%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e19034 %T Early Detection of Dengue Fever Outbreaks Using a Surveillance App (Mozzify): Cross-sectional Mixed Methods Usability Study %A Herbuela,Von Ralph Dane Marquez %A Karita,Tomonori %A Carvajal,Thaddeus Marzo %A Ho,Howell Tsai %A Lorena,John Michael Olea %A Regalado,Rachele Arce %A Sobrepeña,Girly Dirilo %A Watanabe,Kozo %+ Center for Marine Environmental Studies, Ehime University, 3 Bunkyo-cho, Matsuyama, Japan, 81 89 927 9847, watanabe.kozo.mj@ehime-u.ac.jp %K dengue fever %K mHealth %K public health surveillance %K health communication %K behavior modification %K dengue outbreak %D 2021 %7 1.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While early detection and effective control of epidemics depend on appropriate surveillance methods, the Philippines bases its dengue fever surveillance system on a passive surveillance method (notifications from barangay/village health centers, municipal or city health offices, hospitals, and clinics). There is no available mHealth (mobile health) app for dengue fever that includes all the appropriate surveillance methods in early detection of disease outbreaks in the country. Objective: This study aimed to evaluate the usability of the Mozzify app in terms of objective quality (engagement, functionality, aesthetics, information) and app subjective and app-specific qualities and compare total app mean score ratings by sociodemographic profile and self and family dengue fever history to see what factors are associated with high app mean score rating among school-based young adult samples and health care professionals. Individual interviews and focus group discussions were also conducted among participants to develop themes from their comments and suggestions to help structure further improvement and future development of the app. Methods: User experience sessions were conducted among participants, and the Mobile Application Rating Scale (MARS) professional and user versions (uMARS) were administered followed by individual interviews and focus group discussions. Descriptive statistical analysis of the MARS and uMARS score ratings was performed. The total app mean score ratings by sociodemographic and dengue fever history using nonparametric mean difference analyses were also conducted. Thematic synthesis was used to develop themes from the comments and suggestions raised in individual interviews and focus group discussions. Results: Mozzify obtained an overall >4 (out of 5) mean score ratings in the MARS and uMARS app objective quality (4.45), subjective (4.17), and specific (4.55) scales among 948 participants (79 health care professionals and 869 school-based samples). Mean difference analyses revealed that total app mean score ratings were not significantly different across ages and gender among health care professionals and across age, income categories, and self and family dengue fever history but not gender (P<.001) among the school-based samples. Thematic syntheses revealed 7 major themes: multilanguage options and including other diseases; Android version availability; improvements on the app’s content, design, and engagement; inclusion of users from low-income and rural areas; Wi-Fi connection and app size concerns; data credibility and issues regarding user security and privacy. Conclusions: With its acceptable performance as perceived by health care professionals and school-based young adults, Mozzify has the potential to be used as a strategic health intervention system for early detection of disease outbreaks in the Philippines. It can be used by health care professionals of any age and gender and by school-based samples of any age, socioeconomic status, and dengue fever history. The study also highlights the feasibility of school-based young adults to use health-related apps for disease prevention. %M 33646128 %R 10.2196/19034 %U https://publichealth.jmir.org/2021/3/e19034 %U https://doi.org/10.2196/19034 %U http://www.ncbi.nlm.nih.gov/pubmed/33646128 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19498 %T Agreement Between Spatiotemporal Gait Parameters Measured by a Markerless Motion Capture System and Two Reference Systems—a Treadmill-Based Photoelectric Cell and High-Speed Video Analyses: Comparative Study %A García-Pinillos,Felipe %A Jaén-Carrillo,Diego %A Soto Hermoso,Victor %A Latorre Román,Pedro %A Delgado,Pedro %A Martinez,Cristian %A Carton,Antonio %A Roche Seruendo,Luis %+ Universidad San Jorge, Autovía Mudéjar, Zaragoza, Villanueva de Gallego, Spain, 34 678638967, djaen@usj.es %K OptoGait %K runners %K sport technology %K validity %K gait %K motion capture %K video %K feasibility %K accuracy %K Kinect %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Markerless systems to capture body motion require no markers to be attached to the body, thereby improving clinical feasibility and testing time. However, the lack of markers might affect the accuracy of measurements. Objective: This study aimed to determine the absolute reliability and concurrent validity of the Kinect system with MotionMetrix software for spatiotemporal variables during running at a comfortable velocity, by comparing data between the combination system and two widely used systems—OptoGait and high-speed video analysis at 1000 Hz. Methods: In total, 25 runners followed a running protocol on a treadmill at a speed of 12 km/h. The Kinect+MotionMetrix combination measured spatiotemporal parameters during running (ie, contact time, flight time, step frequency, and step length), which were compared to those obtained from two reference systems. Results: Regardless of the system, flight time had the highest coefficients of variation (OptoGait: 16.4%; video analysis: 17.3%; Kinect+MotionMetrix: 23.2%). The rest of the coefficients of variation reported were lower than 8.1%. Correlation analysis showed very high correlations (r>0.8; P<.001) and almost perfect associations (intraclass correlation coefficient>0.81) between systems for all the spatiotemporal parameters except contact time, which had lower values. Bland-Altman plots revealed smaller systematic biases and random errors for step frequency and step length and larger systematic biases and random errors for temporal parameters with the Kinect+MotionMetrix system as compared to OptoGait (difference: contact time +3.0%, flight time −7.9%) and high-speed video analysis at 1000 Hz (difference: contact time +4.2%, flight time −11.3%). Accordingly, heteroscedasticity was found between systems for temporal parameters (r2>0.1). Conclusions: The results indicate that the Kinect+MotionMetrix combination slightly overestimates contact time and strongly underestimates flight time as compared to the OptoGait system and high-speed video analysis at 1000 Hz. However, it is a valid tool for measuring step frequency and step length when compared to reference systems. Future studies should determine the reliability of this system for determining temporal parameters. %M 33095181 %R 10.2196/19498 %U http://mhealth.jmir.org/2020/10/e19498/ %U https://doi.org/10.2196/19498 %U http://www.ncbi.nlm.nih.gov/pubmed/33095181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18160 %T Symbol Digit Modalities Test Variant in a Smartphone App for Persons With Multiple Sclerosis: Validation Study %A van Oirschot,Pim %A Heerings,Marco %A Wendrich,Karine %A den Teuling,Bram %A Martens,Marijn B %A Jongen,Peter J %+ Orikami Digital Health Products, Ridderstraat 29, Nijmegen, 6511TM, Netherlands, 31 243010100, pim@mssherpa.nl %K relapsing-remitting multiple sclerosis %K cognition %K processing speed %K mobile phone %D 2020 %7 5.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The decline of cognitive processing speed (CPS) is a common dysfunction in persons with multiple sclerosis (MS). The Symbol Digit Modalities Test (SDMT) is widely used to formally quantify CPS. We implemented a variant of the SDMT in MS sherpa, a smartphone app for persons with MS. Objective: The aim of this study was to investigate the construct validity and test-retest reliability of the MS sherpa smartphone variant of the SDMT (sSDMT). Methods: We performed a validation study with 25 persons with relapsing-remitting MS and 79 healthy control (HC) subjects. In the HC group, 21 subjects were matched to the persons with MS with regard to age, gender, and education and they followed the same assessment schedule as the persons with MS (the “HC matched” group) and 58 subjects had a less intense assessment schedule to determine reference values (the “HC normative” group). Intraclass correlation coefficients (ICCs) were determined between the paper-and-pencil SDMT and its smartphone variant (sSDMT) on 2 occasions, 4 weeks apart. Other ICCs were determined for test-retest reliability, which were derived from 10 smartphone tests per study participant, with 3 days in between each test. Seven study participants with MS were interviewed regarding their experiences with the sSDMT. Results: The SDMT scores were on average 12.06% higher than the sSDMT scores, with a standard deviation of 10.68%. An ICC of 0.838 was found for the construct validity of the sSDMT in the combined analysis of persons with MS and HC subjects. Average ICCs for test-retest reliability of the sSDMT for persons with MS, the HC matched group, and the HC normative group were 0.874, 0.857, and 0.867, respectively. The practice effect was significant between the first and the second test of the persons with MS and the HC matched group and trivial for all other test-retests. The interviewed study participants expressed a positive attitude toward the sSDMT, but they also discussed the importance of adapting a smartphone cognition test in accordance with the needs of the individual persons with MS. Conclusions: The high correlation between sSDMT and the conventional SDMT scores indicates a very good construct validity. Similarly, high correlations underpin a very good test-retest reliability of the sSDMT. We conclude that the sSDMT has the potential to be used as a tool to monitor CPS in persons with MS, both in clinical studies and in clinical practice. %M 33016886 %R 10.2196/18160 %U https://mhealth.jmir.org/2020/10/e18160 %U https://doi.org/10.2196/18160 %U http://www.ncbi.nlm.nih.gov/pubmed/33016886 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16758 %T Validation of a Mobile Version of the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form: An Observational Randomized Crossover Trial %A Hou,Jingyi %A Li,Qingyue %A Yu,Menglei %A Li,Fangqi %A Tang,Yiyong %A Long,Yi %A Alike,Yamuhanmode %A Zhang,Yuanhao %A Ali,Maslah Idiris %A Zhang,Congda %A Li,Weiping %A Yang,Rui %+ Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang Rd W, Guangzhou, 510120, China, 86 13694200667, yangr@mail.sysu.edu.cn %K ASES %K ePROM %K smartphone %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) questionnaire is an effective tool for evaluating shoulder joint function. The development and usage of a mobile version of the ASES questionnaire has the potential to save time, money, and effort. Objective: The aim of this study is to assess the equivalence between the paper and mobile versions of the ASES questionnaire and their acceptability among patients. Methods: The paper and mobile versions of the ASES questionnaire were used to evaluate the shoulder joint function of 50 patients with shoulder pain. This study included patients from the shoulder clinic of Sun Yat-sen Memorial Hospital. The intraclass correlation coefficient (ICC) and Bland-Altman method were used to evaluate the agreement (reliability) of the scores obtained by the two methods (paper versus mobile). Results: Of the 50 patients recruited from March 2018 to May 2019, 46 (92%) completed the study. There was a high agreement between the paper and mobile versions of the ASES questionnaire (ICC=0.979, 95% CI 0.943-0.987; P<.001). The mean difference between the scores of the mobile and paper versions was 1.0, and only 1/46 (2%) had a difference greater than the minimal clinically important difference of 12 points. About 75% of patients preferred the mobile version to the paper version. Conclusions: Our study shows that the mobile version of the ASES questionnaire is comparable to the paper version, and has a higher patient preference. This could prove to be a useful tool for epidemiological studies and patient follow-up over longer periods of time. %M 32706731 %R 10.2196/16758 %U http://mhealth.jmir.org/2020/7/e16758/ %U https://doi.org/10.2196/16758 %U http://www.ncbi.nlm.nih.gov/pubmed/32706731 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16956 %T The Arabic Version of the Mobile App Rating Scale: Development and Validation Study %A Bardus,Marco %A Awada,Nathalie %A Ghandour,Lilian A %A Fares,Elie-Jacques %A Gherbal,Tarek %A Al-Zanati,Tasnim %A Stoyanov,Stoyan R %+ Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 302, PO Box 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon, 961 1350000 ext 4694, marco.bardus@gmail.com %K validation studies as topic %K mHealth %K mobile app rating scale %K Arab world %K eHealth %K app quality %K app evaluation %K mobile app %D 2020 %7 3.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With thousands of health apps in app stores globally, it is crucial to systemically and thoroughly evaluate the quality of these apps due to their potential influence on health decisions and outcomes. The Mobile App Rating Scale (MARS) is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality, which has been used to compare medical apps from American and European app stores in various areas, available in English, Italian, Spanish, and German. However, this tool is not available in Arabic. Objective: This study aimed to translate and adapt MARS to Arabic and validate the tool with a sample of health apps aimed at managing or preventing obesity and associated disorders. Methods: We followed a well-established and defined “universalist” process of cross-cultural adaptation using a mixed methods approach. Early translations of the tool, accompanied by confirmation of the contents by two rounds of separate discussions, were included and culminated in a final version, which was then back-translated into English. Two trained researchers piloted the MARS in Arabic (MARS-Ar) with a sample of 10 weight management apps obtained from Google Play and the App Store. Interrater reliability was established using intraclass correlation coefficients (ICCs). After reliability was ascertained, the two researchers independently evaluated a set of additional 56 apps. Results: MARS-Ar was highly aligned with the original English version. The ICCs for MARS-Ar (0.836, 95% CI 0.817-0.853) and MARS English (0.838, 95% CI 0.819-0.855) were good. The MARS-Ar subscales were highly correlated with the original counterparts (P<.001). The lowest correlation was observed in the area of usability (r=0.685), followed by aesthetics (r=0.827), information quality (r=0.854), engagement (r=0.894), and total app quality (r=0.897). Subjective quality was also highly correlated (r=0.820). Conclusions: MARS-Ar is a valid instrument to assess app quality among trained Arabic-speaking users of health and fitness apps. Researchers and public health professionals in the Arab world can use the overall MARS score and its subscales to reliably evaluate the quality of weight management apps. Further research is necessary to test the MARS-Ar on apps addressing various health issues, such as attention or anxiety prevention, or sexual and reproductive health. %M 32130183 %R 10.2196/16956 %U https://mhealth.jmir.org/2020/3/e16956 %U https://doi.org/10.2196/16956 %U http://www.ncbi.nlm.nih.gov/pubmed/32130183 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16499 %T Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial %A Rouf,Anika %A Nour,Monica %A Allman-Farinelli,Margaret %+ The University of Sydney, School of Life and Environmental Sciences, Level 4 East, Charles Perkins Centre, Camperdown, 2006, Australia, 61 86274704, arou9270@uni.sydney.edu.au %K calcium %K social media %K young adults %K randomized controlled trial %K telemedicine %D 2020 %7 11.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth. Objective: The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake. Methods: The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data. Results: A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; P=.41) nor calcium-rich food was detected (P=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (P<.001), but habit formation improved less than that in the other 2 groups (P=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants. Conclusions: The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx %M 32044755 %R 10.2196/16499 %U https://mhealth.jmir.org/2020/2/e16499 %U https://doi.org/10.2196/16499 %U http://www.ncbi.nlm.nih.gov/pubmed/32044755 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e15022 %T Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease %A Rawstorn,Jonathan Charles %A Ball,Kylie %A Oldenburg,Brian %A Chow,Clara K %A McNaughton,Sarah A %A Lamb,Karen Elaine %A Gao,Lan %A Moodie,Marj %A Amerena,John %A Nadurata,Voltaire %A Neil,Christopher %A Cameron,Stuart %A Maddison,Ralph %+ Institute for Physical Activity and Nutrition, Deakin University, Locked Bag 20001, Geelong, 3220, Australia, 61 392468461, jonathan.rawstorn@deakin.edu.au %K telemedicine %K telerehabilitation %K mHealth %K myocardial ischemia %K coronary artery disease %K exercise %K behavioral medicine %K health services accessibility %K costs and cost analysis %D 2020 %7 27.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. Objective: The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. Methods: In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. Results: The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. Conclusions: The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. International Registered Report Identifier (IRRID): DERR1-10.2196/15022 %M 32012103 %R 10.2196/15022 %U https://www.researchprotocols.org/2020/1/e15022 %U https://doi.org/10.2196/15022 %U http://www.ncbi.nlm.nih.gov/pubmed/32012103 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13892 %T Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey %A Khalemsky,Michael %A Schwartz,David G %A Silberg,Tamar %A Khalemsky,Anna %A Jaffe,Eli %A Herbst,Raphael %+ Graduate School of Business Administration, Bar-Ilan University, Bar-Ilan University, Ramat Gan, 5290002, Israel, 972 523499011, khalemsky@gmail.com %K mHealth %K emergency %K volunteer %K community %K smartphone %K anaphylaxis %K epinephrine %D 2019 %7 27.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Medical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join. Objective: This study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis. Methods: The willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used. Results: A total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents’ opinion and 13.15 years (SD 3.44) in the children’s opinion. Conclusions: Parents’ willingness to join an ERC was negatively correlated with parents’ age, child’s age, and parents’ adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children’s willingness to join the community was positively correlated with age and negatively correlated with the child’s emotional autonomy. Parents’ willingness to enroll their children in an ERC was positively correlated with child’s age and negatively correlated with parents’ adherence: again, this can be explained by the aforementioned free-rider effect. Parents’ and children’s opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style. %M 31456582 %R 10.2196/13892 %U https://mhealth.jmir.org/2019/8/e13892/ %U https://doi.org/10.2196/13892 %U http://www.ncbi.nlm.nih.gov/pubmed/31456582 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e11575 %T An App to Improve Eating Habits of Adolescents and Young Adults (Challenge to Go): Systematic Development of a Theory-Based and Target Group–Adapted Mobile App Intervention %A Rohde,Anna %A Duensing,Anja %A Dawczynski,Christine %A Godemann,Jasmin %A Lorkowski,Stefan %A Brombach,Christine %+ Institute of Nutritional Sciences, Faculty of Biological Sciences, Friedrich Schiller University Jena, 2nd Fl, Dornburger Straße 25, Jena, 07743, Germany, 49 3641 9 49710, at.anna.rohde@gmail.com %K adolescents %K young adults %K mobile phone %K mobile apps %K mHealth %K health behavior %K healthy eating %K motivation %D 2019 %7 12.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Due to the widespread use of mobile phones, dietary mobile apps are promising tools for preventing diet-related noncommunicable diseases early in life. However, most of the currently available nutrition apps lack scientific evaluation and user acceptance. Objective: The objective of this study was the systematic design of a theory-driven and target group–adapted dietary mobile app concept to promote healthy eating habits with a focus on drinking habits as well as consumption of fruits and vegetables in adolescents and young adults, especially from disadvantaged backgrounds. Methods: The design process was guided by the behavior change wheel (BCW). The development process comprised 3 stages. In stage 1, the target behavior was specified, and facilitators and barriers were identified. Furthermore, important insights into target group interests, needs, and values in the field of nutrition and apps were revealed. To this end, 2 empirical studies were conducted with the target group. In stage 2, results of stage 1 were translated into behavior change techniques (BCTs) and, finally, into app functionalities and features. Consequently, in stage 3, the concept was evaluated and optimized through expert interviews. Results: Facilitators and barriers for achieving the target behavior were psychological capabilities (eg, self-efficacy), reflective motivation (eg, fitness), automatic motivation, social support, and physical opportunity (eg, time). Target group interests, needs, and values in the field of nutrition were translated into target group preferences for app usage, for example, low usage effort, visual feedback, or recipes. Education, training, incentives, persuasion, and enablement were identified as relevant intervention functions. Together with the target group preferences, these were translated via 14 BCTs, such as rewards, graded tasks, or self-monitoring into the app concept Challenge to go (C2go). The expert evaluation suggested changes of some app features for improving adherence, positive health effects, and technical feasibility. The C2go concept comprises 3 worlds: the (1) drinking, (2) vegetable, and (3) fruit worlds. In each world, the users are faced with challenges including feedback and a quiz. Tips were developed based on the health action process approach and to help users gain challenges and, thereby, achieve the target behavior. Challenges can be played alone or against someone in the community. Due to different activities, points can be collected, and levels can be achieved. Collected points open access to an Infothek (information section), where users can choose content that interests them. An avatar guides user through the app. Conclusions: C2go is aimed at adolescents and young adults and aims to improve their fruit and vegetable consumption as well as drinking habits. It is a theory-driven and target group–adapted dietary mobile intervention concept that uses gamification and was systematically developed using the BCW. %M 30903746 %R 10.2196/11575 %U http://mhealth.jmir.org/2019/8/e11575/ %U https://doi.org/10.2196/11575 %U http://www.ncbi.nlm.nih.gov/pubmed/30903746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12996 %T A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing %A Easton,Katherine %A Potter,Stephen %A Bec,Remi %A Bennion,Matthew %A Christensen,Heidi %A Grindell,Cheryl %A Mirheidari,Bahman %A Weich,Scott %A de Witte,Luc %A Wolstenholme,Daniel %A Hawley,Mark S %+ School of Health and Related Research, The University of Sheffield, 217 Portobello, Sheffield, S1 4DA, United Kingdom, 44 1142220690, k.a.easton@sheffield.ac.uk %K COPD %K chronic obstructive pulmonary disease %K mental health %K comorbidity %K chronic illness %K self-management %K artificial intelligence %K virtual systems %K computer-assisted therapy %K chatbot %K conversational agent %D 2019 %7 30.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals living with long-term physical health conditions frequently experience co-occurring mental health problems. This comorbidity has a significant impact on an individual’s levels of emotional distress, health outcomes, and associated health care utilization. As health care services struggle to meet demand and care increasingly moves to the community, digital tools are being promoted to support patients to self-manage their health. One such technology is the autonomous virtual agent (chatbot, conversational agent), which uses artificial intelligence (AI) to process the user’s written or spoken natural language and then to select or construct the corresponding appropriate responses. Objective: This study aimed to co-design the content, functionality, and interface modalities of an autonomous virtual agent to support self-management for patients with an exemplar long-term condition (LTC; chronic pulmonary obstructive disease [COPD]) and then to assess the acceptability and system content. Methods: We conducted 2 co-design workshops and a proof-of-concept implementation of an autonomous virtual agent with natural language processing capabilities. This implementation formed the basis for video-based scenario testing of acceptability with adults with a diagnosis of COPD and health professionals involved in their care. Results: Adults (n=6) with a diagnosis of COPD and health professionals (n=5) specified 4 priority self-management scenarios for which they would like to receive support: at the time of diagnosis (information provision), during acute exacerbations (crisis support), during periods of low mood (emotional support), and for general self-management (motivation). From the scenario testing, 12 additional adults with COPD felt the system to be both acceptable and engaging, particularly with regard to internet-of-things capabilities. They felt the system would be particularly useful for individuals living alone. Conclusions: Patients did not explicitly separate mental and physical health needs, although the content they developed for the virtual agent had a clear psychological approach. Supported self-management delivered via an autonomous virtual agent was acceptable to the participants. A co-design process has allowed the research team to identify key design principles, content, and functionality to underpin an autonomous agent for delivering self-management support to older adults living with COPD and potentially other LTCs. %M 31148545 %R 10.2196/12996 %U http://www.jmir.org/2019/5/e12996/ %U https://doi.org/10.2196/12996 %U http://www.ncbi.nlm.nih.gov/pubmed/31148545 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e11930 %T Smartphones as Sleep Duration Sensors: Validation of the iSenseSleep Algorithm %A Ciman,Matteo %A Wac,Katarzyna %+ Quality of Life Technologies Lab, University of Geneva, Route de Drize 7, Battelle A, UNIGE, Carouge, 1227, Switzerland, 41 792506308, katarzyna.wac@unige.ch %K mobile phone use %K mobile health %K behavioral research %K well being %D 2019 %7 21.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones are becoming increasingly ubiquitous every day; they are becoming more assimilated into our everyday life, being the last thing used before going to sleep and the first one after waking up. This strong correlation between our lifestyle choices and smartphone interaction patterns enables us to use them as sensors for sleep duration assessment to understand individuals’ lifestyle and sleep patterns. Objectives: The objective of this study was to estimate sleep duration based on the analysis of the users’ ON-OFF interaction with their smartphone alone using the iSenseSleep algorithm. Methods: We used smartwatch sleep assessment data as the ground truth. Results were acquired with 14 different subjects collecting smartwatch and smartphone interaction data for up to 6 months each. Results: Results showed that based on the smartphone ON-OFF patterns, individual’s sleep duration can be estimated with an average error of 7% (24/343) [SD 4% (17/343)] min of the total duration), enabling an estimate of sleep start and wake-up times as well as sleep deprivation patterns. Conclusions: It is possible to estimate sleep duration patterns using only data related to smartphone screen interaction. %M 31115341 %R 10.2196/11930 %U http://mhealth.jmir.org/2019/5/e11930/ %U https://doi.org/10.2196/11930 %U http://www.ncbi.nlm.nih.gov/pubmed/31115341 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e13375 %T Quality Principles of App Description Texts and Their Significance in Deciding to Use Health Apps as Assessed by Medical Students: Survey Study %A Albrecht,Urs-Vito %A Malinka,Christin %A Long,Sarah %A Raupach,Tobias %A Hasenfuß,Gerd %A von Jan,Ute %+ Peter L Reichertz Institute for Medical Informatics, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany, 49 511 532 ext 3508, albrecht.urs-vito@mh-hannover.de %K mobile health %K evaluation studies %K mobile applications %K quality criteria %K usage decision %D 2019 %7 27.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Currently, there are no binding requirements for manufacturers prescribing which information must be included in the app descriptions of health apps. Objective: The aim of this study was to investigate how medical students perceive a selection of quality principles, intended for usage decisions in the app context, and establish whether the information presented in a sample of app descriptions is perceived as sufficient for facilitating an informed usage decision. Methods: A total of 123 students (mean age 24.2 years, SD 3.4) participating in a 6-week teaching module covering cardiology and pulmonology at the University of Göttingen (original enrollment 152 students, response rate 80.9%) were included. Students were asked to read 3 store description texts of cardiological or pneumological apps and initially assess whether the descriptions sufficed for a usage decision. Subsequently, they were queried on their perception of the relevance of 9 predefined quality principles, formulated for usage decisions. An appraisal of whether the app description texts contained sufficient information to satisfy these quality principles followed. By means of 20 guiding questions, participants were then asked to identify relevant information (or a lack thereof) within the descriptions. A reassessment of whether the description texts sufficed for making a usage decision ensued. A total of 343 complete datasets were obtained. Results: A majority of the quality principles were described as “very important” and “important” for making a usage decision. When accessed via the predefined principles, students felt unable to identify sufficient information within the app descriptions in 68.81% (2124/3087) of cases. Notably, information regarding undesired effects (91.8%, 315/343), ethical soundness (90.1%, 309/343), measures taken to avert risks (89.2%, 306/343), conflicts of interest (88.3%, 303/343), and the location of data storage (87.8%, 301/343) was lacking. Following participants’ engagement with the quality principles, statistically significant changes in their assessment of whether the app descriptions sufficed for a usage decision can be seen—McNemar-Bowker test (3)=45.803919, P<.001, Cohen g=.295. In 34.1% (117/343) cases, the assessment was revised. About 3 quarters of changed assessments were seen more critically (76.9%, 90/117). Although, initially, 70% (240/343) had been considered “sufficient,” this rate was reduced to 54.2% (186/343) in the second assessment. Conclusions: In a considerable number of app descriptions, participants were unable to locate the information necessary for making an informed usage decision. Participants’ sensitization to the quality principles led to changes in their assessment of app descriptions as a tool for usage decisions. Better transparency in app descriptions released by manufacturers and the exposure of users to quality principles could collectively form the basis for well-founded usage decisions. %M 30810534 %R 10.2196/13375 %U http://mhealth.jmir.org/2019/2/e13375/ %U https://doi.org/10.2196/13375 %U http://www.ncbi.nlm.nih.gov/pubmed/30810534 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10117 %T Perceptions and Acceptance of mHealth in Patients With Cardiovascular Diseases: A Cross-Sectional Study %A Jiang,Jie %A Zhu,Qin %A Zheng,Yimei %A Zhu,Yajing %A Li,Yuxi %A Huo,Yong %+ Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China, 86 1083572283, huoyong@263.net.cn %K age %K cardiovascular disease %K internet %K mHealth %K mobile phone %K secondary prevention %K self-management %D 2019 %7 04.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth)—a method of assisting long-term care in patients with chronic cardiovascular diseases (CVDs)—is gaining popularity in China, mainly owing to the large number of patients and limited clinical resources. Patients of different ages have varying needs for CVD management. However, evidence regarding how age influences Chinese CVD patients’ use and perceptions of mHealth is limited. Objective: This study aimed to explore age-related differences among Chinese patients with CVD regarding their use and perceptions of mHealth and to determine the factors that influence this population’s willingness to use mHealth technologies. Methods: We conducted a cross-sectional study of patients with chronic CVDs in a tertiary hospital in Beijing using a new questionnaire designed by the investigators. Participants were sourced using nonproportional quota-sampling methods, being recruited consecutively in each sampling category (age 18-49, 50-64, 65-74, and ≥75 years, with at least 25 men and 25 women in each age group). The survey consisted of 5 parts, including sociodemographic profile and medical history; current disease management situation; self-evaluation of disease management; current usage of mobile and internet technology (IT); and willingness to use an mHealth solution to perform disease self-management. Responses were compared among the 4 age groups as well as between patients who were willing to use mHealth solutions and those who were not. Multivariate logistic regression model was used to identify predictors of willingness to use mHealth for self-management. Results: Overall, 231 patients (124 men) completed the questionnaire; of these, 53 were aged 18-49 years, 66 were aged 50-64 years, 54 were aged 65-74 years, and 58 were aged ≥75 years. Patients in the older cohorts visited hospitals more often than did those in the younger cohorts (P<.001), and they also showed lower technology skills regarding the use of mobile or internet devices (P<.001) and searched for health-related information on the internet less often (P<.001). In addition, 68.0% (157/231) of the patients showed interest in using mHealth solution to manage their disease; of these, 40.8% (64/157) were aged ≥65 years. Patients who were more willing to use mHealth solution to manage their diseases were younger (P<.001), more educated (P<.001), still working (P=.001), possessed higher skill regarding mobile or internet device use (P<.001), and more frequently searched for health information on the internet (P<.001). Finally, multivariate logistic regression showed that IT skill was the single indicator (P=.003) of willingness to use mHealth, not age. Conclusions: Although age is associated with the use of mobile or internet devices, the sole indicator of mHealth use for self-management was participants’ IT skills. Education regarding the use of mobile devices and development of easy-to-use software might improve the acceptance of mHealth solutions among older patient populations. %M 30714942 %R 10.2196/10117 %U https://mhealth.jmir.org/2019/2/e10117/ %U https://doi.org/10.2196/10117 %U http://www.ncbi.nlm.nih.gov/pubmed/30714942 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e187 %T Mobile Apps for Blood Pressure Monitoring: Systematic Search in App Stores and Content Analysis %A Jamaladin,Hussein %A van de Belt,Tom H %A Luijpers,Lianda CH %A de Graaff,Falco R %A Bredie,Sebastian JH %A Roeleveld,Nel %A van Gelder,Marleen MHJ %+ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein-Noord 21, Nijmegen,, Netherlands, 31 024 366684, hussein.jamaladin@radboudumc.nl %K mobile phone %K mHealth %K app review %K high blood pressure %K self-management %K mobile app %D 2018 %7 14.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using a mobile app for self-management could make it easier for patients to get insight into their blood pressure patterns. However, little is known about the availability, quality, and features of mobile apps targeting blood pressure. Objective: The goal of the research was to determine the availability, functionality, and quality of mobile apps that could be used for blood pressure monitoring purposes. Methods: A systematic app search was performed based on the standards for systematic reviews. We searched the Dutch official app stores for Android and iOS platforms using predefined keywords and included all English and Dutch mobile apps targeting blood pressure. Two independent assessors determined eligibility and quality of the apps using the 5-point Mobile App Rating Scale (MARS). Quality scores of the apps with and without 17 a priori selected characteristics were compared using independent sample t tests. Results: A total of 184 apps (104 Android, 80 iOS) met the inclusion criteria. The mean overall MARS score was 2.63 (95% CI 2.55-2.71) for Android and 2.64 (95% CI 2.56-2.71) for iOS. The apps Bloeddruk (4.1) and AMICOMED BP (3.6) had the highest quality scores on the Android and iOS platforms, respectively. Of the app characteristics recorded, only pricing, in-app advertisements, and local data storage were not associated with the quality scores. In only 3.8% (7/184) of the apps, involvement of medical experts in its development was mentioned, whereas none of the apps was formally evaluated with results published in a peer-reviewed journal. Conclusions: This study provides an overview of the best apps currently available in the app stores and important key features for self-management that can be used by health care providers and patients with hypertension to identify a suitable app targeting blood pressure monitoring. However, the majority of the apps targeting blood pressure monitoring were of poor quality. Therefore, it is important to involve medical experts in the developmental stage of health-related mobile apps to improve the quality of these apps. %M 30429116 %R 10.2196/mhealth.9888 %U https://mhealth.jmir.org/2018/11/e187/ %U https://doi.org/10.2196/mhealth.9888 %U http://www.ncbi.nlm.nih.gov/pubmed/30429116 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10412 %T How Users Experience and Use an eHealth Intervention Based on Self-Regulation: Mixed-Methods Study %A Poppe,Louise %A Van der Mispel,Celien %A Crombez,Geert %A De Bourdeaudhuij,Ilse %A Schroé,Helene %A Verloigne,Maïté %+ Ghent Health Psychology Lab, Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 9 264 86 51, louise.poppe@ugent.be %K eHealth %K self-regulation %K behavioral change theory %K interview %K usage data %D 2018 %7 01.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth interventions show stronger effects when informed by solid behavioral change theories; for example, self-regulation models supporting people in translating vague intentions to specific actions have shown to be effective in altering health behaviors. Although these theories inform developers about which behavioral change techniques should be included, they provide limited information about how these techniques can be engagingly implemented in Web-based interventions. Considering the high levels of attrition in eHealth, investigating users’ experience about the implementation of behavior change techniques might be a fruitful avenue. Objective: The objective of our study was to investigate how users experience the implementation of self-regulation techniques in a Web-based intervention targeting physical activity and sedentary behavior in the general population. Methods: In this study, 20 adults from the general population used the intervention for 5 weeks. Users’ website data were explored, and semistructured interviews with each of the users were performed. A directed content analysis was performed using NVivo Software. Results: The techniques “providing feedback on performance,” “action planning,” and “prompting review of behavioral goals” were appreciated by users. However, the implementation of “barrier identification/problem solving” appeared to frustrate users; this was also reflected by the users’ website data—many coping plans were of poor quality. Most users were well aware of the benefits of adopting a more active way of living and stated not to have learned novel information. However, they appreciated the provided information because it reminded them about the importance of having an active lifestyle. Furthermore, prompting users to self-monitor their behavioral change was not sufficiently stimulating to make users actually monitor their behavior. Conclusions: Iteratively involving potential end users offers guidance to optimally adapt the implementation of various behavior change techniques to the target population. We recommend creating short interventions with a straightforward layout that support users in creating and evaluating specific plans for action. %M 30274961 %R 10.2196/10412 %U https://www.jmir.org/2018/10/e10412/ %U https://doi.org/10.2196/10412 %U http://www.ncbi.nlm.nih.gov/pubmed/30274961 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e96 %T A Mobile Gaming Intervention to Increase Adherence to Antiretroviral Treatment for Youth Living With HIV: Development Guided by the Information, Motivation, and Behavioral Skills Model %A Whiteley,Laura %A Brown,Larry %A Lally,Michelle %A Heck,Nicholas %A van den Berg,Jacob J %+ Department of Psychiatry, Rhode Island Hospital, 167 Point Street Coro East, Suite 161, Providence, RI, 02903, United States, 1 4017938809, laura_whiteley@brown.edu %K mobile phones %K adolescents %K young adults %K patient compliance %D 2018 %7 23.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Highly active combination antiretroviral treatment has been shown to markedly improve the health of HIV-infected adolescents and young adults. Adherence to antiretroviral treatment leads to decreased morbidity and mortality and decreases the number of hospitalizations. However, these clinical achievements can only occur when young persons with HIV are adherent to care. Unfortunately, adolescents and young adults have poorer rates of adherence to antiretroviral medications and poorer rates of retention in care than older adults. Novel and engaging digital approaches are needed to help adolescents and young adults living with HIV be adherent to treatment. Objective: The aim of this study was to develop an immersive, action-oriented iPhone gaming intervention to improve adherence to antiretroviral medication and treatment. Methods: Game development was guided by social learning theory, taking into consideration the perspectives of adolescents and young adults living with HIV. A total of 20 adolescents and young adults were recruited from an HIV care clinic in Rhode Island, and they participated in qualitative interviews guided by the information-motivation-behavioral skills model of behavior change. The mean age of participants was 22 years, 60% (12/20) of the participants identified as male, and 60% (12/20) of the sample reported missing a dose of antiretroviral medication in the previous week. Acceptability of the game was assessed with client service questionnaire and session evaluation form. Results: A number of themes emerged that informed game development. Adolescents and young adults living with HIV desired informational game content that included new and comprehensive details about HIV, details about HIV as it relates to doctors’ visits, and general health information. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and increasing personal relevance of HIV care. Behavioral skills themes centered on self-efficacy and strategies for medical adherence and self-care. On the client service questionnaire, 10 out of the 11 participants indicated they were “satisfied with the game activities,” and 9 out of 11 “would recommend it to a friend.” On the session evaluation form, 9 out of 11 agreed that they “learned a lot from the game.” Conclusions: We utilized youth feedback, social learning theory (information-motivation-behavioral skills), and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to measure and improve treatment adherence for adolescents and young adults living with HIV. There is a dearth of gaming interventions for this population, and this study is a significant step in working toward the development and testing of an iPhone gaming app intervention to promote adherence to antiretroviral treatment. Trial Registration: ClinicalTrials.gov NCT01887210; http://clinicaltrials.gov/ct2/show/NCT01887210 (Archived by WebCite at http://www.webcitation.org/6xHMW0NI1) %M 29685863 %R 10.2196/mhealth.8155 %U http://mhealth.jmir.org/2018/4/e96/ %U https://doi.org/10.2196/mhealth.8155 %U http://www.ncbi.nlm.nih.gov/pubmed/29685863 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e219 %T Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies %A Abbate,Kristopher J %A Hingle,Melanie D %A Armin,Julie %A Giacobbi Jr,Peter %A Gordon,Judith S %+ College of Medicine, University of Arizona, 1450 N. Cherry, Tucson, AZ, 85719, United States, 1 5206261152, kjabbate@email.arizona.edu %K smoking cessation %K mobile applications %K social media %K women %K mHealth %D 2017 %7 03.11.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective: The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods: To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users’ self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results: Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions: Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention’s broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research. %M 29101091 %R 10.2196/resprot.7356 %U http://www.researchprotocols.org/2017/11/e219/ %U https://doi.org/10.2196/resprot.7356 %U http://www.ncbi.nlm.nih.gov/pubmed/29101091