additional 2000 steps per day. Conclusions: The results of this study demonstrate that a mobile phone app can significantly increase physical activity in a young adult sample by setting specific goals, using self-monitoring, and feedback. ",
doi="10.2196/mhealth.5227",
url="http://mhealth.jmir.org/2016/3/e109/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27658677"
}


@Article{info:doi/10.2196/mhealth.5992,
author="Coa, Kisha
and Patrick, Heather",
title="Baseline Motivation Type as a Predictor of Dropout in a Healthy Eating Text Messaging Program",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="29",
volume="4",
number="3",
pages="e114",
keywords="mHealth",
keywords="behavior change",
keywords="diet",
keywords="engagement",
keywords="motivation",
keywords="Self-Determination Theory",
abstract="Background: Growing evidence suggests that text messaging programs are effective in facilitating health behavior change. However, high dropout rates limit the potential effectiveness of these programs. Objective: This paper describes patterns of early dropout in the HealthyYou text (HYTxt) program, with a focus on the impact of baseline motivation quality on dropout, as characterized by Self-Determination Theory (SDT). Methods: This analysis included 193 users of HYTxt, a diet and physical activity text messaging intervention developed by the US National Cancer Institute. Descriptive statistics were computed, and logistic regression models were run to examine the association between baseline motivation type and early program dropout. Results: Overall, 43.0\% (83/193) of users dropped out of the program; of these, 65.1\% (54/83; 28.0\% of all users) did so within the first 2 weeks. Users with higher autonomous motivation had significantly lower odds of dropping out within the first 2 weeks. A one unit increase in autonomous motivation was associated with lower odds (odds ratio 0.44, 95\% CI 0.24--0.81) of early dropout, which persisted after adjusting for level of controlled motivation. Conclusions: Applying SDT-based strategies to enhance autonomous motivation might reduce early dropout rates, which can improve program exposure and effectiveness. ",
doi="10.2196/mhealth.5992",
url="http://mhealth.jmir.org/2016/3/e114/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27688034"
}


@Article{info:doi/10.2196/mhealth.5411,
author="Cotten, Emma
and Prapavessis, Harry",
title="Increasing Nonsedentary Behaviors in University Students Using Text Messages: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="19",
volume="4",
number="3",
pages="e99",
keywords="sedentary behaviour",
keywords="prolonged sitting",
keywords="text messages",
keywords="self-efficacy",
keywords="university students",
keywords="breaks from sitting",
keywords="light intensity physical activity",
keywords="moderate intensity physical activity",
abstract="Background: Sedentary behavior (SB) has been linked to many health problems such as type 2 diabetes and heart disease. Increasing the length and frequency of breaks from sitting and increasing the time spent standing and engaged in light and moderate physical activity are ways to decrease SB. Text message-based interventions have succeeded in aiding smoking cessation and increase both physical activity and healthy eating, but they have not been shown to reduce SB. Objective: The primary purpose of this pilot study was to determine the effectiveness of a text message-based intervention in increasing nonsedentary behaviors in university students. A secondary purpose was to (1) determine whether the intervention could enhance self-efficacy beliefs for decreasing SB and (2) whether these efficacious beliefs could predict actual SB. Methods: Eighty-two university students were recruited via mass emails and randomized into intervention (SB-related text messages) or control (text messages unrelated to SB) groups. Participants received daily text messages scheduled by the researcher encouraging breaks from sitting, standing, light- and moderate-intensity physical activity (PA). They then reported various SBs via Web-based questionnaires at four time points (baseline, 2, 4, and 6 weeks). Self-efficacious beliefs toward taking breaks from sitting and decreasing the amount of time spent sitting were assessed at the same time points. Results: Last observation carried forward (LOCF) method was used for incomplete data as an intent-to-treat (ITT) analysis (intervention group n=15, control group n=11). Small-to-moderate effects favoring the text intervention group were found at 6 weeks for break frequency -14.64 minutes, break length +.59 minutes, standing +24.30 min/day, light-intensity +74.34 min/day, and moderate-intensity + 9.97 min/day PA. Only light-intensity PA approached significance (P=.07). Self-efficacy beliefs also favored the text intervention group and reached significance (P=.032) for sitting less. Significant (P<.05) relations were found between the self-efficacy constructs and breaks, standing, and light or moderate PA. Conclusions: Text messages have the potential to increase nonsedentary behaviors in university students. These messages can increase self-efficacy beliefs to take more breaks and reduce sitting time. Efficacious beliefs can predict actual SB and to a lesser extent light- and moderate-intensity PA. Trial Registration: ClinicalTrials.gov NCT02562937; https://clinicaltrials.gov/ct2/show/NCT02562937 (Archived by WebCite at?http://www.webcitation.org/6jVLwXE5M) ",
doi="10.2196/mhealth.5411",
url="http://mhealth.jmir.org/2016/3/e99/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27543317"
}


@Article{info:doi/10.2196/mhealth.5168,
author="Sheoran, Bhupendra
and Silva, Lynn Cara
and Lykens, Elliot James
and Gamedze, Londiwe
and Williams, Samantha
and Ford, VanNess Jessie
and Habel, A. Melissa",
title="YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="14",
volume="4",
number="3",
pages="e82",
keywords="mHealth",
keywords="homelessness",
keywords="youth",
keywords="STD",
keywords="sexually transmitted diseases",
keywords="mobile app",
abstract="Background: Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. Objective: The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. Methods: Formative research included a literature review on H/UH youths' mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app's youth friendliness, accessibility, and usefulness. Results: H/UH youth and their providers noted the app's functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. Conclusions: YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth. ",
doi="10.2196/mhealth.5168",
url="http://mhealth.jmir.org/2016/3/e82/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27417882"
}


@Article{info:doi/10.2196/mhealth.6041,
author="Toefy, Yoesrie
and Skinner, Donald
and Thomsen, Sarah",
title="``Please Don't Send Us Spam!'' A Participative, Theory-Based Methodology for Developing an mHealth Intervention",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="17",
volume="4",
number="3",
pages="e100",
keywords="mHealth",
keywords="male circumcision",
keywords="postoperative wound-healing period",
keywords="health promotion",
keywords="audio messaging",
keywords="behaviour change",
abstract="Background: Mobile health solutions have the potential of reducing burdens on health systems and empowering patients with important information. However, there is a lack of theory-based mHealth interventions. Objective: The purpose of our study was to develop a participative, theory-based, mobile phone, audio messaging intervention attractive to recently circumcised men at voluntary medical male circumcision (VMMC) clinics in the Cape Town area in South Africa. We aimed to shift some of the tasks related to postoperative counselling on wound management and goal setting on safe sex. We place an emphasis on describing the full method of message generation to allow for replication. Methods: We developed an mHealth intervention using a staggered qualitative methodology: (1) focus group discussions with 52 recently circumcised men and their partners to develop initial voice messages they felt were relevant and appropriate, (2) thematic analysis and expert consultation to select the final messages for pilot testing, and (3) cognitive interviews with 12 recent VMMC patients to judge message comprehension and rank the messages. Message content and phasing were guided by the theory of planned behavior and the health action process approach. Results: Patients and their partners came up with 245 messages they thought would help men during the wound-healing period. Thematic analysis revealed 42 different themes. Expert review and cognitive interviews with more patients resulted in 42 messages with a clear division in terms of needs and expectations between the initial wound-healing recovery phase (weeks 1--3) and the adjustment phase (weeks 4--6). Discussions with patients also revealed potential barriers to voice messaging, such as lack of technical knowledge of mobile phones and concerns about the invasive nature of the intervention. Patients' own suggested messages confirmed Ajzen's theory of planned behavior that if a health promotion intervention can build trust and be relevant to the recipient's needs in the first contacts, then the same recipients will perceive subsequent motivational messages more favorably. The health action process approach was also a useful tool for guiding the phasing of the messages. Participants were more positive and salutogenic than public health experts. Conclusions: The system showed how a process of consultation can work with a set of potential recipients of an mHealth service to ensure that their needs are included. Classic behavioral theories can and should be used to design modern mHealth interventions. We also believe that patients are the best source of messaging, ensuring that messages are culturally relevant and interesting to the recipient. ",
doi="10.2196/mhealth.6041",
url="http://mhealth.jmir.org/2016/3/e100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27535589"
}


@Article{info:doi/10.2196/mhealth.5846,
author="Franco, Zenun Rodrigo
and Fallaize, Rosalind
and Lovegrove, A. Julie
and Hwang, Faustina",
title="Popular Nutrition-Related Mobile Apps: A Feature Assessment",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="01",
volume="4",
number="3",
pages="e85",
keywords="nutrition apps",
keywords="diet apps",
keywords="food diary",
keywords="nutritional assessment",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
keywords="mobile technology",
abstract="Background: A key challenge in human nutrition is the assessment of usual food intake. This is of particular interest given recent proposals of eHealth personalized interventions. The adoption of mobile phones has created an opportunity for assessing and improving nutrient intake as they can be used for digitalizing dietary assessments and providing feedback. In the last few years, hundreds of nutrition-related mobile apps have been launched and installed by millions of users. Objective: This study aims to analyze the main features of the most popular nutrition apps and to compare their strategies and technologies for dietary assessment and user feedback. Methods: Apps were selected from the two largest online stores of the most popular mobile operating systems---the Google Play Store for Android and the iTunes App Store for iOS---based on popularity as measured by the number of installs and reviews. The keywords used in the search were as follows: calorie(s), diet, diet tracker, dietician, dietitian, eating, fit, fitness, food, food diary, food tracker, health, lose weight, nutrition, nutritionist, weight, weight loss, weight management, weight watcher, and ww calculator. The inclusion criteria were as follows: English language, minimum number of installs (1 million for Google Play Store) or reviews (7500 for iTunes App Store), relation to nutrition (ie, diet monitoring or recommendation), and independence from any device (eg, wearable) or subscription. Results: A total of 13 apps were classified as popular for inclusion in the analysis. Nine apps offered prospective recording of food intake using a food diary feature. Food selection was available via text search or barcode scanner technologies. Portion size selection was only textual (ie, without images or icons). All nine of these apps were also capable of collecting physical activity (PA) information using self-report, the global positioning system (GPS), or wearable integrations. Their outputs focused predominantly on energy balance between dietary intake and PA. None of these nine apps offered features directly related to diet plans and motivational coaching. In contrast, the remaining four of the 13 apps focused on these opportunities, but without food diaries. One app---FatSecret---also had an innovative feature for connecting users with health professionals, and another---S Health---provided a nutrient balance score. Conclusions: The high number of installs indicates that there is a clear interest and opportunity for diet monitoring and recommendation using mobile apps. All the apps collecting dietary intake used the same nutrition assessment method (ie, food diary record) and technologies for data input (ie, text search and barcode scanner). Emerging technologies, such as image recognition, natural language processing, and artificial intelligence, were not identified. None of the apps had a decision engine capable of providing personalized diet advice. ",
doi="10.2196/mhealth.5846",
url="http://mhealth.jmir.org/2016/3/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27480144"
}


@Article{info:doi/10.2196/mhealth.5961,
author="Wilson, Hollie
and Stoyanov, R. Stoyan
and Gandabhai, Shailen
and Baldwin, Alexander",
title="The Quality and Accuracy of Mobile Apps to Prevent Driving After Drinking Alcohol",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="08",
volume="4",
number="3",
pages="e98",
keywords="drink driving",
keywords="alcohol",
keywords="mobile apps",
keywords="calculator",
keywords="Mobile Application Rating Scale",
keywords="blood alcohol content",
abstract="Background: Driving after the consumption of alcohol represents a significant problem globally. Individual prevention countermeasures such as personalized mobile apps aimed at preventing such behavior are widespread, but there is little research on their accuracy and evidence base. There has been no known assessment investigating the quality of such apps. Objective: This study aimed to determine the quality and accuracy of apps for drink driving prevention by conducting a review and evaluation of relevant mobile apps. Methods: A systematic app search was conducted following PRISMA guidelines. App quality was assessed using the Mobile App Rating Scale (MARS). Apps providing blood alcohol calculators (hereafter ``calculators'') were reviewed against current alcohol advice for accuracy. Results: A total of 58 apps (30 iOS and 28 Android) met inclusion criteria and were included in the final analysis. Drink driving prevention apps had significantly lower engagement and overall quality scores than alcohol management apps. Most calculators provided conservative blood alcohol content (BAC) time until sober calculations. None of the apps had been evaluated to determine their efficacy in changing either drinking or driving behaviors. Conclusions: This novel study demonstrates that most drink driving prevention apps are not engaging and lack accuracy. They could be improved by increasing engagement features, such as gamification. Further research should examine the context and motivations for using apps to prevent driving after drinking in at-risk populations. Development of drink driving prevention apps should incorporate evidence-based information and guidance, lacking in current apps. ",
doi="10.2196/mhealth.5961",
url="http://mhealth.jmir.org/2016/3/e98/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27502956"
}


@Article{info:doi/10.2196/mhealth.6020,
author="Larsen, Erik Mark
and Nicholas, Jennifer
and Christensen, Helen",
title="Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Aug",
day="09",
volume="4",
number="3",
pages="e96",
keywords="mobile applications",
keywords="mobile apps",
keywords="mental health",
keywords="telemedicine",
keywords="depression",
keywords="bipolar disorder",
keywords="suicide",
abstract="Background: For many mental health conditions, mobile health apps offer the ability to deliver information, support, and intervention outside the clinical setting. However, there are difficulties with the use of a commercial app store to distribute health care resources, including turnover of apps, irrelevance of apps, and discordance with evidence-based practice. Objective: The primary aim of this study was to quantify the longevity and rate of turnover of mental health apps within the official Android and iOS app stores. The secondary aim was to quantify the proportion of apps that were clinically relevant and assess whether the longevity of these apps differed from clinically nonrelevant apps. The tertiary aim was to establish the proportion of clinically relevant apps that included claims of clinical effectiveness. We performed additional subgroup analyses using additional data from the app stores, including search result ranking, user ratings, and number of downloads. Methods: We searched iTunes (iOS) and the Google Play (Android) app stores each day over a 9-month period for apps related to depression, bipolar disorder, and suicide. We performed additional app-specific searches if an app no longer appeared within the main search Results: On the Android platform, 50\% of the search results changed after 130 days (depression), 195 days (bipolar disorder), and 115 days (suicide). Search results were more stable on the iOS platform, with 50\% of the search results remaining at the end of the study period. Approximately 75\% of Android and 90\% of iOS apps were still available to download at the end of the study. We identified only 35.3\% (347/982) of apps as being clinically relevant for depression, of which 9 (2.6\%) claimed clinical effectiveness. Only 3 included a full citation to a published study. Conclusions: The mental health app environment is volatile, with a clinically relevant app for depression becoming unavailable to download every 2.9 days. This poses challenges for consumers and clinicians seeking relevant and long-term apps, as well as for researchers seeking to evaluate the evidence base for publicly available apps. ",
doi="10.2196/mhealth.6020",
url="http://mhealth.jmir.org/2016/3/e96/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27507641"
}


@Article{info:doi/10.2196/mhealth.3726,
author="Frisbee, L. Kathleen",
title="Variations in the Use of mHealth Tools: The VA Mobile Health Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="19",
volume="4",
number="3",
pages="e89",
keywords="caregivers",
keywords="telemedicine",
keywords="stress (psychological)",
keywords="veterans health",
abstract="Background: Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective: The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods: Veteran/family caregiver dyads (N=882) enrolled in VA's Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results: Of the 882 dyads, 94.9\% (837/882) of caregivers were women and 95.7\% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8\% (351/882) lived in rural locations. Most (89\%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions: This mHealth Family Caregiver pilot project effectively establishes the VA's first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities. ",
doi="10.2196/mhealth.3726",
url="http://mhealth.jmir.org/2016/3/e89/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27436165"
}


@Article{info:doi/10.2196/mhealth.5243,
author="Micallef, Christianne
and McLeod, Monsey
and Castro-S{\'a}nchez, Enrique
and Gharbi, Myriam
and Charani, Esmita
and Moore, SP Luke
and Gilchrist, Mark
and Husson, Fran
and Costelloe, Ceire
and Holmes, H. Alison",
title="An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="06",
volume="4",
number="3",
pages="e83",
keywords="mobile electronic devices",
keywords="mHealth",
keywords="mobile health",
keywords="antimicrobial resistance",
keywords="patient involvement",
abstract="Background: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients' experiences of their interactions with health care professionals in relation to this topic. Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England. Results: A total of 99 surveys were completed and analyzed. A total of 82\% (80/98) of respondents had recently been prescribed antimicrobials; 87\% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65\%) and prevention and/or management (32/65, 49\%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100\%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55\%) stated it was ``fine'' for doctors to use a mobile phone/tablet computer during the consultation while 13\% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30\% (27/89) of respondents reported on the use of health care apps, 95\% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience. Conclusions: The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance. ",
doi="10.2196/mhealth.5243",
url="http://mhealth.jmir.org/2016/3/e83/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27383743"
}


@Article{info:doi/10.2196/mhealth.5738,
author="Pereira-Azevedo, Nuno
and Os{\'o}rio, Lu{\'i}s
and Cavadas, Vitor
and Fraga, Avelino
and Carrasquinho, Eduardo
and Cardoso de Oliveira, Eduardo
and Castelo-Branco, Miguel
and Roobol, J. Monique",
title="Expert Involvement Predicts mHealth App Downloads: Multivariate Regression Analysis of Urology Apps",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="15",
volume="4",
number="3",
pages="e86",
keywords="eHealth",
keywords="mHealth",
keywords="urology",
keywords="mobile apps",
keywords="new technologies",
abstract="Background: Urological mobile medical (mHealth) apps are gaining popularity with both clinicians and patients. mHealth is a rapidly evolving and heterogeneous field, with some urology apps being downloaded over 10,000 times and others not at all. The factors that contribute to medical app downloads have yet to be identified, including the hypothetical influence of expert involvement in app development. Objective: The objective of our study was to identify predictors of the number of urology app downloads. Methods: We reviewed urology apps available in the Google Play Store and collected publicly available data. Multivariate ordinal logistic regression evaluated the effect of publicly available app variables on the number of apps being downloaded. Results: Of 129 urology apps eligible for study, only 2 (1.6\%) had >10,000 downloads, with half having ?100 downloads and 4 (3.1\%) having none at all. Apps developed with expert urologist involvement (P=.003), optional in-app purchases (P=.01), higher user rating (P<.001), and more user reviews (P<.001) were more likely to be installed. App cost was inversely related to the number of downloads (P<.001). Only data from the Google Play Store and the developers' websites, but not other platforms, were publicly available for analysis, and the level and nature of expert involvement was not documented. Conclusions: The explicit participation of urologists in app development is likely to enhance its chances to have a higher number of downloads. This finding should help in the design of better apps and further promote urologist involvement in mHealth. Official certification processes are required to ensure app quality and user safety. ",
doi="10.2196/mhealth.5738",
url="http://mhealth.jmir.org/2016/3/e86/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27421338"
}


@Article{info:doi/10.2196/mhealth.5720,
author="Pham, Quynh
and Wiljer, David
and Cafazzo, A. Joseph",
title="Beyond the Randomized Controlled Trial: A Review of Alternatives in mHealth Clinical Trial Methods",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="09",
volume="4",
number="3",
pages="e107",
keywords="mobile health",
keywords="mobile applications",
keywords="smartphones",
keywords="medical informatics",
keywords="research design",
keywords="clinical trials",
abstract="Background: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceived as an impractical evaluation methodology for most mHealth apps. Objective: Given the recent development of alternative evaluation methodologies and tools to automate mHealth research, we sought to determine the breadth of these methods and the extent that they were being used in clinical trials. Methods: We conducted a review of the ClinicalTrials.gov registry to identify and examine current clinical trials involving mHealth apps and retrieved relevant trials registered between November 2014 and November 2015. Results: Of the 137 trials identified, 71 were found to meet inclusion criteria. The majority used a randomized controlled trial design (80\%, 57/71). Study designs included 36 two-group pretest-posttest control group comparisons (51\%, 36/71), 16 posttest-only control group comparisons (23\%, 16/71), 7 one-group pretest-posttest designs (10\%, 7/71), 2 one-shot case study designs (3\%, 2/71), and 2 static-group comparisons (3\%, 2/71). A total of 17 trials included a qualitative component to their methodology (24\%, 17/71). Complete trial data collection required 20 months on average to complete (mean 21, SD 12). For trials with a total duration of 2 years or more (31\%, 22/71), the average time from recruitment to complete data collection (mean 35 months, SD 10) was 2 years longer than the average time required to collect primary data (mean 11, SD 8). Trials had a moderate sample size of 112 participants. Two trials were conducted online (3\%, 2/71) and 7 trials collected data continuously (10\%, 7/68). Onsite study implementation was heavily favored (97\%, 69/71). Trials with four data collection points had a longer study duration than trials with two data collection points: F4,56=3.2, P=.021, $\eta$2=0.18. Single-blinded trials had a longer data collection period compared to open trials: F2,58=3.8, P=.028, $\eta$2=0.12. Academic sponsorship was the most common form of trial funding (73\%, 52/71). Trials with academic sponsorship had a longer study duration compared to industry sponsorship: F2,61=3.7, P=.030, $\eta$2=0.11. Combined, data collection frequency, study masking, sample size, and study sponsorship accounted for 32.6\% of the variance in study duration: F4,55=6.6, P<.01, adjusted r2=.33. Only 7 trials had been completed at the time this retrospective review was conducted (10\%, 7/71). Conclusions: mHealth evaluation methodology has not deviated from common methods, despite the need for more relevant and timely evaluations. There is a need for clinical evaluation to keep pace with the level of innovation of mHealth if it is to have meaningful impact in informing payers, providers, policy makers, and patients. ",
doi="10.2196/mhealth.5720",
url="http://mhealth.jmir.org/2016/3/e107/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27613084"
}


@Article{info:doi/10.2196/mhealth.5637,
author="Chang, Cherng-Shiow Rebecca
and Lu, Hsi-Peng
and Yang, Peishan
and Luarn, Pin",
title="Reciprocal Reinforcement Between Wearable Activity Trackers and Social Network Services in Influencing Physical Activity Behaviors",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="05",
volume="4",
number="3",
pages="e84",
keywords="Wearable activity trackers",
keywords="wearables",
keywords="physical activity",
keywords="social support",
keywords="social network services",
keywords="behavior change techniques",
abstract="Background: Wearable activity trackers (WATs) are emerging consumer electronic devices designed to support physical activities (PAs), which are based on successful behavior change techniques focusing on goal-setting and frequent behavioral feedbacks. Despite their utility, data from both recent academic and market research have indicated high attrition rates of WAT users. Concurrently, evidence shows that social support (SS), delivered/obtained via social network services or sites (SNS), could increase adherence and engagement of PA intervention programs. To date, relatively few studies have looked at how WATs and SS may interact and affect PAs. Objective: The purpose of this study was to explore how these two Internet and mobile technologies, WATs and SNS, could work together to foster sustainable PA behavior changes and habits among middle-aged adults (40-60 years old) in Taiwan. Methods: We used purposive sampling of Executive MBA Students from National Taiwan University of Science and Technology to participate in our qualitative research. In-depth interviews and focus groups were conducted with a total of 15 participants, including 9 WAT users and 6 nonusers. Analysis of the collected materials was done inductively using the thematic approach with no preset categories. Two authors from different professional backgrounds independently annotated and coded the transcripts, and then discussed and debated until consensus was reached on the final themes. Results: The thematic analysis revealed six themes: (1) WATs provided more awareness than motivation in PA with goal-setting and progress monitoring, (2) SS, delivered/obtained via SNS, increased users' adherence and engagement with WATs and vice versa, (3) a broad spectrum of configurations would be needed to deliver WATs with appropriately integrated SS functions, (4) WAT design, style, and appearance mattered even more than those of smartphones, as they are body-worn devices, (5) the user interfaces of WATs left a great deal to be desired, and (6) privacy concerns must be addressed before more mainstream consumers would consider adopting WATs. Conclusions: Participants perceived WATs as an awareness tool to understand one's PA level. It is evident from our study that SS, derived from SNS and other pertinent vehicles such as the LINE social messaging application (similar to WhatsApp and WeChat), will increase the engagement and adherence of WAT usage. Combining WATs and SNS enables cost-effective, scalable PA intervention programs with end-to-end services and data analytics capabilities, to elevate WATs from one-size-fits-all consumer electronics to personalized PA assistants. ",
doi="10.2196/mhealth.5637",
url="http://mhealth.jmir.org/2016/3/e84/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27380798"
}


@Article{info:doi/10.2196/mhealth.6281,
author="Dominick, M. Gregory
and Winfree, N. Kyle
and Pohlig, T. Ryan
and Papas, A. Mia",
title="Physical Activity Assessment Between Consumer- and Research-Grade Accelerometers: A Comparative Study in Free-Living Conditions",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Sep",
day="19",
volume="4",
number="3",
pages="e110",
keywords="Fitbit",
keywords="activity tracker",
keywords="actigraphy",
keywords="physical activity",
keywords="aerobic exercise",
keywords="validity",
abstract="Background: Wearable activity monitors such as Fitbit enable users to track various attributes of their physical activity (PA) over time and have the potential to be used in research to promote and measure PA behavior. However, the measurement accuracy of Fitbit in absolute free-living conditions is largely unknown. Objective: To examine the measurement congruence between Fitbit Flex and ActiGraph GT3X for quantifying steps, metabolic equivalent tasks (METs), and proportion of time in sedentary activity and light-, moderate-, and vigorous-intensity PA in healthy adults in free-living conditions. Methods: A convenience sample of 19 participants (4 men and 15 women), aged 18-37 years, concurrently wore the Fitbit Flex (wrist) and ActiGraph GT3X (waist) for 1- or 2-week observation periods (n=3 and n=16, respectively) that included self-reported bouts of daily exercise. Data were examined for daily activity, averaged over 14 days and for minutes of reported exercise. Average day-level data included steps, METs, and proportion of time in different intensity levels. Minute-level data included steps, METs, and mean intensity score (0 = sedentary, 3 = vigorous) for overall reported exercise bouts (N=120) and by exercise type (walking, n=16; run or sports, n=44; cardio machine, n=20). Results: Measures of steps were similar between devices for average day- and minute-level observations (all P values > .05). Fitbit significantly overestimated METs for average daily activity, for overall minutes of reported exercise bouts, and for walking and run or sports exercises (mean difference 0.70, 1.80, 3.16, and 2.00 METs, respectively; all P values < .001). For average daily activity, Fitbit significantly underestimated the proportion of time in sedentary and light intensity by 20\% and 34\%, respectively, and overestimated time by 3\% in both moderate and vigorous intensity (all P values < .001). Mean intensity scores were not different for overall minutes of exercise or for run or sports and cardio-machine exercises (all P values > .05). Conclusions: Fitbit Flex provides accurate measures of steps for daily activity and minutes of reported exercise, regardless of exercise type. Although the proportion of time in different intensity levels varied between devices, examining the mean intensity score for minute-level bouts across different exercise types enabled interdevice comparisons that revealed similar measures of exercise intensity. Fitbit Flex is shown to have measurement limitations that may affect its potential utility and validity for measuring PA attributes in free-living conditions. ",
doi="10.2196/mhealth.6281",
url="http://mhealth.jmir.org/2016/3/e110/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27644334"
}


@Article{info:doi/10.2196/mhealth.5193,
author="Santos-Lozano, Alejandro
and Garatachea, Nuria
and Pareja-Galeano, Helios
and Fiuza-Luces, Carmen
and Sanchis-Gomar, Fabian
and Lucia, Alejandro",
title="The Era of Smartphones: Back to Our Biological Makeup?",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="27",
volume="4",
number="3",
pages="e63",
doi="10.2196/mhealth.5193",
url="http://mhealth.jmir.org/2016/3/e63/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27465861"
}