@Article{info:doi/10.2196/22321,
author="Nakamoto, Ichiro
and Wang, Sheng
and Guo, Yan
and Zhuang, Weiqing",
title="A QR Code--Based Contact Tracing Framework for Sustainable Containment of COVID-19: Evaluation of an Approach to Assist the Return to Normal Activity",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="7",
volume="8",
number="9",
pages="e22321",
keywords="COVID-19",
keywords="coronavirus",
keywords="symptom-based",
keywords="quick response",
keywords="eHealth",
keywords="digital health",
keywords="telesurveillance",
keywords="pandemic",
keywords="epidemic",
keywords="interoperability",
doi="10.2196/22321",
url="http://mhealth.jmir.org/2020/9/e22321/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32841151"
}


@Article{info:doi/10.2196/20156,
author="Bao, Huanyu
and Cao, Bolin
and Xiong, Yuan
and Tang, Weiming",
title="Digital Media's Role in the COVID-19 Pandemic",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="18",
volume="8",
number="9",
pages="e20156",
keywords="COVID-19",
keywords="digital health",
keywords="media",
keywords="pandemic",
keywords="public health",
keywords="social media",
keywords="dissemination",
keywords="health information",
keywords="mobile health",
doi="10.2196/20156",
url="https://mhealth.jmir.org/2020/9/e20156",
url="http://www.ncbi.nlm.nih.gov/pubmed/32530817"
}


@Article{info:doi/10.2196/18694,
author="Fuller, Daniel
and Colwell, Emily
and Low, Jonathan
and Orychock, Kassia
and Tobin, Ann Melissa
and Simango, Bo
and Buote, Richard
and Van Heerden, Desiree
and Luan, Hui
and Cullen, Kimberley
and Slade, Logan
and Taylor, A. Nathan G.",
title="Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="8",
volume="8",
number="9",
pages="e18694",
keywords="commercial wearable devices",
keywords="systematic review",
keywords="heart rate",
keywords="energy expenditure",
keywords="step count",
keywords="Fitbit",
keywords="Apple Watch",
keywords="Garmin",
keywords="Polar",
abstract="Background: Consumer-wearable activity trackers are small electronic devices that record fitness and health-related measures. Objective: The purpose of this systematic review was to examine the validity and reliability of commercial wearables in measuring step count, heart rate, and energy expenditure. Methods: We identified devices to be included in the review. Database searches were conducted in PubMed, Embase, and SPORTDiscus, and only articles published in the English language up to May 2019 were considered. Studies were excluded if they did not identify the device used and if they did not examine the validity or reliability of the device. Studies involving the general population and all special populations were included. We operationalized validity as criterion validity (as compared with other measures) and construct validity (degree to which the device is measuring what it claims). Reliability measures focused on intradevice and interdevice reliability. Results: We included 158 publications examining nine different commercial wearable device brands. Fitbit was by far the most studied brand. In laboratory-based settings, Fitbit, Apple Watch, and Samsung appeared to measure steps accurately. Heart rate measurement was more variable, with Apple Watch and Garmin being the most accurate and Fitbit tending toward underestimation. For energy expenditure, no brand was accurate. We also examined validity between devices within a specific brand. Conclusions: Commercial wearable devices are accurate for measuring steps and heart rate in laboratory-based settings, but this varies by the manufacturer and device type. Devices are constantly being upgraded and redesigned to new models, suggesting the need for more current reviews and research. ",
doi="10.2196/18694",
url="http://mhealth.jmir.org/2020/9/e18694/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32897239"
}


@Article{info:doi/10.2196/17977,
author="Turicchi, Jake
and O'Driscoll, Ruairi
and Finlayson, Graham
and Duarte, Cristiana
and Palmeira, L. A.
and Larsen, C. Sofus
and Heitmann, L. Berit
and Stubbs, James R.",
title="Data Imputation and Body Weight Variability Calculation Using Linear and Nonlinear Methods in Data Collected From Digital Smart Scales: Simulation and Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="11",
volume="8",
number="9",
pages="e17977",
keywords="weight variability",
keywords="weight fluctuation",
keywords="weight cycling",
keywords="weight instability",
keywords="imputation",
keywords="validation",
keywords="digital tracking",
keywords="smart scales",
keywords="body weight",
keywords="energy balance",
abstract="Background: Body weight variability (BWV) is common in the general population and may act as a risk factor for obesity or diseases. The correct identification of these patterns may have prognostic or predictive value in clinical and research settings. With advancements in technology allowing for the frequent collection of body weight data from electronic smart scales, new opportunities to analyze and identify patterns in body weight data are available. Objective: This study aims to compare multiple methods of data imputation and BWV calculation using linear and nonlinear approaches Methods: In total, 50 participants from an ongoing weight loss maintenance study (the NoHoW study) were selected to develop the procedure. We addressed the following aspects of data analysis: cleaning, imputation, detrending, and calculation of total and local BWV. To test imputation, missing data were simulated at random and using real patterns of missingness. A total of 10 imputation strategies were tested. Next, BWV was calculated using linear and nonlinear approaches, and the effects of missing data and data imputation on these estimates were investigated. Results: Body weight imputation using structural modeling with Kalman smoothing or an exponentially weighted moving average provided the best agreement with observed values (root mean square error range 0.62\%-0.64\%). Imputation performance decreased with missingness and was similar between random and nonrandom simulations. Errors in BWV estimations from missing simulated data sets were low (2\%-7\% with 80\% missing data or a mean of 67, SD 40.1 available body weights) compared with that of imputation strategies where errors were significantly greater, varying by imputation method. Conclusions: The decision to impute body weight data depends on the purpose of the analysis. Directions for the best performing imputation methods are provided. For the purpose of estimating BWV, data imputation should not be conducted. Linear and nonlinear methods of estimating BWV provide reasonably accurate estimates under high proportions (80\%) of missing data. ",
doi="10.2196/17977",
url="http://mhealth.jmir.org/2020/9/e17977/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915155"
}


@Article{info:doi/10.2196/17852,
author="Giurgiu, Marco
and Niermann, Christina
and Ebner-Priemer, Ulrich
and Kanning, Martina",
title="Accuracy of Sedentary Behavior--Triggered Ecological Momentary Assessment for Collecting Contextual Information:
            Development and Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="15",
volume="8",
number="9",
pages="e17852",
keywords="sedentariness",
keywords="Ecological Momentary Assessment",
keywords="accelerometry",
keywords="mHealth",
keywords="context",
abstract="Background: Sedentary behavior has received much attention in the scientific community over the past decade. There is growing evidence that sedentary behavior is negatively associated with physical and mental health. However, an in-depth understanding of the social and environmental context of sedentary behavior is missing. Information about sedentary behavior, such as how everyday sedentary behavior occurs throughout the day (eg, number and length of sedentary bouts), where, when, and with whom it takes place, and what people are doing while being sedentary, is useful to inform the development of interventions aimed at reducing sedentary time. However, examining everyday sedentary behavior requires specific methods. Objective: The purpose of this paper is (1) to introduce sedentary behavior--triggered Ecological Momentary Assessment (EMA) as a methodological advancement in the field of sedentary behavior research and (2) to examine the accuracy of sedentary behavior--triggered EMA in 3 different studies in healthy adults. Moreover, we compare the accuracy of sedentary behavior--triggered EMA to simulations of random-trigger designs. Methods: Sedentary behavior--triggered EMA comprises a continuous assessment of sedentary behavior via accelerometers and repeated contextual assessments via electronic diaries (ie, an application on a smartphone). More specifically, the accelerometer analyzes and transfers data regarding body position (a sitting or lying position, or an upright position) via Bluetooth Low Energy (BLE) to a smartphone in real time and triggers the deployment of questionnaires. Each time a participant spends a specified time (eg, 20 minutes) in a sedentary position, the e-diary triggers contextual assessments. To test the accuracy of this method, we calculated a percentage score for all triggered prompts in relation to the total number of bouts that could trigger a prompt. Results: Based on the accelerometer recordings, 29.3\% (5062/17278) of all sedentary bouts were classified as moderate-to-long (20-40 minutes) and long bouts (? 41 minutes). On average, the accuracy by participant was 82.77\% (3339/4034; SD 21.01\%, range 71.00-88.22\%) on the study level. Compared to simulations of random prompts (every 120 minutes), the number of triggered prompts was up to 47.9\% (n=704) higher through the sedentary behavior--triggered EMA approach. Nearly 40\% (799/2001) of all prolonged sedentary bouts (? 20 minutes) occurred during work, and in 57\% (1140/2001) of all bouts, the participants were not alone. Conclusions: Sedentary behavior--triggered EMA is an accurate method for collecting contextual information on sedentary behavior in daily life. Given the growing interest in sedentary behavior research, this sophisticated approach offers a real advancement as it can be used to collect social and environmental contextual information or to unravel dynamic associations. Furthermore, it can be modified to develop sedentary behavior--triggered mHealth interventions. ",
doi="10.2196/17852",
url="http://mhealth.jmir.org/2020/9/e17852/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32930668"
}


@Article{info:doi/10.2196/17983,
author="Chaniaud, No{\'e}mie
and M{\'e}tayer, Natacha
and Megalakaki, Olga
and Loup-Escande, Emilie",
title="Effect of Prior Health Knowledge on the Usability of Two Home Medical Devices: Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e17983",
keywords="usability",
keywords="prior health knowledge",
keywords="mHealth",
keywords="home medical devices",
keywords="blood pressure monitor",
keywords="pulse oximeter",
abstract="Background: Studies on the usability of health care devices are becoming more common, although usability standards are not necessarily specified and followed. Yet, there is little knowledge about the impact of the context of use on the usability outcome. It is specified in the usability standard (ISO 9241-11, 2018) of a device that it may be affected by its context of use and especially by the characteristics of its users. Among these, prior health knowledge (ie, knowledge about human body functioning) is crucial. However, no study has shown that prior health knowledge influences the usability of medical devices.? Objective: Our study aimed to fill this gap by analyzing the relationship between the usability of two home medical devices (soon to be used in the context of ambulatory surgery) and prior health knowledge through an experimental approach. Methods: For assessing the usability of two home medical devices (blood pressure monitor and pulse oximeter), user tests were conducted among 149 students. A mixed-methods approach (subjective vs objective) using a variety of standard instruments was adopted (direct observation, video analysis, and questionnaires). Participants completed a questionnaire to show the extent of their previous health knowledge and then operated both devices randomly. Efficiency (ie, handling time) and effectiveness (ie, number of handling errors) measures were collected by video analysis. Satisfaction measures were collected by a questionnaire (system usability scale [SUS]). The qualitative observational data were coded using inductive analysis by two independent researchers specialized in cognitive psychology and cognitive ergonomics. Correlational analyses and clusters were performed to test how usability relates to sociodemographic characteristics and prior health knowledge. Results: The results indicated a lack of usability for both devices. Regarding the blood pressure monitor (137 participants), users made approximately 0.77 errors (SD 1.49), and the mean SUS score was 72.4 (SD 21.07), which is considered ``satisfactory.'' The pulse oximeter (147 participants) appeared easier to use, but participants made more errors (mean 0.99, SD 0.92), and the mean SUS score was 71.52 (SD 17.29), which is considered ``satisfactory.'' The results showed a low negative and significant correlation only between the effectiveness of the two devices and previous knowledge (blood pressure monitor: r=?0.191, P=.03; pulse oximeter: r=?0.263, P=.001). More subtly, we experimentally identified the existence of a threshold level ($\chi${\texttwosuperior}2,146=10.9, P=.004) for health knowledge to correctly use the pulse oximeter, but this was missing for the blood pressure monitor. Conclusions: This study has the following two contributions: (1) a theoretical interest highlighting the importance of user characteristics including prior health knowledge on usability outcomes and (2) an applied interest to provide recommendations to designers and medical staff. ",
doi="10.2196/17983",
url="http://mhealth.jmir.org/2020/9/e17983/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955454"
}


@Article{info:doi/10.2196/20203,
author="Jacob, Christine
and Sanchez-Vazquez, Antonio
and Ivory, Chris",
title="Factors Impacting Clinicians' Adoption of a Clinical Photo Documentation App and its Implications for Clinical Workflows and Quality of Care: Qualitative Case Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="23",
volume="8",
number="9",
pages="e20203",
keywords="mHealth",
keywords="mobile health",
keywords="telehealth",
keywords="eHealth",
keywords="health tech",
keywords="digital health",
keywords="user-engagement",
keywords="dermatology",
keywords="wound care",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) tools have shown promise in clinical photo and wound documentation for their potential to improve workflows, expand access to care, and improve the quality of patient care. However, some barriers to adoption persist. Objective: This study aims to understand the social, organizational, and technical factors affecting clinicians' adoption of a clinical photo documentation mHealth app and its implications for clinical workflows and quality of care. Methods: A qualitative case study of a clinical photo and wound documentation app called imitoCam was conducted. The data were collected through 20 in-depth interviews with mHealth providers, clinicians, and medical informatics experts from 8 clinics and hospitals in Switzerland and Germany. Results: According to the study participants, the use of mHealth in clinical photo and wound documentation provides numerous benefits such as time-saving and efficacy, better patient safety and quality of care, enhanced data security and validation, and better accessibility. The clinical workflow may also improve when the app is a good fit, resulting in better collaboration and transparency, streamlined daily work, clinician empowerment, and improved quality of care. The findings included important factors that may contribute to or hinder adoption. Factors may be related to the material nature of the tool, such as the perceived usefulness, ease of use, interoperability, cost, or security of the app, or social aspects such as personal experience, attitudes, awareness, or culture. Organizational and policy barriers include the available clinical practice infrastructure, workload and resources, the complexity of decision making, training, and ambiguity or lack of regulations. User engagement in the development and implementation process is a vital contributor to the successful adoption of mHealth apps. Conclusions: The promising potential of mHealth in clinical photo and wound documentation is clear and may enhance clinical workflow and quality of care; however, the factors affecting adoption go beyond the technical features of the tool itself to embrace significant social and organizational elements. Technology providers, clinicians, and decision makers should work together to carefully address any barriers to improve adoption and harness the potential of these tools. ",
doi="10.2196/20203",
url="http://mhealth.jmir.org/2020/9/e20203/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32965232"
}


@Article{info:doi/10.2196/15460,
author="Hawley-Hague, Helen
and Tacconi, Carlo
and Mellone, Sabato
and Martinez, Ellen
and Ford, Claire
and Chiari, Lorenzo
and Helbostad, Jorunn
and Todd, Chris",
title="Smartphone Apps to Support Falls Rehabilitation Exercise: App Development and Usability and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="28",
volume="8",
number="9",
pages="e15460",
keywords="aged",
keywords="postural balance",
keywords="telerehabilitation",
keywords="patient compliance",
keywords="accidental falls",
abstract="Background: Falls have implications for older adults' health and well-being. Strength and balance interventions significantly reduce the risk of falls. However, patients do not always perform the unsupervised home exercise needed for fall reduction. Objective: This study aims to develop motivational smartphone apps co-designed with health professionals and older adults to support patients to perform exercise proven to aid fall reduction and to explore the apps' usability and acceptability with both health professionals and patients. Methods: There were 3 phases of app development that included analysis, design, and implementation. For analysis, we examined the literature to establish key app components and had a consultation with 12 older adults attending a strength and balance class, exercise instructors, and 3 fall services. For design, we created prototype apps and conducted 2 patient and public involvement workshops, one with 5 health professionals and the second with 8 older adults from an exercise group. The apps were revised based on the feedback. For implementation, we tested them with one fall service and their patients for 3 weeks. Participatory evaluation was used through testing, semistructured interviews, and focus groups to explore acceptability and usability. Focus groups were conducted with the service that tested the apps and two other services. Qualitative data were analyzed using the framework approach. Results: On the basis of findings from the literature and consultations in the analysis phase, we selected Behavior Change Techniques, such as goal setting, action planning, and feedback on behavior, to be key parts of the app. We developed goals using familiar icons for patients to select and add while self-reporting exercise and decided to develop 2 apps, one for patients (My Activity Programme) and one for health professionals (Motivate Me). This enabled health professionals to guide patients through the goal-setting process, making it more accessible to nontechnology users. Storyboards were created during the design phase, leading to prototypes of ``Motivate Me'' and ``My Activity Programme.'' Key changes from the workshops included being able to add more details about the patients' exercise program and a wider selection of goals within ``Motivate Me.'' The overall app design was acceptable to health professionals and older adults. In total, 7 patients and 3 health professionals participated in testing in the implementation phase, with interviews conducted with 6 patients and focus groups, with 3 teams (11 health professionals). Barriers, facilitators, and further functionality were identified for both apps, with 2 cross-cutting themes around phone usability and confidence. Conclusions: The motivational apps were found to be acceptable for older adults taking part in the design stage and patients and health professionals testing the apps in a clinical setting. User-led design is important to ensure that the apps are usable and acceptable. ",
doi="10.2196/15460",
url="http://mhealth.jmir.org/2020/9/e15460/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985992"
}


@Article{info:doi/10.2196/20848,
author="Lee, Seohyun
and Kim, Eunji
and Desta, Birhane Tekaligne",
title="Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="8",
volume="8",
number="9",
pages="e20848",
keywords="team communication",
keywords="health extension workers",
keywords="mobile communication",
keywords="mobile data collection",
keywords="Ethiopia",
keywords="health worker",
keywords="communication",
keywords="data",
abstract="Background: In Ethiopia, health extension workers (HEWs) are deployed across the country by the government to meet public health needs. Team communication is important for effective teamwork, but community health workers in low-resource settings like Ethiopia may face challenges in carrying out team meetings to compile service statistics. This is due to the nature of their outreach activities, which requires extensive travel. Objective: This study aimed to identify gaps in team communication about service statistics among HEWs in Ethiopia. Considering mobile communication and data collection as tools for bridging these gaps, we examined disparities in access to electricity, which has been identified as one of the major barriers to this approach. Methods: Data from the most recent Performance Monitoring and Accountability 2020 service delivery point survey were used for our analysis. Logistic regression analysis was performed to identify disparities in team communication on service statistics for family planning, which is a major component of the HEW's job. Disparities were examined across health facilities with different levels of HEW integration in their staffing structure (ie, no HEWs, at least one HEW, or only HEWs). Additionally, a chi-square test was conducted to examine disparities in access to electricity to explore the potential of mobile communication and data collection integration. Results: In total, 427 health facilities of four different types (ie, hospitals, health centers, health posts, and health clinics) were included in our analysis. At most health posts (84/95, 88\%), only HEWs were employed; none of the health clinics integrated the HEW model into their staffing structure. Among the 84 health posts, the odds of having team meetings on family planning service statistics in the past 12 months were 0.48 times the odds of those without HEWs (P=.02). No statistically significant differences were found between HEW-only facilities and facilities with at least one HEW. Most health facilities (69/83, 83.13\%) with HEWs as the only staff had no electricity at the time of the survey while 71.25\% (57/80) had intermittent access (ie, service disruption lasting 2 or more hours that day). There were statistically significant differences in electricity access among health facilities with different levels of HEW integration (P<.001). Conclusions: Facilities employing only HEWs were less likely to have regular team meetings to discuss service statistics. Since their responsibilities involve extensive outreach activities, travel, and paper-based recordkeeping, empowering HEWs with mobile communication and data collection can be a workable solution. The empirical evidence regarding disparities in electricity access also supports the need for and the feasibility of this approach. ",
doi="10.2196/20848",
url="http://mhealth.jmir.org/2020/9/e20848/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32897231"
}


@Article{info:doi/10.2196/17057,
author="Moon, Youngjin
and Oh, Jeongmin
and Hyun, Jaeho
and Kim, Youngkyu
and Choi, Jaesoon
and Namgoong, Jeongman
and Kim, Ki Jun",
title="Cost-Effective Smartphone-Based Articulable Endoscope Systems for Developing Countries: Instrument Validation Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="10",
volume="8",
number="9",
pages="e17057",
keywords="smartphone-based endoscope",
keywords="mobile health",
keywords="low-resource settings",
keywords="continuum body",
keywords="articulable endoscope",
keywords="low-cost medical device",
keywords="point of care diagnostics",
abstract="Background: Endoscopes are widely used for visualizing the respiratory tract, urinary tract, uterus, and gastrointestinal tracts. Despite high demand, people in underdeveloped and developing countries cannot obtain proper access to endoscopy. Moreover, commercially available endoscopes are mostly nonarticulable as well as not actively controlled, limiting their use. Articulating endoscopes are required for some diagnosis procedures, due to their ability to image wide areas of internal organs. Furthermore, actively controlled articulating endoscopes are less likely to harm the lumen than rigid endoscopes because they can avoid contact with endothelial tissues. Objective: The study aimed to demonstrate the feasibility and acceptability of smartphone-based wide-field articulable endoscope system for minimally invasive clinical applications in developing and less developed countries. Methods: A thin articulable endoscope system that can be attached to and actively controlled by a smartphone was designed and constructed. The system consists of a flexible endoscopic probe with a continuum mechanism, 4 motor modules for articulation, a microprocessor for controlling the motor with a smartphone, and a homebuilt app for streaming, capturing, adjusting images and video, and controlling the motor module with a joystick-like user interface. The smartphone and motor module are connected via an integrated C-type On-The-Go (OTG) USB hub. Results: We tested the device in several human-organ phantoms to evaluate the usability and utility of the smartphone-based articulating endoscope system. The resolution (960 {\texttimes} 720 pixels) of the device was found to be acceptable for medical diagnosis. The maximum bending angle of 110{\textdegree} was designed. The distance from the base of the articulating module to the tip of the endoscope was 45 mm. The angle of the virtual arc was 40.0{\textdegree}, for a curvature of 0.013. The finest articulation resolution was 8.9{\textdegree}. The articulating module succeeded in imaging all 8 octants of a spherical target, as well as all 4 quadrants of the indices marked in human phantoms. Conclusions: The portable wide-field endoscope was successfully controlled using a smartphone, yielding clear images with a resolution of 960 {\texttimes} 720 pixels at realistic focal distances. Actively and precisely controlled articulating movements have resulted in minimally invasive monitoring in the narrow space of internal organs providing a wide-area view. We found our smartphone-based active articulated endoscope to be suitable for point-of-care applications in developing and less developed countries. ",
doi="10.2196/17057",
url="http://mhealth.jmir.org/2020/9/e17057/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909951"
}


@Article{info:doi/10.2196/20356,
author="Johri, Mira
and Chandra, Dinesh
and Kone, Georges Karna
and Sylvestre, Marie-Pierre
and Mathur, K. Alok
and Harper, Sam
and Nandi, Arijit",
title="Social and Behavior Change Communication Interventions Delivered Face-to-Face and by a Mobile Phone to Strengthen Vaccination Uptake and Improve Child Health in Rural India: Randomized Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e20356",
keywords="randomized controlled trial",
keywords="immunization programs",
keywords="child health",
keywords="mHealth",
keywords="health promotion",
keywords="health services accessibility",
keywords="implementation science",
keywords="pilot projects",
keywords="developing countries",
keywords="global health",
abstract="Background: In resource-poor settings, lack of awareness and low demand for services constitute important barriers to expanding the coverage of effective interventions. In India, childhood immunization is a priority health strategy with suboptimal uptake. Objective: To assess study feasibility and key implementation outcomes for the Tika Vaani model, a new approach to educate and empower beneficiaries to improve immunization and child health. Methods: A cluster-randomized pilot trial with a 1:1 allocation ratio was conducted in rural Uttar Pradesh, India, from January to September 2018. Villages were randomly assigned to either the intervention or control group. In each participating village, surveyors conducted a complete enumeration to identify eligible households and requested participation before randomization. Interventions were designed through formative research using a social marketing approach and delivered over 3 months using strategies adapted to disadvantaged populations: (1) mobile health (mHealth): entertaining educational audio capsules (edutainment) and voice immunization reminders via mobile phone and (2) face-to-face: community mobilization activities, including 3 small group meetings offered to each participant. The control group received usual services. The main outcomes were prespecified criteria for feasibility of the main study (recruitment, randomization, retention, contamination, and adoption). Secondary endpoints tested equity of coverage and changes in intermediate outcomes. Statistical methods included descriptive statistics to assess feasibility, penalized logistic regression and ordered logistic regression to assess coverage, and generalized estimating equation models to assess changes in intermediate outcomes. Results: All villages consented to participate. Gaps in administrative data hampered recruitment; 14.0\% (79/565) of recorded households were nonresident. Only 1.4\% (8/565) of households did not consent. A total of 387 households (184 intervention and 203 control) with children aged 0 to 12 months in 26 villages (13 intervention and 13 control) were included and randomized. The end line survey occurred during the flood season; 17.6\% (68/387) of the households were absent. Contamination was less than 1\%. Participation in one or more interventions was 94.0\% (173/184), 78.3\% (144/184) for the face-to-face strategy, and 67.4\% (124/184) for the mHealth strategy. Determinants including place of residence, mobile phone access, education, and female empowerment shaped intervention use; factors operated differently for face-to-face and mHealth strategies. For 11 of 13 intermediate outcomes, regression results showed significantly higher basic health knowledge among the intervention group, supporting hypothesized causal mechanisms. Conclusions: A future trial of a new intervention model is feasible. The interventions could strengthen the delivery of immunization and universal primary health care. Social and behavior change communication via mobile phones proved viable and contributed to standardization and scalability. Face-to-face interactions remain necessary to achieve equity and reach, suggesting the need for ongoing health system strengthening to accompany the introduction of communication technologies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 44840759; https://doi.org/10.1186/ISRCTN44840759 ",
doi="10.2196/20356",
url="http://mhealth.jmir.org/2020/9/e20356/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955455"
}


@Article{info:doi/10.2196/16958,
author="Hossain, Mosharaf Md
and Mani, Kulanthayan
and Mat Min, Ruhani",
title="SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="23",
volume="8",
number="9",
pages="e16958",
keywords="acceptability",
keywords="SMS",
keywords="drowning",
keywords="parents",
abstract="Background: In many cases, greater use is being made of mobile phone text messages as a means of communication between patients and health care providers in countries around the world. Objective: We studied the use of mobile phones and the factors related to the acceptability of text messages for parents for the prevention of child drowning in Bangladesh. Methods: From a randomized controlled trial involving 800 parents, 10\% (80/800) were selected, and socioeconomic status, mobile phone use, and acceptability of SMS text messages for drowning prevention were measured. Participants with at least one child under 5 years of age were selected from rural areas in Rajshahi District in Bangladesh. Mobile phone--based SMS text messages were sent to the participants. Multivariate regression was used to determine the factors related to the acceptability of text messages for the prevention of child drowning in Bangladesh. Results: The acceptability of SMS text messages for the prevention of child drowning in Bangladesh was significantly lower among women (odds ratio [OR] 0.50, 95\% CI 0.12-1.96, P=.02) than among men, lower for parents older than 30 years (OR 0.17, 95\% CI 0.14-1.70, P=.01) compared to parents younger than 30 years, higher among parents who had an education (OR 1.63, 95\% CI 1.11-5.80, P=.04) than among illiterate parents, and higher among parents with a monthly household income over 7000 Bangladeshi Taka (approximately US \$82.54; OR 1.27, 95\% CI 1.06-1.96, P=.05) than among parents whose monthly income was less than 7000 Bangladeshi Taka. Conclusions: The high percentage of mobile phone use and the acceptability of SMS text messages for parents for the prevention of child drowning are encouraging, in terms of identifying the best strategy for using such technologies, and deserve further evaluation. ",
doi="10.2196/16958",
url="http://mhealth.jmir.org/2020/9/e16958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32965224"
}


@Article{info:doi/10.2196/16444,
author="Heidel, Alexandra
and Hagist, Christian",
title="Potential Benefits and Risks Resulting From the Introduction of Health Apps and Wearables Into the German Statutory Health Care System: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="23",
volume="8",
number="9",
pages="e16444",
keywords="health apps",
keywords="wearables",
keywords="digital health application",
keywords="mHealth",
abstract="Background: Germany is the first country worldwide that has introduced a digital care act as an incentive system to enhance the use of digital health devices, namely health apps and wearables, among its population. The act allows physicians to prescribe statutory financed and previously certified health apps and wearables to patients. This initiative has the potential to improve treatment quality through better disease management and monitoring. Objective: The aim of this paper was to outline the key concepts related to the potential risks and benefits discussed in the current literature about health apps and wearables. Furthermore, this study aimed to answer the research question: Which risks and benefits may result from the implementation of the digital care act in Germany? Methods: We conducted the scoping study by searching the databases PubMed, Google Scholar, and JMIR using the keywords health apps and wearables. We discussed 55 of 136 identified articles published in the English language from 2015 to March 2019 in this paper using a qualitative thematic analysis approach. Results: We identified four key themes within the articles: Effectivity of health apps and wearables to improve health; users of health apps and wearables; the potential of bring-your-own, self-tracked data; and concerns and data privacy risks. Within these themes, we identified three main stages of benefits for the German health care system: Usage of health apps and wearables; continuing to use health apps and wearables; and sharing bring-your-own; self-tracked data with different agents in the health care sector. Conclusions: The digital care act could lead to an improvement in treatment quality through better patient monitoring, disease management, personalized therapy, and better health education. However, physicians should play an active role in recommendingand supervising health app use to reach digital-illiterate or health-illiterate people. Age must not be an exclusion criterion. Yet, concerns about data privacy and security are very strong in Germany. Transparency about data processing should be provided at all times for continuing success of the digital care act in Germany. ",
doi="10.2196/16444",
url="http://mhealth.jmir.org/2020/9/e16444/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32965231"
}


@Article{info:doi/10.2196/18896,
author="Zhu, Haihua
and Chen, Xiuwan
and Yang, Jinqiu
and Wu, Qiaoling
and Zhu, Jiemin
and Chan, Wai-Chi Sally",
title="Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18896",
keywords="breast cancer",
keywords="chemotherapy",
keywords="mobile app",
keywords="mHealth",
abstract="Background: Many app-based interventions targeting women with breast cancer have been developed and tested for effectiveness. However, information regarding the evaluation of the usage of these interventions is scarce. A better understanding of usage data is important to determine how women use apps and how these interventions affect health outcomes. Objective: This study aimed to examine the usage duration and login frequency of an app-based intervention, the Breast Cancer e-Support (BCS) program, and to investigate the association between usage data and participants' demographic and medical characteristics. Methods: This study is a secondary data analysis of a randomized controlled trial assessing the effectiveness of the BCS program. The BCS program contains four modules: Learning Forum, Discussion Forum, Ask-the-Expert Forum, and Your Story Forum. A total of 57 women in the intervention group accessed the BCS program during their 12-week chemotherapy. The app's background system tracked the usage duration and login frequency for each forum and the entire BCS program. Results: The total usage duration per participant ranged from 0 to 9371 minutes, and the login frequency per participant ranged from 0 to 774 times. The Discussion Forum and the Learning Forum were the most frequently used modules. The general linear model showed that age, education, family monthly income, and employment were associated with BCS usage duration and/or login frequency. Age (F1,45=10.09, P=.003, B=115.34, 95\% CI 42.22-188.47) and education level (F1,45=7.22, P=.01, B=1949.63, 95\% CI 487.76-3411.50) were positively associated with the usage duration of the entire BCS program. Family monthly income was positively associated with the usage duration of the Learning Forum (F1,45=11.85, P=.001, B=1488.55, 95\% CI 617.58-2359.51) and the login frequency of the entire BCS program (F1,45=4.47, P=.04, B=113.68, 95\% CI 5.33-222.03). Employment was negatively associated with the usage duration of the Ask-the-expert Forum (F1,45=4.50, P=.04, B=--971.87, 95\% CI --1894.66 to --49.07) and the Your Story Forum (F1,45=5.36, P=.03, B=--640.71, 95\% CI --1198.30 to --83.11) and positively associated with the login frequency of the entire BCS program (F1,45=10.86, P=.002, B=192.88, 95\% CI 75.01-310.74). No statistical differences were found between BCS usage data and cancer stage, BMI, comorbidity, types of surgery, or cycles of chemotherapy. Conclusions: Overall, this study found considerable variability in the usage of app-based interventions. When health care professionals incorporate app-based interventions into their routine care for women with breast cancer, the learning and discussion functions of apps should be strengthened to promote engagement. Additionally, characteristics of women with breast cancer, such as age, level of education, income, and employment status, should be taken in consideration to develop tailored apps that address their particular needs and therefore improve their engagement with the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ACTRN12616000639426.aspx ",
doi="10.2196/18896",
url="http://mhealth.jmir.org/2020/9/e18896/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936087"
}


@Article{info:doi/10.2196/16745,
author="Osborn, Y. Chandra
and Hirsch, Ashley
and Sears, E. Lindsay
and Heyman, Mark
and Raymond, Jennifer
and Huddleston, Brian
and Dachis, Jeff",
title="One Drop App With an Activity Tracker for Adults With Type 1 Diabetes: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="17",
volume="8",
number="9",
pages="e16745",
keywords="diabetes",
keywords="type 1 diabetes",
keywords="digital therapy",
keywords="mobile app",
keywords="coaching",
keywords="glucometer",
keywords="activity tracker",
abstract="Background: In 2017, mobile app support for managing diabetes was available to 64\% of the global population of adults with diabetes. One Drop's digital therapeutics solution includes an evidence-based mobile app with global reach, a Bluetooth-connected glucometer, and in-app coaching from Certified Diabetes Educators. Among people with type 1 diabetes and an estimated hemoglobin A1c level?7.5\%, using One Drop for 3 months has been associated with an improved estimated hemoglobin A1c level of 22.2 mg/dL (--0.80\%). However, the added value of integrated activity trackers is unknown. Objective: We conducted a pragmatic, remotely administered randomized controlled trial to evaluate One Drop with a new-to-market activity tracker against One Drop only on the 3-month hemoglobin A1c level of adults with type 1 diabetes. Methods: Social media advertisements and online newsletters were used to recruit adults (?18 years old) diagnosed (?1 year) with T1D, na{\"i}ve to One Drop's full solution and the activity tracker, with a laboratory hemoglobin A1c level?7\%. Participants (N=99) were randomized to receive One Drop and the activity tracker or One Drop only at the start of the study. The One Drop only group received the activity tracker at the end of the study. Multiple imputation, performed separately by group, was used to correct for missing data. Analysis of covariance models, controlling for baseline hemoglobin A1c, were used to evaluate 3-month hemoglobin A1c differences in intent-to-treat (ITT) and per protocol (PP) analyses. Results: The enrolled sample (N=95) had a mean age of 41 (SD 11) years, was 73\% female, 88\% White, diagnosed for a mean of 20 (SD 11) years, and had a mean hemoglobin A1c level of 8.4\% (SD 1.2\%); 11\% of the participants did not complete follow up. Analysis of covariance assumptions were met for the ITT and PP models. In ITT analysis, participants in the One Drop and activity tracker condition had a significantly lower 3-month hemoglobin A1c level (mean 7.9\%, SD 0.60\%, 95\% CI 7.8-8.2) than that of the participants in the One Drop only condition (mean 8.4\%, SD 0.62\%, 95\% CI 8.2-8.5). In PP analysis, participants in the One Drop and activity tracker condition also had a significantly lower 3-month hemoglobin A1c level (mean 7.9\%, SD 0.59\%, 95\% CI 7.7-8.1) than that of participants in the One Drop only condition (mean 8.2\%, SD 0.58\%, 95\% CI 8.0-8.4). Conclusions: Participants exposed to One Drop and the activity tracker for the 3-month study period had a significantly lower 3-month hemoglobin A1c level compared to that of participants exposed to One Drop only during the same timeframe. One Drop and a tracker may work better together than alone in helping people with type 1 diabetes. Trial Registration: ClinicalTrials.gov NCT03459573; https://clinicaltrials.gov/ct2/show/NCT03459573. ",
doi="10.2196/16745",
url="http://mhealth.jmir.org/2020/9/e16745/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32540842"
}


@Article{info:doi/10.2196/19153,
author="Lee, Young Da
and Yoo, Seung-Hyun
and Min, Pil Kyong
and Park, Cheol-Young",
title="Effect of Voluntary Participation on Mobile Health Care in Diabetes Management: Randomized Controlled Open-Label Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="18",
volume="8",
number="9",
pages="e19153",
keywords="diabetes mellitus",
keywords="health services research",
keywords="mobile applications",
keywords="diabetes",
keywords="mHealth",
keywords="app",
keywords="lifestyle",
keywords="self-management",
keywords="volunteer",
keywords="participation",
abstract="Background: The role of mobile health care (mHealth) in glycemic control has been investigated, but its impact on self-management skills and its psychological aspects have not been studied. Objective: We evaluated the efficacy of mHealth-based diabetes self-management education and the effect of voluntary participation on its effects. Methods: This study was a randomized controlled open-label trial conducted for 6 months at Kangbuk Samsung Hospital. Participants in the control group (n=31) maintained their previous diabetes management strategies. Participants in the intervention group (n=41) additionally received mHealth-based diabetes self-management education through a mobile app and regular individualized feedback from health care professionals. The primary outcome was change in glycated hemoglobin (HbA1c) level over 6 months between the 2 groups (intervention versus control) and within each group (at 6 months versus baseline). The secondary outcomes were changes in body mass index, blood pressure, lipid profile, and questionnaire scores (the Korean version of the Summary of Diabetes Self-Care Activities Questionnaire, an Audit of Diabetes Dependent Quality of Life, the Appraisal of Diabetes Scale, and Problem Areas in Diabetes) over 6 months between groups and within each group. Results: A total of 66 participants completed this study. HbA1c (P=.04), total cholesterol level (P=.04), and Problem Areas in Diabetes scores (P=.02) significantly decreased; total diet (P=.03) and self-monitoring of blood glucose level scores (P=.01), based on the Summary of Diabetes Self-Care Activities Questionnaire, markedly increased within the intervention group. These significant changes were observed in self-motivated participants who were recruited voluntarily via advertisements. Conclusions: mHealth-based diabetes self-management education was effective at improving glycemic control and diabetes self-management skills and lowering diabetes-related distress in voluntary participants. Trial Registration: ClinicalTrials.gov NCT03468283; http://clinicaltrials.gov/ct2/show/NCT03468283 ",
doi="10.2196/19153",
url="http://mhealth.jmir.org/2020/9/e19153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945775"
}


@Article{info:doi/10.2196/19225,
author="Jones, V. Helen
and Smith, Harry
and Cooksley, Tim
and Jones, Philippa
and Woolley, Toby
and Gwyn Murdoch, Derick
and Thomas, Dafydd
and Foster, Betty
and Wakefield, Valerie
and Innominato, Pasquale
and Mullard, Anna
and Ghosal, Niladri
and Subbe, Christian",
title="Checklists for Complications During Systemic Cancer Treatment Shared by Patients, Friends, and Health Care Professionals: Prospective Interventional Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="25",
volume="8",
number="9",
pages="e19225",
keywords="cancer",
keywords="patient safety",
keywords="checklist",
keywords="quality of life",
keywords="anxiety",
keywords="depression",
keywords="health economics",
keywords="mHealth",
keywords="smartphone",
keywords="redundancy",
abstract="Background: Advances in cancer management have been associated with an increased incidence of emergency presentations with disease- or treatment-related complications. Objective: This study aimed to measure the ability of patients and members of their social network to complete checklists for complications of systemic treatment for cancer and examine the impact on patient-centered and health-economic outcomes. Methods: A prospective interventional cohort study was performed to assess the impact of a smartphone app used by patients undergoing systemic cancer therapy and members of their network to monitor for common complications. The app was used by patients, a nominated ``safety buddy,'' and acute oncology services. The control group was made up of patients from the same institution. Measures were based on process (completion of checklists over 60 days), patient experience outcomes (Hospital Anxiety and Depression Scale and the General version of the Functional Assessment of Cancer Therapy at baseline, 1 month, and 2 months) and health-economic outcomes (usage of appointments in primary care and elective and unscheduled hospital admissions). Results: At the conclusion of the study, 50 patients had completed 2882 checklists, and their 50 ``safety buddies'' had completed 318 checklists. Near daily usage was maintained over the 60-day study period. When compared to a cohort of 50 patients with matching disease profiles from the same institution, patients in the intervention group had comparable changes in Hospital Anxiety and Depression Scale and General version of the Functional Assessment of Cancer Therapy. Patients in the Intervention Group required a third (32 vs 97 nights) of the hospital days with overnight stay compared to patients in the Control Group, though the difference was not significant. The question, ``I feel safer with the checklist,'' received a mean score of 4.27 (SD 0.87) on a Likert scale (1-5) for patients and 4.55 (SD 0.65) for family and friends. Conclusions: Patients undergoing treatment for cancer and their close contacts can complete checklists for common complications of systemic treatments and take an active role in systems supporting their own safety. A larger sample size will be needed to assess the impact on clinical outcomes and health economics. ",
doi="10.2196/19225",
url="http://mhealth.jmir.org/2020/9/e19225/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32975526"
}


@Article{info:doi/10.2196/17646,
author="Garg, Rani Priyanka
and Uppal, Leena
and Mehra, Sunil
and Mehra, Devika",
title="Mobile Health App for Self-Learning on HIV Prevention Knowledge and Services Among a Young Indonesian Key Population: Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="8",
volume="8",
number="9",
pages="e17646",
keywords="mHealth",
keywords="Indonesia",
keywords="HIV",
keywords="key populations",
abstract="Background: Indonesia is the only country in the Asia Pacific region where the incidence of HIV is still on the rise, and its prevalence is extremely high among the key populations such as men who have sex with men, transgender women, and people who inject/use drugs. Mobile health (mHealth) apps provide an innovative platform for delivering tailored HIV prevention and care among these populations more efficiently than possible through the direct face-to-face approach. Objective: The aim of this study was to assess the role of a peer-customized mobile app based on the principle of self-learning for improving HIV prevention knowledge and access to health services among men who have sex with men, transgender women (known as Waria in Indonesia), and people who use drugs in Indonesia. Methods: A prospective intervention cohort study was conducted among the key populations in five provinces of Indonesia (Jakarata, West Java, East Java, Special Region of Yogyakarta, and Bali). The data were evaluated using a pre-post assessment survey conducted on a sample of 200 unique users, including 50 men who have sex with men and transgender women each, and 100 people who use drugs, with a follow-up response rate of 98\% and 70\%, respectively. An mHealth app named RUMAH SELA was developed and implemented among the key populations. Results: From baseline to the endpoint of the study, there was a significant increase in comprehensive HIV-related knowledge from 20\% (10/49) to 60\% (29/49), 22\% (11/49) to 57\% (28/49), and 49\% (34/70) to 74\% (52/70) among men who have sex with men (P=.004), transgender women (P<.001), and people who use drugs (P<.001), respectively. There was also a reduction in sexual activities without condom use from 22\% (11/49) to 19\% (9/49), 18\% (9/49) to 12\% (6/49), and 21\% (15/70) to 10\% (7/70) among men who have sex with men (P=.45), transgender women (P=.25), and people who use drugs (P<.001), respectively. There was an uptake of HIV testing by 31\% (15/49) for men who have sex with men, 49\% (24/49) for transgender women, and 26\% (18/70) for people who use drugs after using the app. There was a reduction in injecting drugs with a used needle in drug users from 45/70 (78\%) to 15/70 (26\%). Measures of self-esteem increased among men who have sex with men (mean 26.4 vs mean 27.1), transgender women (mean 26.5 vs mean 27.8; P=.02), and people who use drugs (mean 24.0 vs mean 25.0). In addition, 27\% (7/24) of men who have sex with men, 25\% (4/15) of transgender women, and 11\% (2/18) of drug users made an appointment for an HIV test through the app. The app was quite highly accepted by the key populations as nearly a quarter felt that they became more confident in discussing issues about sexuality, more than 80\% found that the app provided sufficient knowledge about HIV, and more than half of the participants found the app to be user friendly. Conclusions: This one-of-a-kind mHealth intervention with an mHealth app as a self-learning tool is effective in increasing HIV-related knowledge and behavior, and access to services with strong acceptability by the community. There is a need to scale up such interventions for efficacy testing in a larger population to provide evidence for national-level mHealth programs addressing HIV. ",
doi="10.2196/17646",
url="https://mhealth.jmir.org/2020/9/e17646",
url="http://www.ncbi.nlm.nih.gov/pubmed/32896831"
}


@Article{info:doi/10.2196/16953,
author="Ji, Yuwei
and Plourde, Hugues
and Bouzo, Valerie
and Kilgour, D. Robert
and Cohen, R. Tamara",
title="Validity and Usability of a Smartphone Image-Based Dietary Assessment App Compared to 3-Day Food Diaries in Assessing Dietary Intake Among Canadian Adults: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="9",
volume="8",
number="9",
pages="e16953",
keywords="mobile food record",
keywords="validity",
keywords="image-based dietary assessment",
keywords="healthy adults",
keywords="3-day food diary",
keywords="diet",
keywords="application",
keywords="nutrition",
keywords="mHealth",
keywords="Canada",
abstract="Background: Accurate dietary assessment is needed in studies that include analysis of nutritional intake. Image-based dietary assessment apps have gained in popularity for assessing diet, which may ease researcher and participant burden compared to traditional pen-to-paper methods. However, few studies report the validity of these apps for use in research. Keenoa is a smartphone image-based dietary assessment app that recognizes and identifies food items using artificial intelligence and permits real-time editing of food journals. Objective: This study aimed to assess the relative validity of an image-based dietary assessment app --- Keenoa --- against a 3-day food diary (3DFD) and to test its usability in a sample of healthy Canadian adults. Methods: We recruited 102 participants to complete two 3-day food records. For 2 weeks, on 2 non-consecutive days and 1 weekend day, in random order, participants completed a traditional pen-to-paper 3DFD and the Keenoa app. At the end of the study, participants completed the System Usability Scale. The nutrient analyses of the 3DFD and Keenoa data before (Keenoa-participant) and after they were reviewed by dietitians (Keenoa-dietitian) were analyzed using analysis of variance. Multiple tests, including the Pearson coefficient, cross-classification, kappa score, \% difference, paired t test, and Bland-Altman test, were performed to analyze the validity of Keenoa (Keenoa-dietitian). Results: The study was completed by 72 subjects. Most variables were significantly different between Keenoa-participant and Keenoa-dietitian (P<.05) except for energy, protein, carbohydrates, fiber, vitamin B1, vitamin B12, vitamin C, vitamin D, and potassium. Significant differences in total energy, protein, carbohydrates, \% fat, saturated fatty acids, iron, and potassium were found between the 3DFD and Keenoa-dietitian data (P<.05). The Pearson correlation coefficients between the Keenoa-dietitian and 3DFD ranged from .04 to .51. Differences between the mean intakes assessed by the 3DFD and Keenoa-dietitian were within 10\% except for vitamin D (misclassification rate=33.8\%). The majority of nutrients were within an acceptable range of agreement in the Bland-Altman analysis; no agreements were seen for total energy, protein, carbohydrates, fat (\%), saturated fatty acids, iron, potassium, and sodium (P<.05). According to the System Usability Scale, 34.2\% of the participants preferred using Keenoa, while 9.6\% preferred the 3DFD. Conclusions: The Keenoa app provides acceptable relative validity for some nutrients compared to the 3DFD. However, the average intake of some nutrients, including energy, protein, carbohydrates, \% fat, saturated fatty acids, and iron, differed from the average obtained using the 3DFD. These findings highlight the importance of verifying data entries of participants before proceeding with nutrient analysis. Overall, Keenoa showed better validity at the group level than the individual level, suggesting it can be used when focusing on the dietary intake of the general population. Further research is recommended with larger sample sizes and objective dietary assessment approaches. ",
doi="10.2196/16953",
url="https://mhealth.jmir.org/2020/9/e16953",
url="http://www.ncbi.nlm.nih.gov/pubmed/32902389"
}


@Article{info:doi/10.2196/17919,
author="Shoneye, L. Charlene
and Mullan, Barbara
and Begley, Andrea
and Pollard, M. Christina
and Jancey, Jonine
and Kerr, A. Deborah",
title="Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="9",
volume="8",
number="9",
pages="e17919",
keywords="obesity",
keywords="diet",
keywords="physical activity",
keywords="sedentary behavior",
keywords="digital behavioral interventions",
keywords="health behavior",
keywords="wearable activity monitor",
keywords="health",
keywords="mobile food record",
keywords="clinical trial",
keywords="focus group",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 ",
doi="10.2196/17919",
url="https://mhealth.jmir.org/2020/9/e17919",
url="http://www.ncbi.nlm.nih.gov/pubmed/32641284"
}


@Article{info:doi/10.2196/21243,
author="Horsham, Caitlin
and Antrobus, Jodie
and Olsen, M. Catherine
and Ford, Helen
and Abernethy, David
and Hacker, Elke",
title="Testing Wearable UV Sensors to Improve Sun Protection in Young Adults at an Outdoor Festival: Field Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e21243",
keywords="melanoma",
keywords="health promotion",
keywords="public health",
keywords="preventive medicine",
keywords="sunlight",
keywords="sunburn",
keywords="adolescents",
abstract="Background: Australia and New Zealand have the highest skin cancer incidence rates worldwide, and sun exposure is the main risk factor for developing skin cancer. Sun exposure during childhood and adolescence is a critical factor in developing skin cancer later in life. Objective: This study aims to test the effectiveness of wearable UV sensors to increase sun protection habits (SPH) and prevent sunburn in adolescents. Methods: During the weeklong school leavers outdoor festival (November 2019) at the Gold Coast, Australia, registered attendees aged 15-19 years were recruited into the field study. Participants were provided with a wearable UV sensor and free sunscreen. The primary outcome was sun exposure practices using the SPH index. Secondary outcomes were self-reported sunburns, sunscreen use, and satisfaction with the wearable UV sensor. Results: A total of 663 participants were enrolled in the study, and complete data were available for 188 participants (188/663, 28.4\% response rate). Participants provided with a wearable UV sensor significantly improved their use of sunglasses (P=.004) and sunscreen use both on the face (P<.001) and on other parts of the body (P=.005). However, the use of long-sleeve shirts (P<.001) and the use of a hat (P<.001) decreased. During the study period, 31.4\% (59/188) of the participants reported receiving one or more sunburns. Satisfaction with the wearable UV sensor was high, with 73.4\% (138/188) of participants reporting the UV sensor was helpful to remind them to use sun protection. Conclusions: Devices that target health behaviors when outdoors, such as wearable UV sensors, may improve use of sunscreen and sunglasses in adolescents. ",
doi="10.2196/21243",
url="http://mhealth.jmir.org/2020/9/e21243/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936083"
}


@Article{info:doi/10.2196/18867,
author="Monteiro-Guerra, Francisco
and Signorelli, Ruiz Gabriel
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Caulfield, Brian",
title="Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App--Based Physical Activity Coaching Interventions: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e18867",
keywords="mHealth",
keywords="mobile app",
keywords="mobile phone",
keywords="coaching",
keywords="physical activity",
keywords="breast cancer",
abstract="Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app--based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual's interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants' perspectives on potential mobile app--based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57\% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. ",
doi="10.2196/18867",
url="https://mhealth.jmir.org/2020/9/e18867",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955446"
}


@Article{info:doi/10.2196/18491,
author="Crane, E. Tracy
and Skiba, B. Meghan
and Miller, Austin
and Garcia, O. David
and Thomson, A. Cynthia",
title="Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="24",
volume="8",
number="9",
pages="e18491",
keywords="wearable electronic devices",
keywords="physical activity",
keywords="cancer survivors",
keywords="activity trackers",
keywords="mobile phone",
abstract="Background: The collection of self-reported physical activity using validated questionnaires has known bias and measurement error. Objective: Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control. Methods: From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns. Results: We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ?4 consecutive days with ?10 hours daily wear time, exceeded 90\% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer. Conclusions: The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area. ",
doi="10.2196/18491",
url="http://mhealth.jmir.org/2020/9/e18491/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969828"
}


@Article{info:doi/10.2196/18505,
author="Kim, Hyunmin
and Choi, Young In
and Kim, Dai-Jin",
title="Excessive Smartphone Use and Self-Esteem Among Adults With Internet Gaming Disorder: Quantitative Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="29",
volume="8",
number="9",
pages="e18505",
keywords="excessive smartphone use",
keywords="internet gaming disorder",
keywords="smartphone overuse",
keywords="self-esteem",
keywords="mental health",
keywords="gender difference",
keywords="Korean smartphone addiction proneness scale",
keywords="smartphone",
keywords="gaming",
keywords="young adult",
keywords="adult",
keywords="gender",
abstract="Background: Smartphone overuse can harm individual health and well-being. Although several studies have explored the relationship between problematic or excessive smartphone use and mental health, much less is known about effects on self-esteem, which is essential in having a healthy life, among adults with mental health disorders, including internet gaming disorder. Furthermore, given that smartphone usage differs by gender, little is known about gender differences in the relationship between smartphone overuse and self-esteem. Objective: The objective of this study was to assess self-esteem among individuals with mental health disorders and explore the relationship with excessive smartphone use. Methods: Participants were selected based on their responses to the internet gaming disorder assessment, which includes 9 items developed based on Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria, from among a Korean cohort of smartphone users aged 20-40 years, resulting in a sample of 189 participants (men:120, women: 69). The Rosenberg self-esteem scale and the Korean smartphone addiction proneness scale were utilized to assess the outcome self-esteem with excessive smartphone use as the primary independent variable. Guided by the Bowlby attachment theory and prior studies, we selected several covariates. Generalized linear regression analyses, as well as subgroup analyses by gender, were performed. Results: Among adults with internet gaming disorder, the average Korean smartphone addiction proneness scale score was significantly higher in women than that in men (41.30 vs. 37.94; P=.001), and excessive smartphone use was significantly more prevalent in women than it was in men (30.43\% vs. 20.83\%; P=.02). Our findings from the generalized linear regression analyses indicated that an increase in Korean smartphone addiction proneness scale score had a negative relationship with self-esteem among those with internet gaming disorder ($\beta$=--0.18, P=.001). Furthermore, our interaction models showed that, among those with internet gaming disorder, more men than women had lower self-esteem associated with an increase in Korean smartphone addiction proneness scale score and a high degree of smartphone overuse ($\beta$=--0.19, P=.004; $\beta$=--3.73, P<.001). Conclusions: Excessive smartphone use was found to be adversely associated with self-esteem among young and middle-aged adults with internet gaming disorder; notably, more men than women were negatively influenced (regarding self-esteem) by smartphone overuse. Based on our findings, more efforts should be made to reduce excessive or problematic smartphone use by considering developing public health interventions or policy, particularly among those with mental health disorders such as internet gaming disorder. ",
doi="10.2196/18505",
url="https://mhealth.jmir.org/2020/9/e18505",
url="http://www.ncbi.nlm.nih.gov/pubmed/32990637"
}


@Article{info:doi/10.2196/17963,
author="Lunardini, Francesca
and Luperto, Matteo
and Romeo, Marta
and Basilico, Nicola
and Daniele, Katia
and Azzolino, Domenico
and Damanti, Sarah
and Abbate, Carlo
and Mari, Daniela
and Cesari, Matteo
and Borghese, Alberto Nunzio
and Ferrante, Simona",
title="Supervised Digital Neuropsychological Tests for Cognitive Decline in Older Adults: Usability and Clinical Validity Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e17963",
keywords="aging",
keywords="Bells Test",
keywords="computerized testing",
keywords="dementia",
keywords="early diagnosis",
keywords="eHealth",
keywords="mild cognitive impairment",
keywords="neuropsychological assessment",
keywords="Trail Making Test",
abstract="Background: Dementia is a major and growing health problem, and early diagnosis is key to its management. Objective: With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user's performance after test completion. Methods: To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. Results: The results obtained from 83 older adults showed high system acceptance, despite the patients' low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. Conclusions: Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline. ",
doi="10.2196/17963",
url="http://mhealth.jmir.org/2020/9/e17963/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955442"
}


@Article{info:doi/10.2196/14346,
author="Peuchot, Jeremy
and Allard, Etienne
and Dureuil, Bertrand
and Veber, Benoit
and Comp{\`e}re, Vincent",
title="Efficiency of Text Message Contact on Medical Safety in Outpatient Surgery: Retrospective Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="10",
volume="8",
number="9",
pages="e14346",
keywords="outpatient surgery",
keywords="short message service (SMS)",
keywords="patient information",
keywords="organizational",
keywords="cost",
keywords="unanticipated admission",
keywords="preoperative instructions",
abstract="Background: Establishing pre- and postoperative contact with patients is part of successful medical management in outpatient surgery. In France, this is mostly done via telephone. Automated information with short message service (SMS) reminders might be an interesting alternative to increase the rate of compliance with preoperative instructions, but no study has shown the safety of this approach. Objective: The objective of this study was to evaluate the impact of pre- and postoperative automated information with SMS reminders on medical safety in outpatient surgery. Methods: We conducted a retrospective, single-center, nonrandomized, controlled study with a before-after design. All adult patients who had outpatient surgery between September 2016 and December 2017 in our university hospital center were included. Before April 2017, patients were contacted by telephone by an outpatient surgery nurse. After April 2017, patients were contacted by SMS reminder. All patients were contacted the day before and the day after surgery. Patients contacted by SMS reminder were also contacted on day 7 after surgery. The primary end point was the conversion rate to full-time hospitalization. Secondary end points were hospitalization causes (anesthetic, surgical, organizational) and hospitalization costs. Results: A total of 4388 patients were included, 2160 before and 2228 after the introduction of SMS reminders. The conversion rate to full-time hospitalization was 34/4388 (0.77\%) with a difference between SMS group (8/2228, 0.36\%) and telephone group (26/2160, 1.20\%). The cost of SMS reminders was estimated as half that of telephone calls. Conclusions: In this work, we report a decrease in the rate of conversion to full-time hospitalization with the use of pre- and postoperative SMS reminders. This new approach could represent a safe and cost-effective method in an outpatient surgery setting. ",
doi="10.2196/14346",
url="https://mhealth.jmir.org/2020/9/e14346",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909948"
}


@Article{info:doi/10.2196/17563,
author="Thomas, Kristin
and Bendtsen, Marcus
and Linderoth, Catharina
and Bendtsen, Preben",
title="Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients' and Health Care Professionals' Perspectives",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="18",
volume="8",
number="9",
pages="e17563",
keywords="mHealth",
keywords="mobile health",
keywords="text messages",
keywords="health care",
keywords="smoking cessation",
keywords="patients with elective surgery",
keywords="implementation",
abstract="Background: There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective: This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods: A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results: Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions: Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery. ",
doi="10.2196/17563",
url="https://mhealth.jmir.org/2020/9/e17563",
url="http://www.ncbi.nlm.nih.gov/pubmed/32945772"
}


@Article{info:doi/10.2196/20317,
author="Liu, Ying-Chieh
and Chen, Chien-Hung
and Lin, Yu-Sheng
and Chen, Hsin-Yun
and Irianti, Denisa
and Jen, Ting-Ni
and Yeh, Jou-Yin
and Chiu, Yueh-Hsia Sherry",
title="Design and Usability Evaluation of Mobile Voice-Added Food Reporting for Elderly People: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="28",
volume="8",
number="9",
pages="e20317",
keywords="voice-added design",
keywords="food report",
keywords="elderly",
keywords="usability evaluation",
keywords="automatic speech recognition",
keywords="mHealth",
keywords="randomized trial",
abstract="Background: Advances in voice technology have raised new possibilities for apps related to daily health maintenance. However, the usability of such technologies for older users remains unclear and requires further investigation. Objective: We designed and evaluated two innovative mobile voice-added apps for food intake reporting, namely voice-only reporting (VOR) and voice-button reporting (VBR). Each app features a unique interactive procedure for reporting food intake. With VOR, users verbally report the main contents of each dish, while VBR provides both voice and existing touch screen inputs for food intake reporting. The relative usability of the two apps was assessed through the metrics of accuracy, efficiency, and user perception. Methods: The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. A group of 57 adults aged 60-90 years (12 male and 45 female participants) was recruited from a retirement community and randomized into two experimental groups, that is, VOR (n=30) and VBR (n=27) groups. Both groups were tested using the same set of 17 food items including dishes and beverages selected and allocated to present distinct breakfast, lunch, and dinner meals. All participants used a 7-inch tablet computer for the test. The resulting data were analyzed to evaluate reporting accuracy and time efficiency, and the system usability scale (SUS) was used to measure user perception. Results: For eight error types identified in the experiment, the VBR group participants were significantly (P<.001) more error prone owing to the required use of button-tapping actions. The highest error rates in the VOR group were related to incomprehensible reporting speech (28/420, 6.7\%), while the highest error rates in the VBR group were related to failure to make required button taps (39/378, 10.3\%). The VOR group required significantly (P<.001) less time to complete food reporting. The overall subjective reactions of the two groups based on the SUS surpassed the benchmark and were not significantly different (P=.20). Conclusions: Experimental results showed that VOR outperformed VBR, suggesting that voice-only food input reporting is preferable for elderly users. Voice-added apps offer a potential mechanism for the self-management of dietary intake by elderly users. Our study contributes an evidence-based evaluation of prototype design and selection under a user-centered design model. The results provide a useful reference for selecting optimal user interaction design. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN17335889; http://www.isrctn.com/ISRCTN17335889. ",
doi="10.2196/20317",
url="http://mhealth.jmir.org/2020/9/e20317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32985999"
}


@Article{info:doi/10.2196/18339,
author="Mandracchia, Floriana
and Llaurad{\'o}, Elisabet
and Tarro, Lucia
and Valls, Maria Rosa
and Sol{\`a}, Rosa",
title="Mobile Phone Apps for Food Allergies or Intolerances in App Stores: Systematic Search and Quality Assessment Using the Mobile App Rating Scale (MARS)",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e18339",
keywords="food allergy",
keywords="food hypersensitivity",
keywords="food intolerance",
keywords="allergens",
keywords="mobile applications",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth.",
abstract="Background: Food allergies and intolerances are increasing worldwide, and mobile phone apps could be a promising tool for self-management of these issues. Objective: This study aimed to systemically search and assess food allergy or intolerance apps in app stores using the multidimensional Mobile App Rating Scale (MARS) to rate the objective and subjective quality and to identify critical points for future improvements. Methods: This systematic search identified apps through the keywords ``food allergy,'' ``food intolerance,'' and ``allergens'' in English, Spanish, and Italian in the Apple App Store (iOS) and Google Play Store (Android). The inclusion criteria were a user star rating of ?3 (of 5 stars) to limit the selection to the most highly rated apps; ?1000 reviews as an indicator of reliability; and the most recent update performed up to 2017. Then, the apps were divided according to their purpose (searching for allergen-free ``food products,'' ``restaurants,'' or recipes in ``meal planners'') and evaluated on a scale of 1 to 5 points using the MARS in terms of (1) app classification category with a descriptive aim; (2) app subjective and objective quality categories comprised of engagement, functionality, esthetics, and information sections (Medline was searched for eligible apps to check whether they had been tested in trials); and (3) an optional app-specific section. Furthermore, the output and input features were evaluated. Differences between MARS sections and between app purposes and correlations among MARS sections, star ratings, and numbers of reviews were evaluated. Results: Of the 1376 apps identified, 14 were included: 12 related to food allergies and intolerances that detect 2-16 food allergens and 2 related only to gluten intolerance. The mean (SD) MARS scores (maximum 5 points) were 3.8 (SD 0.4) for objective quality, highlighting whether any app had been tested in trials; 3.5 (SD 0.6) for subjective quality; and 3.6 (SD 0.7) for the app-specific section. Therefore, a rating ?3 points indicated overall acceptable quality. From the between-section comparison, engagement (mean 3.5, SD 0.6) obtained significantly lower scores than functionality (mean 4.1, SD 0.6), esthetics (mean 4, SD 0.5), and information (mean 3.8, SD 0.4). However, when the apps were compared by purpose, critical points were identified: meal planner apps showed significantly higher engagement (mean 4.1, SD 0.4) than food product (mean 3.0, SD 0.6; P=.05) and restaurant (mean 3.2, SD 0.3; P=.02) apps. Conclusions: In this systematic search of food allergy or intolerance apps, acceptable MARS quality was identified, although the engagement section for food product and restaurant purpose apps should be improved and the included apps should be tested in trials. The critical points identified in this systematic search can help improve the innovativeness and applicability of future food allergy and intolerance apps. ",
doi="10.2196/18339",
url="http://mhealth.jmir.org/2020/9/e18339/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32936078"
}


@Article{info:doi/10.2196/17135,
author="Schoenthaler, Antoinette
and Leon, Michelle
and Butler, Mark
and Steinhaeuser, Karsten
and Wardzinski, William",
title="Development and Evaluation of a Tailored Mobile Health Intervention to Improve Medication Adherence in Black Patients With Uncontrolled Hypertension and Type 2 Diabetes: Pilot Randomized Feasibility Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="23",
volume="8",
number="9",
pages="e17135",
keywords="mHealth",
keywords="medication adherence",
keywords="hypertension",
keywords="type 2 diabetes",
keywords="African Americans",
abstract="Background: Research has underscored the need to develop socioculturally tailored interventions to improve adherence behaviors in minority patients with hypertension (HTN) and type 2 diabetes (T2D). Novel mobile health (mHealth) approaches are potential methods for delivering tailored interventions to minority patients with increased cardiovascular risk. Objective: This study aims to develop and evaluate the acceptability and preliminary efficacy of a tailored mHealth adherence intervention versus attention control (AC) on medication adherence, systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemoglobin A1c (HbA1c) at 3 months in 42 Black patients with uncontrolled HTN and/or T2D who were initially nonadherent to their medications. Methods: This was a two-phase pilot study consisting of a formative phase and a clinical efficacy phase. The formative phase consisted of qualitative interviews with 10 members of the target patient population (7/10, 70\% female; mean age 65.8 years, SD 5.6) to tailor the intervention based on the Information-Motivation-Behavioral skills model of adherence. The clinical efficacy phase consisted of a 3-month pilot randomized controlled trial to evaluate the tailored mHealth intervention versus an AC. The tablet-delivered intervention included a tailoring survey, an individualized adherence profile, and a personalized list of interactive adherence-promoting modules, whereas AC included the tailoring survey and health education videos delivered on the tablet. Acceptability was assessed through semistructured exit interviews. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale, whereas blood pressure and HbA1c were assessed using automated devices. Results: In phase 1, thematic analysis of the semistructured interviews revealed the following 5 major barriers to adherence: disruptions in daily routine, forgetfulness, concerns about adverse effects, preference for natural remedies, and burdens of medication taking. Patients recommended the inclusion of modules that address improving patient-provider communication, peer vignettes, and stress reduction strategies to facilitate adherence. A total of 42 Black patients (23/42, 55\% male; mean age 57.6 years, SD 11.1) participated in the clinical efficacy pilot trial. At 3 months, both groups showed significant improvements in adherence (mean 1.35, SD 1.60; P<.001) and SBP (?4.76 mm Hg; P=.04) with no between-group differences (P=.50 and P=.10). The decreases in DBP and HbA1c over time were nonsignificant (?1.97 mm Hg; P=.20; and ?0.2\%; P=.45, respectively). Patients reported high acceptability of the intervention for improving their adherence. Conclusions: This pilot study demonstrated preliminary evidence on the acceptability of a tailored mHealth adherence intervention among a sample of Black patients with uncontrolled HTN and T2D who were initially nonadherent to their medications. Future research should explore whether repeated opportunities to use the mHealth intervention would result in improvements in behavioral and clinical outcomes over time. Modifications to the intervention as a result of the pilot study should guide future efforts. Trial Registration: ClinicalTrials.gov NCT01643473; http://clinicaltrials.gov/ct2/show/ NCT01643473 ",
doi="10.2196/17135",
url="http://mhealth.jmir.org/2020/9/e17135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32965230"
}


@Article{info:doi/10.2196/18782,
author="Gondoh-Noda, Yuko
and Kometani, Mitsuhiro
and Nomura, Akihiro
and Aono, Daisuke
and Karashima, Shigehiro
and Ushijima, Hiromi
and Tamiya, Eiichi
and Murayama, Toshinori
and Yoneda, Takashi",
title="Feasibility of a Novel Mobile C-Reactive Protein--Testing Device Using Gold-Linked Electrochemical Immunoassay: Clinical Performance Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="7",
volume="8",
number="9",
pages="e18782",
keywords="gold-linked electrochemical immunoassay (GLEIA)",
keywords="home-based care",
keywords="mobile CRP testing device",
keywords="mHealth",
keywords="diagnostic",
keywords="infection",
keywords="assay",
keywords="CRP",
keywords="c-reactive protein",
keywords="immunoassay",
abstract="Background: Home-based care is one of the most promising solutions to provide sufficient medical care for several older patients in Japan. However, because of insufficient diagnostic devices, it is sometimes difficult to detect early signs of the occurrence or worsening of diseases, such as infections under home-based care settings. C-reactive protein (CRP) is highly sensitive to diagnosing infections, and its elevation can help diagnose acute infection in older patients. Therefore, a CRP-measuring device that can be used in such a specific occasion is needed for home-based care. However, aspects such as its size, weight, and procedure are still challenging with respect to the practical use of mobile devices that quantitatively measure CRP levels easily and quickly under home-based care settings. Objective: We developed a new mobile, rapid CRP measurement device using a gold-linked electrochemical immunoassay (GLEIA) system. The aim of this study was to evaluate the feasibility of this mobile CRP-testing device. Methods: First, we assessed the performance of bare GLEIA-based electrode chips as the foundation of the device. After embedding the bare GLEIA-based electrode chips in a special plastic case and developing the mobile CRP-testing device, we further tested the device prototype using clinical blood samples. Finally, we evaluated the intra-assay variability for precision in the same condition and inter-assay variability for reproducibility in different conditions. Results: Blood samples for analysis were obtained by direct vein puncture from outpatients (N=85; females: 57/85; males: 28/85; age: 19-88 years) at Kanazawa University Hospital in Japan. For performance evaluation of bare GLEIA-based electrode chips, we used 85 clinical blood samples. There was a significant positive correlation between the electrode-predicted CRP levels and the reference CRP concentrations (R2=0.947; P<.001). The assembled device was mobile (size 45{\texttimes}90{\texttimes}2.4 mm; weight 10 g) and disposable. The minimum volume of the sample needed for measuring CRP was 1.4 {\textmu}L. The estimated preanalytical time was approximately 7 minutes and 40 seconds, and analysis time was approximately 1 minute and 10 seconds. Subsequently, for performance evaluation of the mobile CRP-testing device using GLEIA-based electrode chips, we used 26 clinical blood samples and found a significant positive correlation between the mobile device-predicted CRP levels and the reference CRP concentrations (R2=0.866, P<.001). The intra-assay variabilities were 34.2\%, 40.8\%, and 24.5\% for low, medium, and high CRP concentrations, respectively. The inter-assay variabilities were 46.5\%, 38.3\%, and 64.1\% for low, medium, and high CRP concentrations, respectively. Conclusions: Our findings suggest that this new mobile CRP-testing device might be suitable for use in home-based care settings. ",
doi="10.2196/18782",
url="http://mhealth.jmir.org/2020/9/e18782/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32894233"
}


@Article{info:doi/10.2196/17083,
author="Alenazi, A. Hanan
and Jamal, Amr
and Batais, A. Mohammed",
title="Identification of Type 2 Diabetes Management Mobile App Features and Engagement Strategies: Modified Delphi Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="11",
volume="8",
number="9",
pages="e17083",
keywords="diabetes",
keywords="mobile features",
keywords="engagement strategies",
keywords="mobile app",
keywords="Delphi consensus",
abstract="Background: Diabetes is a significant public health issue. Saudi Arabia has the highest prevalence of type 2 diabetes mellitus (T2DM) in the Arab world. Currently, it affects 31.6\% of the general population, and the prevalence of T2DM is predicted to rise to 45.36\% by 2030. Mobile health (mHealth) offers improved and cost-effective care to people with T2DM. However, the efficiency of engagement strategies and features of this technology need to be reviewed and standardized according to stakeholder and expert perspectives. Objective: The main objective of this study was to identify the most agreed-upon features for T2DM self-management mobile apps; the secondary objective was to identify the most agreed-upon strategies that prompt users to use these apps. Methods: In this study, a 4-round modified Delphi method was applied by experts in the domain of diabetes care. Results: In total, 11 experts with a mean age of 47.09 years (SD 11.70) consented to participate in the study. Overall, 36 app features were generated. The group of experts displayed weak agreement in their ranking of intervention components (Kendall W=0.275; P<.001). The top 5 features included insulin dose adjustment according to carbohydrate counting and blood glucose readings (5.36), alerting a caregiver of abnormal or critical readings (6.09), nutrition education (12.45), contacts for guidance if required (12.64), and offering patient-specific education tailored to the user's goals, needs, and blood glucose readings (12.90). In total, 21 engagement strategies were generated. Overall, the experts showed a moderate degree of consensus in their strategy rankings (Kendall W=0.454; P<.001). The top 5 engagement strategies included a user-friendly design (educational and age-appropriate design; 2.82), a free app (3.73), allowing the user to communicate or send information/data to a health care provider (HCP; 5.36), HCPs prescribing the mobile app in the clinic and asking about patients' app use compliance during clinical visits (6.91), and flexibility and customization (7.91). Conclusions: This is the first study in the region consisting of a local panel of experts from the diabetes field gathering together. We used an iterative process to combine the experts' opinions into a group consensus. The results of this study could thus be useful for health app developers and HCPs and inform future decision making on the topic. ",
doi="10.2196/17083",
url="http://mhealth.jmir.org/2020/9/e17083/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32678798"
}


@Article{info:doi/10.2196/22079,
author="Jones, Chelsea
and Miguel-Cruz, Antonio
and Smith-MacDonald, Lorraine
and Cruikshank, Emily
and Baghoori, Delaram
and Kaur Chohan, Avneet
and Laidlaw, Alexa
and White, Allison
and Cao, Bo
and Agyapong, Vincent
and Burback, Lisa
and Winkler, Olga
and Sevigny, R. Phillip
and Dennett, Liz
and Ferguson-Pell, Martin
and Greenshaw, Andrew
and Br{\'e}mault-Phillips, Suzette",
title="Virtual Trauma-Focused Therapy for Military Members, Veterans, and Public Safety Personnel With Posttraumatic Stress Injury: Systematic Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e22079",
keywords="trauma",
keywords="mental health",
keywords="telemedicine",
keywords="therapy",
keywords="rehabilitation",
keywords="digital health",
keywords="psychotherapy",
keywords="military",
keywords="veteran",
keywords="first responder",
keywords="public safety personnel",
keywords="teletherapy",
keywords="telepsychiatry",
keywords="mobile phone",
abstract="Background: A necessary shift from in-person to remote delivery of psychotherapy (eg, teletherapy, eHealth, videoconferencing) has occurred because of the COVID-19 pandemic. A corollary benefit is a potential fit in terms of the need for equitable and timely access to mental health services in remote and rural locations. Owing to COVID-19, there may be an increase in the demand for timely, virtual delivery of services among trauma-affected populations, including public safety personnel (PSP; eg, paramedics, police, fire, correctional officers), military members, and veterans. There is a lack of evidence on the question of whether digital delivery of trauma-therapies for military members, veterans, and PSP leads to similar outcomes to in-person delivery. Information on barriers and facilitators and recommendations regarding digital-delivery is also scarce. Objective: This study aims to evaluate the scope and quality of peer-reviewed literature on psychotherapeutic digital health interventions delivered remotely to military members, veterans, and PSP and synthesize the knowledge of needs, gaps, barriers to, and facilitators for virtual assessment of and virtual interventions for posttraumatic stress injury. Methods: Relevant studies were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica dataBASE), APA (American Psychological Association) PsycINFO, CINAHL (Cumulative Index of Nursing and Allied Health Literature) Plus with Full Text, and Military \& Government Collection. For collation, analysis, summarizing, and reporting of results, we used the CASP (Critical Skills Appraisal Program) qualitative checklist, PEDro (Physiotherapy Evidence Database) scale, level of evidence hierarchy, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews), and narrative synthesis. Results: A total of 38 studies were included in this review. Evidence for the effectiveness of digital delivery of prolonged exposure therapy, cognitive processing therapy, behavioral activation treatment with therapeutic exposure to military members, veterans, and PSP was rated level 1a, whereas evidence for cognitive behavioral therapy was conflicting. The narrative synthesis indicated that virtual delivery of these therapies can be as effective as in-person delivery but may reduce stigma and cost while increasing access to therapy. Issues of risk, safety, potential harm (ie, suicidality, enabling avoidance), privacy, security, and the match among the therapist, modality, and patient warrant further consideration. There is a lack of studies on the influences of gender, racial, and cultural factors that may result in differential outcomes, preferences, and/or needs. An investigation into other therapies that may be suitable for digital delivery is needed. Conclusions: Digital delivery of trauma therapies for military members, veterans, and PSP is a critical area for further research. Although promising evidence exists regarding the effectiveness of digital health within these populations, many questions remain, and a cautious approach to more widespread implementation is warranted. ",
doi="10.2196/22079",
url="http://mhealth.jmir.org/2020/9/e22079/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955456"
}


@Article{info:doi/10.2196/22208,
author="Seo, Minseok
and Shin, Myung-Jun
and Park, Sung Tae
and Park, Jong-Hwan",
title="Clinometric Gait Analysis Using Smart Insoles in Patients With Hemiplegia After Stroke: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="10",
volume="8",
number="9",
pages="e22208",
keywords="stroke",
keywords="hemiplegia",
keywords="gait",
keywords="smart insole",
keywords="medical informatics",
keywords="rehabilitation",
keywords="observational",
keywords="wearable",
keywords="assessment",
abstract="Background: For effective rehabilitation after stroke, it is essential to conduct an objective assessment of the patient's functional status. Several stroke severity scales have been used for this purpose, but such scales have various limitations. Objective: Gait analysis using smart insole technology can be applied continuously, objectively, and quantitatively, thereby overcoming the shortcomings of other assessment tools. Methods: To confirm the reliability of gait analysis using smart insole technology, normal healthy controls wore insoles in their shoes during the Timed Up and Go (TUG) test. The gait parameters were compared with the manually collected data. To determine the gait characteristics of patients with hemiplegia due to stroke, they were asked to wear insoles and take the TUG test; gait parameters were calculated and compared with those of control subjects. To investigate whether the gait analysis accurately reflected the patients' clinical condition, we analyzed the relationships of 22 gait parameters on 4 stroke severity scales. Results: The smart insole gait parameter data were similar to those calculated manually. Among the 18 gait parameters tested, 14 were significantly effective at distinguishing patients from healthy controls. The smart insole data revealed that the stance duration on both sides was longer in patients than controls, which has proven difficult to show using other methods. Furthermore, the sound side in patients showed a markedly longer stance duration. Regarding swing duration, that of the sound side was shorter in patients than controls, whereas that of the hemiplegic side was longer. We identified 10 significantly correlated gait parameters on the stroke severity scales. Notably, the difference in stance duration between the sound and hemiplegic sides was significantly correlated with the Fugl-Meyer Assessment (FMA) lower extremity score. Conclusions: This study confirmed the feasibility and applicability of the smart insole as a device to assess the gait of patients with hemiplegia due to stroke. In addition, we demonstrated that the FMA score was significantly correlated with the smart insole data. Providing an environment where stroke patients can easily measure walking ability helps to maintain chronic functions as well as acute rehabilitation. Trial Registration: UMIN Clinical Trials Registry UMIN000041646, https://upload.umin.ac.jp/cgi-open-bin/ctr\_e/ctr\_view.cgi?recptno=R000047538 ",
doi="10.2196/22208",
url="http://mhealth.jmir.org/2020/9/e22208/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32909949"
}


@Article{info:doi/10.2196/18142,
author="Mohammadi, Ramin
and Atif, Mursal
and Centi, Jayne Amanda
and Agboola, Stephen
and Jethwani, Kamal
and Kvedar, Joseph
and Kamarthi, Sagar",
title="Neural Network--Based Algorithm for Adjusting Activity Targets to Sustain Exercise Engagement Among People Using Activity Trackers: Retrospective Observation and Algorithm Development Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="8",
volume="8",
number="9",
pages="e18142",
keywords="activity tracker",
keywords="exercise engagement",
keywords="dynamic activity target",
keywords="neural network",
keywords="activity target prediction",
keywords="machine learning",
abstract="Background: It is well established that lack of physical activity is detrimental to the overall health of an individual. Modern-day activity trackers enable individuals to monitor their daily activities to meet and maintain targets. This is expected to promote activity encouraging behavior, but the benefits of activity trackers attenuate over time due to waning adherence. One of the key approaches to improving adherence to goals is to motivate individuals to improve on their historic performance metrics. Objective: The aim of this work was to build a machine learning model to predict an achievable weekly activity target by considering (1) patterns in the user's activity tracker data in the previous week and (2) behavior and environment characteristics. By setting realistic goals, ones that are neither too easy nor too difficult to achieve, activity tracker users can be encouraged to continue to meet these goals, and at the same time, to find utility in their activity tracker. Methods: We built a neural network model that prescribes a weekly activity target for an individual that can be realistically achieved. The inputs to the model were user-specific personal, social, and environmental factors, daily step count from the previous 7 days, and an entropy measure that characterized the pattern of daily step count. Data for training and evaluating the machine learning model were collected over a duration of 9 weeks. Results: Of 30 individuals who were enrolled, data from 20 participants were used. The model predicted target daily count with a mean absolute error of 1545 (95\% CI 1383-1706) steps for an 8-week period. Conclusions: Artificial intelligence applied to physical activity data combined with behavioral data can be used to set personalized goals in accordance with the individual's level of activity and thereby improve adherence to a fitness tracker; this could be used to increase engagement with activity trackers. A follow-up prospective study is ongoing to determine the performance of the engagement algorithm. ",
doi="10.2196/18142",
url="https://mhealth.jmir.org/2020/9/e18142",
url="http://www.ncbi.nlm.nih.gov/pubmed/32897235"
}


@Article{info:doi/10.2196/24250,
author="Lee, B. Stephen
and Valerius, Joanne",
title="Correction: mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="15",
volume="8",
number="9",
pages="e24250",
doi="10.2196/24250",
url="http://mhealth.jmir.org/2020/9/e24250/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32931442"
}


@Article{info:doi/10.2196/20488,
author="Gazi, H. Asim
and Gurel, Z. Nil
and Richardson, S. Kristine L.
and Wittbrodt, T. Matthew
and Shah, J. Amit
and Vaccarino, Viola
and Bremner, Douglas J.
and Inan, T. Omer",
title="Digital Cardiovascular Biomarker Responses to Transcutaneous Cervical Vagus Nerve Stimulation: State-Space Modeling, Prediction, and Simulation",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="22",
volume="8",
number="9",
pages="e20488",
keywords="vagus nerve stimulation",
keywords="noninvasive",
keywords="wearable sensing",
keywords="digital biomarkers",
keywords="dynamic models",
keywords="state space",
keywords="biomarker",
keywords="cardiovascular",
keywords="neuromodulation",
keywords="bioelectronic medicine",
abstract="Background: Transcutaneous cervical vagus nerve stimulation (tcVNS) is a promising alternative to implantable stimulation of the vagus nerve. With demonstrated potential in myriad applications, ranging from systemic inflammation reduction to traumatic stress attenuation, closed-loop tcVNS during periods of risk could improve treatment efficacy and reduce ineffective delivery. However, achieving this requires a deeper understanding of biomarker changes over time. Objective: The aim of the present study was to reveal the dynamics of relevant cardiovascular biomarkers, extracted from wearable sensing modalities, in response to tcVNS. Methods: Twenty-four human subjects were recruited for a randomized double-blind clinical trial, for whom electrocardiography and photoplethysmography were used to measure heart rate and photoplethysmogram amplitude responses to tcVNS, respectively. Modeling these responses in state-space, we (1) compared the biomarkers in terms of their predictability and active vs sham differentiation, (2) studied the latency between stimulation onset and measurable effects, and (3) visualized the true and model-simulated biomarker responses to tcVNS. Results: The models accurately predicted future heart rate and photoplethysmogram amplitude values with root mean square errors of approximately one-fifth the standard deviations of the data. Moreover, (1) the photoplethysmogram amplitude showed superior predictability (P=.03) and active vs sham separation compared to heart rate; (2) a consistent delay of greater than 5 seconds was found between tcVNS onset and cardiovascular effects; and (3) dynamic characteristics differentiated responses to tcVNS from the sham stimulation. Conclusions: This work furthers the state of the art by modeling pertinent biomarker responses to tcVNS. Through subsequent analysis, we discovered three key findings with implications related to (1) wearable sensing devices for bioelectronic medicine, (2) the dominant mechanism of action for tcVNS-induced effects on cardiovascular physiology, and (3) the existence of dynamic biomarker signatures that can be leveraged when titrating therapy in closed loop. Trial Registration: ClinicalTrials.gov NCT02992899; https://clinicaltrials.gov/ct2/show/NCT02992899 International Registered Report Identifier (IRRID): RR2-10.1016/j.brs.2019.08.002 ",
doi="10.2196/20488",
url="http://mhealth.jmir.org/2020/9/e20488/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32960179"
}


@Article{info:doi/10.2196/17818,
author="Sultana, Madeena
and Al-Jefri, Majed
and Lee, Joon",
title="Using Machine Learning and Smartphone and Smartwatch Data to Detect Emotional States and Transitions: Exploratory Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="29",
volume="8",
number="9",
pages="e17818",
keywords="mHealth",
keywords="mental health",
keywords="emotion detection",
keywords="emotional transition detection",
keywords="spatiotemporal context",
keywords="supervised machine learning",
keywords="artificial intelligence",
keywords="mobile phone",
keywords="digital biomarkers",
keywords="digital phenotyping",
abstract="Background: Emotional state in everyday life is an essential indicator of health and well-being. However, daily assessment of emotional states largely depends on active self-reports, which are often inconvenient and prone to incomplete information. Automated detection of emotional states and transitions on a daily basis could be an effective solution to this problem. However, the relationship between emotional transitions and everyday context remains to be unexplored. Objective: This study aims to explore the relationship between contextual information and emotional transitions and states to evaluate the feasibility of detecting emotional transitions and states from daily contextual information using machine learning (ML) techniques. Methods: This study was conducted on the data of 18 individuals from a publicly available data set called ExtraSensory. Contextual and sensor data were collected using smartphone and smartwatch sensors in a free-living condition, where the number of days for each person varied from 3 to 9. Sensors included an accelerometer, a gyroscope, a compass, location services, a microphone, a phone state indicator, light, temperature, and a barometer. The users self-reported approximately 49 discrete emotions at different intervals via a smartphone app throughout the data collection period. We mapped the 49 reported discrete emotions to the 3 dimensions of the pleasure, arousal, and dominance model and considered 6 emotional states: discordant, pleased, dissuaded, aroused, submissive, and dominant. We built general and personalized models for detecting emotional transitions and states every 5 min. The transition detection problem is a binary classification problem that detects whether a person's emotional state has changed over time, whereas state detection is a multiclass classification problem. In both cases, a wide range of supervised ML algorithms were leveraged, in addition to data preprocessing, feature selection, and data imbalance handling techniques. Finally, an assessment was conducted to shed light on the association between everyday context and emotional states. Results: This study obtained promising results for emotional state and transition detection. The best area under the receiver operating characteristic (AUROC) curve for emotional state detection reached 60.55\% in the general models and an average of 96.33\% across personalized models. Despite the highly imbalanced data, the best AUROC curve for emotional transition detection reached 90.5\% in the general models and an average of 88.73\% across personalized models. In general, feature analyses show that spatiotemporal context, phone state, and motion-related information are the most informative factors for emotional state and transition detection. Our assessment showed that lifestyle has an impact on the predictability of emotion. Conclusions: Our results demonstrate a strong association of daily context with emotional states and transitions as well as the feasibility of detecting emotional states and transitions using data from smartphone and smartwatch sensors. ",
doi="10.2196/17818",
url="http://mhealth.jmir.org/2020/9/e17818/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32990638"
}


@Article{info:doi/10.2196/19579,
author="Campbell, M. Laura
and Paolillo, W. Emily
and Heaton, Anne
and Tang, Bin
and Depp, A. Colin
and Granholm, Eric
and Heaton, K. Robert
and Swendsen, Joel
and Moore, J. David
and Moore, C. Raeanne",
title="Daily Activities Related to Mobile Cognitive Performance in Middle-Aged and Older Adults: An Ecological Momentary Cognitive Assessment Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="24",
volume="8",
number="9",
pages="e19579",
keywords="ecological momentary assessment",
keywords="daily functioning",
keywords="telemedicine",
keywords="digital health",
keywords="neuropsychological test",
keywords="cognition",
keywords="HIV",
keywords="aging",
keywords="mobile phone",
abstract="Background: Daily activities have been associated with neurocognitive performance. However, much of this research has used in-person neuropsychological testing that requires participants to travel to a laboratory or clinic, which may not always be feasible and does not allow for the examination of real-time relationships between cognition and behavior. Thus, there is a need to understand the real-time relationship between activities in the real world and neurocognitive functioning to improve tracking of symptoms or disease states and aid in the early identification of neurocognitive deficits among at-risk individuals. Objective: We used a smartphone-based ecological momentary cognitive assessment (EMCA) platform to examine real-time relationships between daily activities and neurocognitive performance (executive functioning and verbal learning) in the everyday environment of middle-aged and older adults with and without HIV. Methods: A total of 103 adults aged 50-74 years (67 persons with HIV; mean age 59 years, SD 6.4) were recruited from the University of California, San Diego HIV Neurobehavioral Research Program and the San Diego community. Participants completed our EMCA protocol for 14 days. Participants reported their current daily activities 4 times per day; following 2 of the 4 daily ecological momentary assessment (EMA) surveys, participants were administered the mobile Color-Word Interference Test (mCWIT) and mobile Verbal Learning Test (mVLT), each once per day. Activities were categorized into cognitively stimulating activities, passive leisure activities, and instrumental activities of daily living (IADLs). We used multilevel modeling to examine the same-survey and lagged within-person and between-person effects of each activity type on mobile cognitive performance. Results: On average, participants completed 91\% of the EMA surveys, 85\% of the mCWIT trials, and 80\% of the mVLT trials, and they reported engaging in cognitively stimulating activities on 17\% of surveys, passive leisure activities on 33\% of surveys, and IADLs on 20\% of surveys. Adherence and activity percentages did not differ by HIV status. Within-persons, engagement in cognitively stimulating activities was associated with better mCWIT performance ($\beta$=?1.12; P=.007), whereas engagement in passive leisure activities was associated with worse mCWIT performance ($\beta$=.94; P=.005). There were no lagged associations. At the aggregate between-person level, a greater percentage of time spent in cognitively stimulating activities was associated with better mean mVLT performance ($\beta$=.07; P=.02), whereas a greater percentage of time spent in passive leisure activities was associated with worse mean mVLT performance ($\beta$=?.07; P=.01). IADLs were not associated with mCWIT or mVLT performance. Conclusions: Smartphones present unique opportunities for assessing neurocognitive performance and behavior in middle-aged and older adults' own environment. Measurement of cognition and daily functioning outside of clinical settings may generate novel insights on the dynamic association of daily behaviors and neurocognitive performance and may add new dimensions to understanding the complexity of human behavior. ",
doi="10.2196/19579",
url="http://mhealth.jmir.org/2020/9/e19579/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969829"
}


@Article{info:doi/10.2196/19796,
author="Ming, Chiau Long
and Untong, Noorazrina
and Aliudin, Amalina Nur
and Osili, Norliza
and Kifli, Nurolaini
and Tan, Siang Ching
and Goh, Wen Khang
and Ng, Wei Pit
and Al-Worafi, Mohammed Yaser
and Lee, Seng Kah
and Goh, Poh Hui",
title="Mobile Health Apps on COVID-19 Launched in the Early Days of the Pandemic: Content Analysis and Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="16",
volume="8",
number="9",
pages="e19796",
keywords="coronavirus",
keywords="mobile medical app",
keywords="self-care",
keywords="mHealth",
keywords="health education",
keywords="app",
keywords="COVID-19",
keywords="content analysis",
abstract="Background: Mobile health (mHealth) app use is a major concern because of the possible dissemination of misinformation that could harm the users. Particularly, it can be difficult for health care professionals to recommend a suitable app for coronavirus disease (COVID-19) education and self-monitoring purposes. Objective: This study aims to analyze and evaluate the contents as well as features of COVID-19 mobile apps. The findings are instrumental in helping health care professionals to identify suitable mobile apps for COVID-19 self-monitoring and education. The results of the mobile apps' assessment could potentially help mobile app developers improve or modify their existing mobile app designs to achieve optimal outcomes. Methods: The search for the mHealth apps available in the android-based Play Store and the iOS-based App Store was conducted between April 18 and May 5, 2020. The region of the App Store where we performed the search was the United States, and a virtual private network app was used to locate and access COVID-19 mobile apps from all countries on the Google Play Store. The inclusion criteria were apps that are related to COVID-19 with no restriction in language type. The basic features assessment criteria used for comparison were the requirement for free subscription, internet connection, education or advisory content, size of the app, ability to export data, and automated data entry. The functionality of the apps was assessed according to knowledge (information on COVID-19), tracing or mapping of COVID-19 cases, home monitoring surveillance, online consultation with a health authority, and official apps run by health authorities. Results: Of the 223 COVID-19--related mobile apps, only 30 (19.9\%) found in the App Store and 28 (44.4\%) in the Play Store matched the inclusion criteria. In the basic features assessment, most App Store (10/30, 33.3\%) and Play Store (10/28, 35.7\%) apps scored 4 out of 7 points. Meanwhile, the outcome of the functionality assessment for most App Store apps (13/30, 43.3\%) was a score of 3 compared to android-based apps (10/28, 35.7\%), which scored 2 (out of the maximum 5 points). Evaluation of the basic functions showed that 75.0\% (n=36) of the 48 included mobile apps do not require a subscription, 56.3\% (n=27) provide symptom advice, and 41.7\% (n=20) have educational content. In terms of the specific functions, more than half of the included mobile apps are official mobile apps maintained by a health authority for COVID-19 information provision. Around 37.5\% (n=18) and 31.3\% (n=15) of the mobile apps have tracing or mapping and home monitoring surveillance functions, respectively, with only 17\% (n=8) of the mobile apps equipped with an online consultation function. Conclusions: Most iOS-based apps incorporate infographic mapping of COVID-19 cases, while most android-based apps incorporate home monitoring surveillance features instead of providing focused educational content on COVID-19. It is important to evaluate the contents and features of COVID-19 mobile apps to guide users in choosing a suitable mobile app based on their requirements. ",
doi="10.2196/19796",
url="https://mhealth.jmir.org/2020/9/e19796",
url="http://www.ncbi.nlm.nih.gov/pubmed/32609622"
}


@Article{info:doi/10.2196/21845,
author="Sacco, Guillaume
and Ll{\'e}onart, S{\'e}bastien
and Simon, Romain
and Noublanche, Fr{\'e}d{\'e}ric
and Annweiler, C{\'e}dric
and ",
title="Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="18",
volume="8",
number="9",
pages="e21845",
keywords="video communication",
keywords="telephone",
keywords="older adults",
keywords="nursing home",
keywords="hospital",
keywords="confinement",
keywords="elderly",
keywords="COVID-19",
keywords="communication",
keywords="technology",
keywords="social isolation",
keywords="loneliness",
abstract="Background: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. Objective: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. Methods: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. Results: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8\%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3\%) over video calls (59/132, 44.7\%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98\%) and video calls (33/38, 87\%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93\%) versus the use of telephone calls (6/12, 50\%; P=.02). Conclusions: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. Trial Registration: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849. ",
doi="10.2196/21845",
url="http://mhealth.jmir.org/2020/9/e21845/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32896832"
}


@Article{info:doi/10.2196/23153,
author="Clavier, Thomas
and Popoff, Benjamin
and Selim, Jean
and Beuzelin, Marion
and Roussel, Melanie
and Compere, Vincent
and Veber, Benoit
and Besnier, Emmanuel",
title="Association of Social Network Use With Increased Anxiety Related to the COVID-19 Pandemic in Anesthesiology, Intensive Care, and Emergency Medicine Teams: Cross-Sectional Web-Based Survey Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="24",
volume="8",
number="9",
pages="e23153",
keywords="social network",
keywords="nurse",
keywords="physician",
keywords="anxiety",
keywords="emergency medicine, anesthesiology, critical care medicine",
keywords="coronavirus disease 2019",
keywords="mental health",
keywords="COVID-19",
abstract="Background: Critical care teams are on the front line of managing the COVID-19 pandemic, which is stressful for members of these teams. Objective: Our objective was to assess whether the use of social networks is associated with increased anxiety related to the COVID-19 pandemic among members of critical care teams. Methods: We distributed a web-based survey to physicians, residents, registered and auxiliary nurses, and nurse anesthetists providing critical care (anesthesiology, intensive care, or emergency medicine) in several French hospitals. The survey evaluated the respondents' use of social networks, their sources of information on COVID-19, and their levels of anxiety and information regarding COVID-19 on analog scales from 0 to 10. Results: We included 641 respondents in the final analysis; 553 (86.3\%) used social networks, spending a median time of 60 minutes (IQR 30-90) per day on these networks. COVID-19--related anxiety was higher in social network users than in health care workers who did not use these networks (median 6, IQR 5-8 vs median 5, IQR 3-7) in univariate (P=.02) and multivariate (P<.001) analyses, with an average anxiety increase of 10\% in social network users. Anxiety was higher among health care workers using social networks to obtain information on COVID-19 than among those using other sources (median 6, IQR 5-8 vs median 6, IQR 4-7; P=.04). Social network users considered that they were less informed about COVID-19 than those who did not use social networks (median 8, IQR 7-9 vs median 7, IQR 6-8; P<.01). Conclusions: Our results suggest that social networks contribute to increased anxiety in critical care teams. To protect their mental health, critical care professionals should consider limiting their use of these networks during the COVID-19 pandemic. ",
doi="10.2196/23153",
url="http://mhealth.jmir.org/2020/9/e23153/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32924946"
}