%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 13
%N 
%P e59884
%T Trustworthiness of Web-Based Pharmacy Apps in Pakistan Based on the Mobile App Rating Scale: Content Analysis and Quality Evaluation
%A Sattar,Anum
%A Rehman,Hina
%A Naveed,Safila
%A Khadim,Sumaira
%A Khan,Nargis
%A Kazi,Ahmad Furqan
%A Syed,Wajid
%A Al-Rawi,Mahmood Basil A
%A Jamshed,Shazia
%K online pharmacy
%K online pharmacy apps
%K apps
%K mobile app
%K smartphone app
%K trustworthiness
%K pharmacy
%K digital platforms
%K questionnaire
%K engagement
%K functionality
%K Mobile App Rating Scale
%K MARS
%K user
%K efficacy
%K Pakistan
%D 2025

%7 17.4.2025
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Web-based pharmacy apps facilitate the electronic exchange of health-related supplies. They are digital platforms that run on websites and smartphones. Pakistan is experiencing significant progress in smartphone integration and digital services, leading to the expansion of the online pharmacy business. However, concerns remain over the legitimacy and precision of these apps. Objective: The aim of this study was to undertake a thorough assessment of digital pharmacy apps accessible in Pakistan. Specifically, our focus was on apps accessible via the Google Play Store and the iOS App Store. To fulfill this objective, an evaluation of these apps was performed using the Mobile App Rating Scale (MARS). Methods: A research investigation was conducted to analyze the online pharmacy apps in Pakistan. Initially, 50 apps were identified, but 10 were excluded for not meeting pre-established criteria, 10 were excluded for being in languages other than English, and 7 could not be downloaded. All paid and non-English apps were also excluded. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. The evaluation was conducted by 2 researchers who maintained independence from one another by using the MARS. Results: Initially, 50 apps were identified, of which 27 were excluded for not meeting the predetermined criteria. A total of 23 apps were selected for the study, acquired via the Google Play Store and iOS App Store. Strong positive correlations between higher user engagement and better app functionality and information quality were observed. The average rating of the 23 apps ranged between 2.64 and 4.00 on a scale up to 5. The aesthetics dimension had the highest mean score of 3.6, while the information dimension had the lowest mean score of 3.2. For credibility and reliability, different tests (intraclass correlation, Cohen κ, Krippendorff α, and Cronbach α) on each dimension of the MARS were performed by using SPSS Statistics 27. The intraclass correlation of all MARS dimensions ranged from 0.702‐0.913 (95% CI 0.521‐0.943), the Cohen κ of all MARS dimensions ranged from 0.388‐0.907 (95% CI 0.151‐0.994), the Krippendorff α of all MARS dimensions ranged from 0.705‐0.979 (95% CI 0.657‐0.923), and Cronbach α had a lower score of 0.821 in the information dimension and a higher score of .911 in the subjective quality dimension of the MARS. Conclusion: This study evaluated online pharmacy apps in Pakistan by using the MARS. It is the first study on online pharmacy apps in Pakistan. The findings of the evaluation have provided insights into the reliability and efficacy of these apps. 
%R 10.2196/59884
%U https://mhealth.jmir.org/2025/1/e59884
%U https://doi.org/10.2196/59884

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e67885
%T Using the Healthy Native Youth Implementation Toolbox to Provide Web-Based Adolescent Health Promotion Decision Support to American Indian and Alaska Native Communities: Implementation Study
%A Sidhu,Amrita
%A Shegog,Ross
%A Craig-Rushing,Stephanie
%A Trevino,Nicole
%A Singer,Michelle
%A Jessen,Cornelia
%A Gorman,Gwenda
%A Simpson,Sean
%A Peskin,Melissa
%A Hernandez,Belinda
%A Markham,Christine
%K implementation
%K culturally relevant program
%K evidence-based health promotion
%K user engagement
%K reach
%K decision support system
%K American Indian
%K Alaska
%K native communities
%K youth
%K adolescent
%K decision support
%K Alaska native
%K health inequities
%K sexual
%K reproductive
%K mental health
%K AI/AN
%K Tribal organization
%K Google Analytics
%K toolbox
%D 2025

%7 16.4.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: American Indian and Alaska Native (AI/AN) youth experience numerous health inequities, including those in sexual, reproductive, and mental health. Implementation of culturally relevant, age-appropriate evidence-based programs may mitigate these inequities. However, numerous barriers limit the adoption and implementation of evidence-based adolescent health promotion programs in AI/AN communities. Objective: This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY Implementation Toolbox), designed to increase the implementation of evidence-based adolescent health promotion programming in AI/AN communities. Methods: Promotional strategies were designed for optimal geographic reach to Tribal organizations, opinion leaders, federal decision makers, and funders. Promotional channels included grassroots, community, and professional networks. We used Google Analytics to examine the uptake of the HNY website and HNY Implementation Toolbox from January 2022 to January 2024. The Toolbox provides culturally relevant tools and templates to help users navigate through 5 phases of program adoption and implementation: Gather, Choose, Prepare, Implement, and Grow. User reach was estimated by demographic characteristics and geographic location; user engagement was estimated by visit frequency and duration, bounce rates, and frequency of page and tool access. Results: Over the study period, page views of the HNY website and HNY Toolbox increased 10-fold and 27-fold, respectively. Over the 2-year evaluation period since the Toolbox “go live” date, approximately 1 in 8 users of the HNY website visited the Toolbox. The majority of HNY website users were located in Washington (n=1515), California (n=1290), and Oregon (n=1019) and were aged between 18 and 24 (n=1559, 21.7%) and 25‐34 (n=1676, 23.29%) years. Toolbox users were primarily located in California (n=1238), Washington (n=1142), and Oregon (n=986), mostly aged between 35 and 44 years (n=444, 35%). Both website and Toolbox users were primarily female, who accessed the site and Toolbox via desktop computers. The most frequently accessed phase pages within the Implementation Toolbox were Gather, Choose, Implement, and Prepare, as supported by bounce rates and average time on page. The most viewed phase was the “Gather” phase, with 3278 views. The most frequently downloaded tools within the Toolbox were Gather: Community Needs and Resource Assessment, with 136 downloads. The phases and tools accessed may have differed based on the user’s goal or stage of implementation. Conclusions: Findings indicate positive initial reach and engagement of the HNY website and HNY Implementation Toolbox among AI/AN educators that has consistently increased over the 2 years. The provision of web-based decision support that guides AI/AN users through the adoption, implementation, and maintenance of culturally relevant, age-appropriate, evidence-based adolescent health promotion programs in their communities may help increase the implementation of effective adolescent health promotion programs to ultimately increase health equity among AI/AN youth. 
%R 10.2196/67885
%U https://formative.jmir.org/2025/1/e67885
%U https://doi.org/10.2196/67885

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e71071
%T Mental Health Apps Available in App Stores for Indian Users: Protocol for a Systematic Review
%A Mehrotra,Seema
%A Tripathi,Ravikesh
%A Sengupta,Pramita
%A Karishiddimath,Abhishek
%A Francis,Angelina
%A Sharma,Pratiksha
%A Sudhir,Paulomi
%A TK,Srikanth
%A Rao,Girish N
%A Sagar,Rajesh
%+ Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India, 91 9448503853, drmehrotra_seema@yahoo.com
%K mental health apps
%K mHealth
%K review of apps
%K smartphone apps
%K MHApps for Indian users
%K India
%K mobile phones
%D 2025

%7 16.4.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There has been a surge in mental health apps over the past few years. While these have great potential to address the unmet mental health needs of the population, the recent proliferation of mental health apps in the commercial marketplace has raised several concerns, such as privacy, evidence-based, and quality. Although there is mounting research on the effectiveness of mental health apps, the majority of these are not accessible to the public and most of those available have not been researched. Despite the rapid growth of the digital health market in India, there are no comprehensive reviews of publicly available mental health apps for Indian users. Hence it becomes important to review mental health apps freely available to potential end users in terms of their scope, functions, and quality. Objective: This study aims to systematically evaluate mental health apps available to Indian users in app stores. Methods: This systematic review of mental health apps will be performed following the Target user, Evaluation focus, Connectedness and Health domain approach and the PASSR (Protocol for App Store Systematic Reviews) checklist. Fifteen key search terms covering various mental health conditions and therapies will be used on the Android and iOS stores. The identified apps will be further screened and reviewed based on the inclusion and exclusion criteria. The pool of eligible apps will be downloaded for detailed review. The following steps will be adopted to streamline the review process and interrater consistency. Six apps will be randomly selected from the downloaded apps, for joint discussion and review by a team of 4 primary reviewers and 2 mentors. Following this, a new set of 6 randomly selected apps will be rated independently by the primary reviewers and the differences in ratings will be jointly discussed for generating consensus. Subsequently, the primary reviewers will individually review the remaining apps in the list. Data will be extracted based on predecided parameters such as privacy policy, basic purpose, type of developer, nature of intervention strategies, and guided versus unguided nature. Additionally, the apps will be reviewed for quality using the Mobile Application Rating Scale. The data analysis and synthesis strategy will incorporate descriptive statistics based on quality evaluation using the Mobile Application Rating Scale and examining the content of the apps for generating descriptive information. Results: The initial screening of mental health apps available for Indian users on the Google Play Store and Apple App Store was initiated in October 2024. We expect to complete the detailed systematic review by April 2025. Conclusions: This study will offer a comprehensive review of mental health apps available in digital marketplaces for Indian users and has implications for end users, policy makers, developers, and mental health professionals. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY2024100035; https://inplasy.com/inplasy-2024-10-0035/ International Registered Report Identifier (IRRID): DERR1-10.2196/71071 
%M 40239205
%R 10.2196/71071
%U https://www.researchprotocols.org/2025/1/e71071
%U https://doi.org/10.2196/71071
%U http://www.ncbi.nlm.nih.gov/pubmed/40239205

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e68352
%T Technology-Assisted Interventions in the Delivery of HIV Prevention, Care, and Treatment Services in Sub-Saharan Africa: Scoping Review
%A Kamulegeya,Louis Henry
%A Kagolo,Ivan
%A Kabakaari,Brenda
%A Atuhaire,Joan
%A Nasamula,Racheal
%A Bwanika,J M
%+ Africa Center for Applied Digital Health, Lugogo Bypass, Kampala, 256, Uganda, 256 0783216066, louiskamu@gmail.com
%K digital health
%K telehealth
%K HIV
%K Sub-Sahara Africa
%K chatbots
%K mobile application
%K mHealth
%D 2025

%7 15.4.2025
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Sub-Saharan Africa (SSA) accounts for up to 67% of the global HIV burden yet grapples with health system challenges like distant health facilities, low doctor-to-patient ratio, and poor or non-functioning post-hospital follow-up mechanisms. The rising phone ownership and internet penetration in SSA (46% and 67%, respectively) offer an opportunity to leverage technology to address these gaps and drive toward achieving the UNAIDS (Joint United Nations Programme on HIV and AIDS) 95-95-95 targets. Objective: We undertook a scoping review to understand how digital technologies have been integrated into HIV prevention, care, and treatment services delivery in SSA. Methods: A scoping review involving 4 databases (PubMed, CINAHL, Cochrane, and Google Scholar) was carried out, encompassing studies related to technology use in the delivery of HIV prevention, care, and treatment published from January 1, 2019, to December 30, 2023. Search terms like “telemedicine,” “telehealth,” “mobile health,” “eHealth,” “mHealth,” “telecommunication,” “mobile application,” and “digital health,” among others, were used. Of the 310 papers identified, 11 were excluded due to duplicity, 299 were from outside SSA and the intervention was not well described, and 149 were due to the year of publication and study type being a literature review or study protocols, leaving 17 papers that were considered for the review. Results: From the 17 studies summarized, the technologies identified included social media (n=1), interactive voice response (n=1), hotlines (n=1), mobile apps (n=7), health information systems (n=2), chatbots (n=1), and SMS text messages (n=5). Adolescents (11-14 years) and youths (20-35 years) formed the majority of users. The use cases included reminders on facility events, teleconsultations, patient registration, and health information dissemination, among others. Different parameters of individual digital tools were tracked, including feasibility, usability, adoption, and impact on the desired outcome. Conclusions: The integration of digital technologies in health care can address the known challenges in the delivery of HIV prevention, care, and treatment services, facilitate customization of care to individual needs, and thus increase or diversify options available to patients. 
%M 40233346
%R 10.2196/68352
%U https://www.jmir.org/2025/1/e68352
%U https://doi.org/10.2196/68352
%U http://www.ncbi.nlm.nih.gov/pubmed/40233346

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 8
%N 
%P e67137
%T Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes
%A Ibrahim,Radhwan Hussein
%A Yaas,Marghoob Hussein
%A Hamarash,Mariwan Qadir
%A Al-Mukhtar,Salwa Hazim
%A Abdulghani,Mohammed Faris
%A Al Mushhadany,Osama
%K cognitive behavioral therapy
%K CBT
%K psychotherapy
%K mHealth
%K app
%K adolescents
%K teenager
%K mental health
%K usability
%K engagement
%K anxiety
%K depression
%K user experience
%K UX
%K focus group
%K interview
%K digital health
%D 2025

%7 11.4.2025
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13‐19 years (mean age 15.8, SD 1.9 years; 18/40, 45% male; 22/40, 55% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50%), depression (15/40, 38%), and both (5/40, 13%). Of these, 10 (25%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16‐19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13‐15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95% CI 1.6‐5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95% CI 1.7‐5.6; P=.001). Usability challenges included complex navigation (20/40, 50%), interface design issues (12/40, 30%), and content overload (8/40, 20%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50%) and gamification features (10/40, 25%), while lack of personalization (14/40, 35%) and external distractions (18/40, 45%) were significant barriers. Mood improvement (15/40, 38%) and learning new coping skills (12/40, 30%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. 
%R 10.2196/67137
%U https://pediatrics.jmir.org/2025/1/e67137
%U https://doi.org/10.2196/67137

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e42406
%T Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study
%A Kola,Lola
%A Fatodu,Tobi
%A Kola,Manasseh
%A Olayemi,Bisola A
%A Adefolarin,Adeyinka O
%A Dania,Simpa
%A Kumar,Manasi
%A Ben-Zeev,Dror
%+ WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 3017 G.P.O, Ibadan, 23401, Nigeria, 234 (2) 2411768, lola_kola2004@yahoo.com
%K adolescent perinatal depression
%K primary care
%K mHealth app
%K user centered design
%K smartphone
%K human-centered design
%K HCD
%K depression
%K postpartum
%K perinatal
%K postnatal
%K teenage
%K adolescent
%K youth
%K low-middle-income countries
%K LMIC
%K middle income
%K adoption
%K acceptability
%K mobile health
%K mHealth
%K mobile app
%K women’s health
%K mental health
%K depressive
%D 2025

%7 9.4.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants’ knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients’ relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. 
%M 40203299
%R 10.2196/42406
%U https://formative.jmir.org/2025/1/e42406
%U https://doi.org/10.2196/42406
%U http://www.ncbi.nlm.nih.gov/pubmed/40203299

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 14
%N 
%P e53849
%T Using an Electronic Immunization Registry (Aplikasi Sehat IndonesiaKu) in Indonesia: Cross-Sectional Study
%A Aisyah,Dewi Nur
%A Utami,Astri
%A Rahman,Fauziah Mauly
%A Adriani,Nathasya Humaira
%A Fitransyah,Fiqi
%A Endryantoro,M Thoriqul Aziz
%A Hutapea,Prima Yosephine
%A Tandy,Gertrudis
%A Manikam,Logan
%A Kozlakidis,Zisis
%+ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076792000, logan.manikam.10@ucl.ac.uk
%K immunization
%K registry
%K digital
%K puskesmas
%K public health center
%K mobile app
%D 2025

%7 27.3.2025
%9 Original Paper
%J Interact J Med Res
%G English
                
%X Background: Electronic immunization registries (EIRs) are being increasingly used in low- and middle-income countries. In 2022, Indonesia’s Ministry of Health introduced its first EIR, named Aplikasi Sehat IndonesiaKu (ASIK), as part of a comprehensive nationwide immunization program. This marked a conversion from traditional paper-based immunization reports to digital routine records encompassing a network of 10,000 primary health centers (puskesmas). Objective: This paper provides an overview of the use of ASIK as the first EIR in Indonesia. It describes the coverage of the nationwide immunization program (Bulan Imunisasi Anak Nasional) using ASIK data and assesses the implementation challenges associated with the adoption of the EIR in the context of Indonesia. Methods: Data were collected from primary care health workers’ submitted reports using ASIK. The data were reported in real time, analyzed, and presented using a structured dashboard. Data on ASIK use were collected from the ASIK website. A quantitative assessment was conducted through a cross-sectional survey between September 2022 and October 2022. A set of questionnaires was used to collect feedback from ASIK users. Results: A total of 93.5% (9708/10,382) of public health centers, 93.5% (6478/6928) of subdistricts, and 97.5% (501/514) of districts and cities in 34 provinces reported immunization data using ASIK. With >21 million data points recorded, the national coverage for immunization campaigns for measles-rubella; oral polio vaccine; inactivated polio vaccine; and diphtheria, pertussis, tetanus, hepatitis B, and Haemophilus influenzae type B vaccine were 50.1% (18,301,057/36,497,694), 36.2% (938,623/2,595,240), 30.7% (1,276,668/4,158,289), and 40.2% (1,371,104/3,407,900), respectively. The quantitative survey showed that, generally, users had a good understanding of ASIK as the EIR (650/809, 80.3%), 61.7% (489/793) of the users expressed that the user interface and user experience were overall good but could still be improved, 54% (422/781) of users expressed that the ASIK variable fit their needs yet could be improved further, and 59.1% (463/784) of users observed sporadic system interference. Challenges faced during the implementation of ASIK included a heavy workload burden for health workers, inadequate access to the internet at some places, system integration and readiness, and dual reporting using the paper-based format. Conclusions: The EIR is beneficial and helpful for monitoring vaccination coverage. Implementation and adoption of ASIK as Indonesia’s first EIR still faces challenges related to human resources and digital infrastructure as the country transitions from paper-based reports to electronic or digital immunization reports. Continuous improvement, collaboration, and monitoring efforts are crucial to encourage the use of the EIR in Indonesia. 
%M 40146988
%R 10.2196/53849
%U https://www.i-jmr.org/2025/1/e53849
%U https://doi.org/10.2196/53849
%U http://www.ncbi.nlm.nih.gov/pubmed/40146988

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e64079
%T Best Practice Guide for Reducing Barriers to Video Call–Based Telehealth: Modified Delphi Study Among Health Care Professionals
%A Rettinger,Lena
%A Aichinger,Lea
%A Ertelt-Bach,Veronika
%A Huber,Andreas
%A Javorszky,Susanne Maria
%A Maul,Lukas
%A Putz,Peter
%A Sargis,Sevan
%A Werner,Franz
%A Widhalm,Klaus
%A Kuhn,Sebastian
%+ Research Center Digital Health and Care, FH Campus Wien, University of Applied Sciences Vienna, Favoritenstrasse 226, Vienna, 1100, Austria, 43 6066977 ext 4382, lena.rettinger@fh-campuswien.ac.at
%K telehealth
%K best practices
%K video call
%K Delphi study
%K health communication
%K barriers
%K health care professionals
%K qualitative interviews
%K web-based survey
%K physiotherapists
%K speech therapists
%K language therapists
%K dietitians
%K midwife
%D 2025

%7 26.3.2025
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers. Objective: The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines. Methods: We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus. Results: This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support. Conclusions: This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education. 
%M 40138694
%R 10.2196/64079
%U https://humanfactors.jmir.org/2025/1/e64079
%U https://doi.org/10.2196/64079
%U http://www.ncbi.nlm.nih.gov/pubmed/40138694

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e63671
%T Decomposition and Comparative Analysis of Urban-Rural Disparities in eHealth Literacy Among Chinese University Students: Cross-Sectional Study
%A Yu,Yao
%A Liang,Zhenning
%A Zhou,Qingping
%A Tuersun,Yusupujiang
%A Liu,Siyuan
%A Wang,Chenxi
%A Xie,Yuying
%A Wang,Xinyu
%A Wu,Zhuotong
%A Qian,Yi
%+ , School of Health Management, Southern Medical University, Number 1023, Shatai South Road, Baiyun District, Guangzhou, , China, 86 13632101533, qianyi_smu@163.com
%K university students
%K eHealth literacy
%K urban-rural disparities
%K Fairlie decomposition model
%K health equity
%D 2025

%7 26.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Mobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. Objective: This study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. Methods: The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. Results: The average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90%) compared with urban students (1298/2720, 47.72%; P<.001). The Fairlie decomposition analysis showed that 71.4% of the disparity in eHealth literacy was attributable to urban-rural factors and unobserved variables, while 28.6% resulted from observed factors. The primary contributors were monthly per capita household income (13.4%), exercise habits (11.7%), and 9-item Patient Health Questionnaire (PHQ-9) scores (2.1%). Conclusions: Rural university students exhibit lower eHealth literacy levels than their urban counterparts, a disparity influenced by differences in socioeconomic status, individual lifestyles, and personal health status. These findings highlight the need for targeted intervention strategies, including (1) improving access to eHealth resources in rural and underserved areas; (2) fostering an environment that encourages physical activity to promote healthy behaviors; (3) expanding school-based mental health services to enhance health information processing capacity; and (4) implementing systematic eHealth literacy training with ongoing evaluation. These strategies will support equitable access to and utilization of eHealth resources for all students, regardless of their geographic location. 
%M 40138681
%R 10.2196/63671
%U https://www.jmir.org/2025/1/e63671
%U https://doi.org/10.2196/63671
%U http://www.ncbi.nlm.nih.gov/pubmed/40138681

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e68085
%T Multilevel Intervention to Support Tailored and Responsive HIV Pre-Exposure Prophylaxis Care in Rural North Carolina: Protocol for a Randomized Controlled Trial
%A Rutstein,Sarah E
%A Ferguson,Ella
%A Mansour,Odai
%A Brown,Nicole
%A Stocks,Jacob B
%A Washington,Anja
%A Mobley,Victoria
%A Dowler,Shannon
%A Edwards,Jessie
%A Hightow-Weidman,Lisa B
%A Hurt,Christopher B
%A Pence,Brian
%A Muessig,Kathryn E
%+ Department of Medicine, University of North Carolina at Chapel Hill, 130 Mason Farm Rd, Chapel Hill, NC, 27514, United States, 1 919 843 5859, srutstein@unc.edu
%K pre-exposure prophylaxis navigation
%K PrEP navigation
%K digital health app
%K mobile health
%K mHealth
%K telehealth
%K public health
%K sexually transmitted infection
%K HIV prevention
%K mobile phone
%D 2025

%7 21.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: While access to pre-exposure prophylaxis (PrEP) is an important tool for reducing HIV incidence in the United States, disparities in uptake by race, sex, socioeconomic status, and geography persist. In 2018, the US South accounted for more than half of all new HIV diagnoses but only one-third of PrEP users. PrEP use in North Carolina (NC) similarly lags, with uptake being the lowest among young, sexual and gender minority populations, who account for nearly two-thirds of the state’s incident infections. The PrEP-to-need ratio, a metric of PrEP equity that measures PrEP uptake relative to new HIV diagnoses, highlights disparities in PrEP uptake among specific demographic groups such as women and Black, Hispanic, and Southern people, indicating that these groups are underserved relative to their epidemic need. Despite behavioral risk overlap of incident sexually transmitted infections (STIs) and HIV, in NC, PrEP is only offered at a few primarily urban health department–affiliated STI clinics. The lack of robust health care infrastructure in these areas presents challenges for HIV prevention services. Objective: This protocol describes a randomized controlled trial of a multilevel PrEP intervention recruiting from rural and periurban STI clinics. Methods: This trial aims to enroll up to 336 participants and randomly assign them 1:1 to either the intervention or control group. The intervention consists of access to a digital health app, linkage to a remote PrEP navigator, and the option of referral to telehealth-based PrEP services. Persons randomly assigned to the control condition will receive an enhanced standard of care, including access to a limited version of the digital health app. All participants will be followed up on quarterly for at least 3 months. The primary outcome is the initiation of PrEP within 3 months of an index STI clinic visit; secondary outcomes evaluate PrEP care engagement and adherence, incident HIV and bacterial STI infections, PrEP stigma, and cost-effectiveness. Binary outcome analyses will estimate the proportion of participants achieving an event (eg, PrEP uptake) in each arm and a probability difference and the corresponding 95% CI to compare the intervention versus control arm at each time point. Continuous end points will use nonparametric Wilcoxon rank sum tests comparing the intervention and control groups. Results: Enrollment opened on August 31, 2023, at 15 health departments in NC and subsequently expanded to 21 facilities in 20 counties by July 2024. Completion of the enrollment and data collection phases is expected by May 2025. Results will be published thereafter. Conclusions: This study directly addresses multiple barriers to PrEP use in rural and periurban areas of the Southeastern United States and can inform policy and programming that seek to expand PrEP access and promote use in underserved communities. Trial Registration: ClinicalTrials.gov NCT05984030; https://clinicaltrials.gov/study/NCT05984030 International Registered Report Identifier (IRRID): DERR1-10.2196/68085 
%M 40117579
%R 10.2196/68085
%U https://www.researchprotocols.org/2025/1/e68085
%U https://doi.org/10.2196/68085
%U http://www.ncbi.nlm.nih.gov/pubmed/40117579

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e51524
%T Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama “Secure Voucher” Study Cluster Randomized Controlled Trial
%A Vey,Trinity
%A Kinnicutt,Eleonora
%A Day,Andrew G
%A West,Nicola
%A Sleeth,Jessica
%A Nchimbi,Kenneth Bernard
%A Yeates,Karen
%+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada, 1 613 533 2000, 16tv7@queensu.ca
%K malaria prevention
%K pregnant
%K mHealth
%K mobile health
%K short message service
%K behaviour change communication
%K long-lasting insecticidal nets
%K protozoan infections
%K parasitic diseases
%K vector borne diseases
%K randomized controlled trial
%K morbidity
%K mortality
%K intervention
%D 2025

%7 19.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 
%M 40106816
%R 10.2196/51524
%U https://www.jmir.org/2025/1/e51524
%U https://doi.org/10.2196/51524
%U http://www.ncbi.nlm.nih.gov/pubmed/40106816

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e67049
%T Integration of a Patient-Centered mHealth Intervention (Support-Moms) Into Routine Antenatal Care to Improve Maternal Health Among Pregnant Women in Southwestern Uganda: Protocol for a Randomized Controlled Trial
%A Atukunda,Esther Cathyln
%A Mugyenyi,Godfrey Rwambuka
%A Haberer,Jessica E
%A Siedner,Mark J
%A Musiimenta,Angella
%A Najjuma,Josephine N
%A Obua,Celestino
%A Matthews,Lynn T
%+ Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda, 256 702949832, eatukunda@must.ac.ug
%K social support
%K intervention development
%K maternal health
%K antenatal care attendance
%K skilled births
%K Uganda
%D 2025

%7 19.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mobile health (mHealth) interventions that leverage social support (SS) can improve partner involvement and pregnancy experiences and promote antenatal care (ANC) attendance and skilled births. In our previous studies, we used behavioral frameworks to develop a user-centered mHealth-based, audio SMS text messaging app to support pregnant individuals to use maternity care services in rural Uganda (Support-Moms app). In our pilot study, we observed high intervention uptake, acceptability, and feasibility, as well as increased ANC attendance and skilled births. Objective: With the promising pilot data, we propose a type 1 hybrid implementation-effectiveness trial to test if this novel patient-centered automated and customized mHealth-based SS intervention is effective and cost-effective enough to warrant future large-scale implementation into Uganda’s routine maternity care. Methods: We will physically recruit 824 pregnant women at <20 weeks of gestation living in Mbarara and Mitooma districts, southwestern Uganda, and randomize them (1:1) to receive standard of care or the Support-Moms app, with at least 2 of their identified social supporters. Our primary outcome will be the proportion of skilled births. Secondary outcomes will include number of ANC visits<strong>,</strong> institution-based delivery, mode of infant delivery, preterm birth, birth weight, SS, obstetric complications, and deaths (maternal, fetal, and newborn). We will assess other implementation, service, and client outcomes through study records, the mHealth platform, and questionnaires with all women in the intervention, their social supporters, health care providers (HCPs), and managers from participating facilities. We will conduct face-to-face in-depth exit interviews with 30 purposively selected intervention participants and 15 facility HCPs and managers to explore implementation strategies for scale-up. Annual maternity resource allocations, costs, number of ANC visits, and deliveries will be assessed from facility records up to 36 months after implementation. We will estimate incremental cost-effectiveness ratios concerning cost per additional HCP-led delivery, per death averted, and per quality-adjusted life year gained as cost-effectiveness measures. Results: This study was funded in September 2023. Ethics approval was obtained in February 2024, and actual data collection started in March 2024. As of January 2025, 75% (618/824) of all projected study participants provided consent and were recruited into the study. Participants are expected to be followed up until delivery, and 15% (124/824) have so far exited. Data analysis for the trial is expected to start as soon as the last participant exits from the study. The qualitative interviews will start in April 2025, and data will be analyzed and published as soon as data collection is done, which is expected in March 2027. Conclusions: We are testing the feasibility, acceptability, and cost-effectiveness of implementing Support-Moms into routine maternity care from individual and facility perspectives. We hypothesize that Support-Moms will be an effective and cost-effective strategy to improve maternity service use for women in rural Uganda and similar settings. Trial Registration: ClinicalTrials.gov NCT05940831; https://clinicaltrials.gov/study/NCT05940831 International Registered Report Identifier (IRRID): DERR1-10.2196/67049 
%M 40105879
%R 10.2196/67049
%U https://www.researchprotocols.org/2025/1/e67049
%U https://doi.org/10.2196/67049
%U http://www.ncbi.nlm.nih.gov/pubmed/40105879

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e69264
%T Evaluation of a Smartphone-Based Weight Loss Intervention with Telephone Support for Merchant Women With Obesity in Côte d'Ivoire: Protocol for a Randomized Controlled Trial
%A Usui,Rui
%A Aomori,Maki
%A Kanamori,Shogo
%A Watabe,Setsuko
%A Sehi,Bi Tra Jamal
%A Kawano,Kei
%A Kanoya,Yuka
%+ Department of Nursing, Shonan University of Medical Science, 27, Yamatecho, Naka-ku, Yokohama, Kanagawa, 231-0862, Japan, 81 45 222 0810, usuir@yokohama-cu.ac.jp
%K West Africa
%K sub-Saharan Africa
%K obesity
%K noncommunicable diseases
%K mHealth
%K mobile health
%K eHealth
%K randomized controlled trial
%K Côte d'Ivoire
%K weight loss program
%D 2025

%7 18.3.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The obesity rate among women in Côte d'Ivoire is rising, particularly in urban areas. Merchantry is the leading occupation for women in the country, and merchant women face a high risk of obesity owing to their sedentary lifestyle. A previous survey indicated that the obesity rate among merchant women was 30%, double the national average. Furthermore, 82.2% of merchant women with obesity were unaware of their condition, and 40.1% expressed no interest in losing weight. While most weight loss programs target individuals ready to lose weight, community interventions should also address those with minimal readiness. Additionally, low-cost weight-loss interventions that do not require health professionals are needed in countries with limited medical resources. Smartphones could offer a cost-effective solution as they enable self-monitoring and remote communication. Objective: This study will evaluate a low-cost smartphone-based intervention that targets individuals who are not ready to lose weight without the involvement of health professionals. Methods: The intervention will run for 6 months, and its efficacy will be assessed in an unblinded, parallel-group, randomized controlled trial with 108 participants per group. All direct interventions for participants in this study will be carried out by staff without medical qualifications. The intervention group will receive weighing scales and be encouraged to record their weight with a smartphone app. Health education will be provided via weekly group messages and monthly phone calls. The evaluation will be conducted face-to-face. The primary outcome will be the weight change, and the secondary outcome will be differences in body fat percentage, abdominal circumference, and stage of behavioral change in weight loss behaviors from baseline to 3, 6, and 12 months. Results: In accordance with this protocol, the recruitment of participants started on August 26, 2024. A total of 216 participants were allocated, with 108 in the intervention group and 108 in the control group. The baseline survey began on November 15, 2024, and is currently ongoing as of the end of November 2024. Conclusions: This study will be the first in sub-Saharan African countries to implement a smartphone app-based weight loss program in sub-Saharan Africa that does not require direct intervention by health care professionals but specifically targets communities. Furthermore, if the effectiveness of this program is confirmed, it has the potential to serve as a low-cost sustainable weight loss model at the policy level. International Registered Report Identifier (IRRID): DERR1-10.2196/69264 
%M 40101743
%R 10.2196/69264
%U https://www.researchprotocols.org/2025/1/e69264
%U https://doi.org/10.2196/69264
%U http://www.ncbi.nlm.nih.gov/pubmed/40101743

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e64973
%T The Interactive Care Coordination and Navigation mHealth Intervention for People Experiencing Homelessness: Cost Analysis, Exploratory Financial Cost-Benefit Analysis, and Budget Impact Analysis
%A McCullough,Hannah P
%A Moczygemba,Leticia R
%A Avanceña,Anton L V
%A Baffoe,James O
%K people experiencing homelessness
%K budget impact analysis
%K financial cost-benefit analysis
%K mHealth
%K care coordination
%K care
%K mobile health
%K smartphones
%K homeless
%K hospitalization
%K cost analysis
%K health care cost
%K economic
%K emergency department
%K United States
%K cost-benefit
%K digital health
%D 2025

%7 18.3.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: The Interactive Care Coordination and Navigation (iCAN) mobile health intervention aims to improve care coordination and reduce hospital and emergency department visits among people experiencing homelessness. Objective: This study aimed to conduct a three-part economic evaluation of iCAN, including a (1) cost analysis, (2) exploratory financial cost-benefit analysis, and (3) budget impact analysis (BIA). Methods: We collected cost and expenditure data from a randomized controlled trial of iCAN to conduct a cost analysis and exploratory financial cost-benefit analysis. Costs were classified as startup and recurring costs for participants and the program. Startup costs included participant supplies for each participant and SMS implementation costs. Recurring costs included the cost of recurring services, SMS text messaging platform maintenance, health information access fees, and personnel salaries. Using the per participant per year (PPPY) costs of iCAN, the minimum savings reduction in the average health care costs among people experiencing homelessness that would lead to a benefit-cost ratio >1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0% (no savings) to 50%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US $. Results: The total cost of iCAN was US $2865 PPPY, which was made up of US $265 in startup (9%) and US $2600 (91%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8%. This means that if average health care costs (US $36,917) among people experiencing homelessness were reduced by more than 7.8% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25% ($9229/$36,917; equal to 56% [$9229/$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US $2.22 in health care savings per US $1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US $28.7 million, which could be reduced to US $2.2 million if at least 8% ($2880/$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention. Conclusions: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8% ($2880/$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio. Trial Registration: ClinicalTrials NCT05365867; https://clinicaltrials.gov/study/NCT05365867 
%R 10.2196/64973
%U https://formative.jmir.org/2025/1/e64973
%U https://doi.org/10.2196/64973

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e60102
%T Optimizing Engagement With a Smartphone App to Prevent Violence Against Adolescents: Results From a Cluster Randomized Factorial Trial in Tanzania
%A Janowski,Roselinde
%A Cluver,Lucie D
%A Shenderovich,Yulia
%A Wamoyi,Joyce
%A Wambura,Mwita
%A Stern,David
%A Clements,Lily
%A Melendez-Torres,G J
%A Baerecke,Lauren
%A Ornellas,Abigail
%A Chetty,Angelique Nicole
%A Klapwijk,Jonathan
%A Christine,Laetitia
%A Mukabana,Ateamate
%A Te Winkel,Esmee
%A Booij,Anna
%A Mbosoli,Gervas
%A Lachman,Jamie M
%+ Department of Social Policy and Intervention, University of Oxford, Barnett House, 32-37 Wellington Square, Oxford, OX1 2ER, United Kingdom, 44 01865270325, roselinde.janowski@spi.ox.ac.uk
%K digital health
%K engagement
%K parenting
%K adolescents
%K low- and middle-income country
%K violence against children
%K Multiphase Optimization Strategy
%K randomized factorial experiment
%K mobile phone
%D 2025

%7 10.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Violence and abuse exert extensive health, social, and economic burdens on adolescents in low- and middle-income countries. Digital parenting interventions are promising for mitigating risks at scale. However, their potential for public health impact hinges on meaningful engagement with the digital platform. Objective: The objective of this study was to evaluate the impact of 3 intervention design and implementation factors aimed at increasing engagement with a noncommercialized, offline-first smartphone app for caregivers of adolescents in Tanzania, in partnership with the United Nations Children’s Fund, the World Health Organization, and the Tanzanian national government. Methods: Following Multiphase Optimization Strategy (MOST) principles, we conducted a 2×2×2 cluster randomized factorial trial involving caregivers of adolescents aged 10 to 17 years. Caregivers were recruited by community representatives from 16 urban and periurban communities (ie, clusters) in the Mwanza region of Tanzania. Each cluster was randomized to 1 of 2 levels of each factor: guidance (self-guided or guided via facilitator-moderated WhatsApp groups), app design (structured or unstructured), and preprogram digital support (basic or enhanced). Primary outcomes were automatically tracked measures of engagement (app launches, modules completed, and home practice activities reviewed), with secondary outcomes including modules started, time spent in the app, and positive behaviors logged. Generalized linear mixed-effects models assessed the impact of experimental factors on engagement. Results: Automatically tracked engagement data from 614 caregivers were analyzed, of which 205 (33.4%) were men. Compared to self-guided participants, receiving guidance alongside the app led to significantly more app launches (mean ratio [MR] 2.93, 95% CI 1.84-4.68; P<.001), modules completed (MR 1.29, 95% CI 1.05-1.58; P=.02), modules started (MR 1.20, 95% CI 1.02-1.42; P=.03), time spent in the app (MR 1.45, 95% CI 1.39-1.51; P<.001), and positive behavior logs (MR 2.73, 95% CI 2.07-3.60; P<.001). Compared to the structured design, unstructured design use resulted in significantly more modules completed (MR 1.49, 95% CI 1.26-1.76; P<.001), home practice activity reviews (MR 7.49, 95% CI 5.19-10.82; P<.001), modules started (MR 1.27, 95% CI 1.06-1.52; P=.01), time spent in the app (MR 1.84, 95% CI 1.70-1.99; P<.001), and positive behavior logs (MR 55.68, 95% CI 16.48-188.14; P<.001). While analyses did not detect an effect of enhanced digital support on directly observed engagement, the combination of enhanced digital support and guidance positively influenced engagement across a range of outcomes. Conclusions: This study is the first to systematically optimize engagement with a digital parenting intervention in a low- and middle-income country. Our findings offer important learnings for developing evidence-based, scalable digital interventions in resource-constrained settings. Trial Registration: Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-023-15989-x 
%M 40063069
%R 10.2196/60102
%U https://www.jmir.org/2025/1/e60102
%U https://doi.org/10.2196/60102
%U http://www.ncbi.nlm.nih.gov/pubmed/40063069

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e53823
%T Exploring Heart Disease–Related mHealth Apps in India: Systematic Search in App Stores and Metadata Analysis
%A Dubbala,Keerthi
%A Prizak,Roshan
%A Metzler,Ingrid
%A Rubeis,Giovanni
%+ Division of Biomedical and Public Health Ethics, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6646194677, keerthi.dubbala@kl.ac.at
%K mobile health apps
%K mHealth apps
%K heart disease
%K data collection methods
%K natural language processing
%K metadata analysis
%K Apple App Store
%K Google Play Store
%K mobile phone
%D 2025

%7 10.3.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Smartphone mobile health (mHealth) apps have the potential to enhance access to health care services and address health care disparities, especially in low-resource settings. However, when developed without attention to equity and inclusivity, mHealth apps can also exacerbate health disparities. Understanding and creating solutions for the disparities caused by mHealth apps is crucial for achieving health equity. There is a noticeable gap in research that comprehensively assesses the entire spectrum of existing health apps and extensively explores apps for specific health priorities from a health care and public health perspective. In this context, with its vast and diverse population, India presents a unique context for studying the landscape of mHealth apps. Objective: This study aimed to create a comprehensive dataset of mHealth apps available in India with an initial focus on heart disease (HD)–related apps. Methods: We collected individual app data from apps in the “medical” and “health and fitness” categories from the Google Play Store and the Apple App Store in December 2022 and July 2023, respectively. Using natural language processing techniques, we selected HD apps, performed statistical analysis, and applied latent Dirichlet allocation for clustering and topic modeling to categorize the resulting HD apps. Results: We collected 118,555 health apps from the Apple App Store and 108,945 health apps from the Google Play Store. Within these datasets, we found that approximately 1.7% (1990/118,555) of apps on the Apple App Store and 0.5% (548/108,945) on the Google Play Store included support for Indian languages. Using monograms and bigrams related to HD, we identified 1681 HD apps from the Apple App Store and 588 HD apps from the Google Play Store. HD apps make up only a small fraction of the total number of health apps available in India. About 90% (1496/1681 on Apple App Store and 548/588 on Google Play Store) of the HD apps were free of cost. However, more than 70% (1329/1681, 79.1% on Apple App Store and 423/588, 71.9% on Google Play Store) of HD apps had no reviews and rating-scores, indicating low overall use. Conclusions: Our study proposed a robust method for collecting and analyzing metadata from a wide array of mHealth apps available in India through the Apple App Store and Google Play Store. We revealed the limited representation of India’s linguistic diversity within the health and medical app landscape, evident from the negligible presence of Indian-language apps. We observed a scarcity of mHealth apps dedicated to HD, along with a lower level of user engagement, as indicated by reviews and app ratings. While most HD apps are financially accessible, uptake remains a challenge. Further research should focus on app quality assessment and factors influencing user adoption. 
%M 40063078
%R 10.2196/53823
%U https://www.jmir.org/2025/1/e53823
%U https://doi.org/10.2196/53823
%U http://www.ncbi.nlm.nih.gov/pubmed/40063078

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e63607
%T Factors Associated With the Intention to Use mHealth Among Thai Middle-Aged Adults and Older Adults: Cross-Sectional Study
%A Buawangpong,Nida
%A Sirikul,Wachiranun
%A Siviroj,Penprapa
%K mHealth
%K mobile healthcare
%K older adults
%K elderly
%K aging
%K questionnaire
%K smartphone
%K mHealth usage
%K intention to use
%D 2025

%7 7.3.2025
%9 
%J JMIR Hum Factors
%G English
                
%X Background: Mobile health care (mHealth) apps are emerging worldwide as a vital component of internet health care, but there are issues, especially among older adults. Objective: We aim to investigate the factors influencing the intention to use (ITU) mHealth apps, focusing on those with and without prior mHealth experience. Methods: A cross-sectional study conducted from August 2022 to July 2023 included Thai citizens aged 45 years or older. Self-reported questionnaires collected data on sociodemographic information, health conditions, smartphone or tablet ownership, and mHealth usage experience. The Thai mHealth Senior Technology Acceptance Model questionnaires with a 10-point Likert scale evaluated mHealth acceptance. A multivariable logistic regression analysis, adjusted for age, gender, education, income, and living area, was performed for 2 subgroups: those who used ITU mHealth apps and those who did not. Results: Of 1100 participants, 537 (48.8%) intended to use mHealth apps, while 563 (51.2%) did not. The ITU group had a younger average age, higher education levels, higher income, and fewer underlying diseases compared to those who did not intend to use mHealth apps. For those who had never used mHealth apps, having a smartphone was strongly associated with higher odds of ITU (adjusted odds ratio 2.81, 95% CI 1.6 to 4.93; P<.001), while having any underlying disease was associated with lower odds of ITU (adjusted odds ratio 0.63, 95% CI 0.42 to 0.97; P=.034). Higher acceptance levels, characterized by a positive attitude toward mHealth and lower fear of making mistakes, were also associated with higher ITU. For those with prior mHealth experience, acceptance in areas such as perceived ease of use, gerontechnology anxiety, and facilitating conditions was significantly associated with ITU. Conclusions: Among inexperienced users, a positive attitude toward mHealth significantly enhanced ITU. Conversely, having an underlying disease decreased ITU, indicating a need for tailored mHealth apps. For experienced users, acceptance levels in areas such as ease of use and gerontechnology anxiety were crucial. Future research should explore specific mHealth apps for more targeted insights. 
%R 10.2196/63607
%U https://humanfactors.jmir.org/2025/1/e63607
%U https://doi.org/10.2196/63607

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e63482
%T Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review
%A Yew,Sheng Qian
%A Trivedi,Daksha
%A Adanan,Nurul Iman Hafizah
%A Chew,Boon How
%+ Centre for Research in Public Health and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertforshire, AL10 9AB, United Kingdom, 44 01707286389, d.trivedi@herts.ac.uk
%K digital health implementation
%K facilitators
%K barriers
%K digital health classification framework
%K lower- and middle-income countries
%D 2025

%7 6.3.2025
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons. Objective: To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs’ hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs. Methods: Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework. Results: Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs’ hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported. Conclusions: In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients. 
%M 40053793
%R 10.2196/63482
%U https://www.jmir.org/2025/1/e63482
%U https://doi.org/10.2196/63482
%U http://www.ncbi.nlm.nih.gov/pubmed/40053793

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e54921
%T Long-Term Experiences of Health Care Providers Using Iris Scanning as an Identification Tool in a Vaccine Trial in the Democratic Republic of the Congo: Qualitative Study
%A Zola Matuvanga,Trésor
%A Paviotti,Antea
%A Bikioli Bolombo,Freddy
%A Lemey,Gwen
%A Larivière,Ynke
%A Salloum,Maha
%A Isekah Osang'ir,Bernard
%A Esanga Longomo,Emmanuel
%A Milolo,Solange
%A Matangila,Junior
%A Maketa,Vivi
%A Mitashi,Patrick
%A Van Damme,Pierre
%A Muhindo-Mavoko,Hypolite
%A Van geertruyden,Jean-Pierre
%+ Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Avenue Université, N° 1, Commune de Lemba, Kinshasa, BP 834 KINSHASA XI, the Democratic Republic of the Congo, 243 810046306, zola.matuvanga@unikin.ac.cd
%K iris scan
%K vaccine trial
%K iris
%K perception
%K experience
%K views
%K biometric identification
%K Democratic Republic of the Congo
%D 2025

%7 6.3.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Iris scanning has increasingly been used for biometric identification over the past decade, with continuous advancements and expanding applications. To better understand the acceptability of this technology, we report the long-term experiences of health care providers and frontline worker participants with iris scanning as an identification tool in the EBL2007 Ebola vaccine trial conducted in the Democratic Republic of the Congo. Objective: This study aims to document the long-term experiences of using iris scanning for identity verification throughout the vaccine trial. Methods: Two years after the start of the EBL2007 vaccine trial (February to March 2022), 69 trial participants—including nurses, first aid workers, midwives, and community health workers—were interviewed through focus group discussions. Additionally, 13 in-depth individual interviews were conducted with physicians involved in the trial, iris scan operators, trial staff physicians, and trial participants who declined iris scanning. Qualitative content analysis was used to identify key themes. Results: Initially, interviewees widely accepted the iris scan and viewed it as a distinctive tool for identifying participants in the EBL2007 vaccine trial. However, over time, perceptions became less favorable. Some participants expressed concerns that their vision had diminished shortly after using the tool and continued to decline until the end of the study. Others reported experiencing perceived vision loss long after the trial had concluded. However, no vision impairment was reported as an adverse event or assessed in the trial as being linked to the iris scan, which uses a previously certified safe infrared light for scanning. Conclusions: Our findings highlight the sustained acceptability and perceived high accuracy of the iris scan tool for uniquely identifying adult participants in a vaccine trial over time. Continued efforts to systematically disseminate and reinforce information about the function and safety of this technology are essential. Clearly presenting iris scanning as a safe procedure could help dispel misconceptions, concerns, and perceived risks among potential users in vaccine trials. 
%M 40053756
%R 10.2196/54921
%U https://formative.jmir.org/2025/1/e54921
%U https://doi.org/10.2196/54921
%U http://www.ncbi.nlm.nih.gov/pubmed/40053756

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e68720
%T Natural Language Processing Technologies for Public Health in Africa: Scoping Review
%A Hu,Songbo
%A Oppong,Abigail
%A Mogo,Ebele
%A Collins,Charlotte
%A Occhini,Giulia
%A Barford,Anna
%A Korhonen,Anna
%+ , Language Technology Lab, University of Cambridge, English Faculty Building, 9 West Road, Cambridge, CB3 9DA, United Kingdom, 44 1223 335010, sh2091@cam.ac.uk
%K public health
%K global health
%K health promotion
%K essential public health functions
%K Africa
%K natural language processing
%K artificial intelligence
%K machine learning
%K technology
%K mobile phone
%D 2025

%7 5.3.2025
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Natural language processing (NLP) has the potential to promote public health. However, applying these technologies in African health systems faces challenges, including limited digital and computational resources to support the continent’s diverse languages and needs. Objective: This scoping review maps the evidence on NLP technologies for public health in Africa, addressing the following research questions: (1) What public health needs are being addressed by NLP technologies in Africa, and what unmet needs remain? (2) What factors influence the availability of public health NLP technologies across African countries and languages? (3) What stages of deployment have these technologies reached, and to what extent have they been integrated into health systems? (4) What measurable impact has these technologies had on public health outcomes, where such data are available? (5) What recommendations have been proposed to enhance the quality, cost, and accessibility of health-related NLP technologies in Africa? Methods: This scoping review includes academic studies published between January 1, 2013, and October 3, 2024. A systematic search was conducted across databases, including MEDLINE via PubMed, ACL Anthology, Scopus, IEEE Xplore, and ACM Digital Library, supplemented by gray literature searches. Data were extracted and the NLP technology functions were mapped to the World Health Organization’s list of essential public health functions and the United Nations’ sustainable development goals (SDGs). The extracted data were analyzed to identify trends, gaps, and areas for future research. This scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines, and its protocol is publicly available. Results: Of 2186 citations screened, 54 studies were included. While existing NLP technologies support a subset of essential public health functions and SDGs, language coverage remains uneven, with limited support for widely spoken African languages, such as Kiswahili, Yoruba, Igbo, and Zulu, and no support for most of Africa’s >2000 languages. Most technologies are in prototyping phases, with only one fully deployed chatbot addressing vaccine hesitancy. Evidence of measurable impact is limited, with 15% (8/54) studies attempting health-related evaluations and 4% (2/54) demonstrating positive public health outcomes, including improved participants’ mood and increased vaccine intentions. Recommendations include expanding language coverage, targeting local health needs, enhancing trust, integrating solutions into health systems, and adopting participatory design approaches. The gray literature reveals industry- and nongovernmental organizations–led projects focused on deployable NLP applications. However, these projects tend to support only a few major languages and specific use cases, indicating a narrower scope than academic research. Conclusions: Despite growth in NLP research for public health, major gaps remain in deployment, linguistic inclusivity, and health outcome evaluation. Future research should prioritize cross-sectoral and needs-based approaches that engage local communities, align with African health systems, and incorporate rigorous evaluations to enhance public health outcomes. International Registered Report Identifier (IRRID): RR2-doi:10.1101/2024.07.02.24309815 
%M 40053738
%R 10.2196/68720
%U https://www.jmir.org/2025/1/e68720
%U https://doi.org/10.2196/68720
%U http://www.ncbi.nlm.nih.gov/pubmed/40053738

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 13
%N 
%P e60811
%T Impact of a Mobile Money–Based Conditional Cash Transfer Intervention on Health Care Utilization in Southern Madagascar: Mixed-Methods Study
%A Franke,Mara Anna
%A Neumann,Anne
%A Nordmann,Kim
%A Suleymanova,Daniela
%A Ravololohanitra,Onja Gabrielle
%A Emmrich,Julius Valentin
%A Knauss,Samuel
%K cash transfer intervention
%K Madagascar
%K Sub-Saharan Africa
%K health care utilization
%K humanitarian assistance
%K Africa
%K mobile
%K mixed methods study
%K money
%K quantitative
%K qualitative
%K thematic analysis
%K policy
%K service
%K delivery
%K health care system
%K cash
%K economic
%K financial
%K payment
%K time series
%D 2025

%7 3.3.2025
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile money–based cash transfer interventions are becoming increasingly utilized, especially in humanitarian settings. southern Madagascar faced a humanitarian emergency in 2021-2022, when the second wave of the COVID-19 pandemic and a severe famine affected the fragile region simultaneously. Objective: This mixed-methods study aims to analyze the impact and factors influencing the success of a mobile money–based conditional cash transfer intervention for health care utilization at 4 primary and 11 secondary facilities in Madagascar. Methods: We obtained quantitative data from 11 facility registers, detailing patient numbers per month, categorized into maternity care, surgical care, pediatric care, outpatient care, and inpatient care. An interrupted time series analysis, without a control group, was conducted using the end of the intervention in July 2022 as the cut off point. For qualitative data, 64 in-depth interviews were conducted with health care providers, NGO staff, policymakers, beneficiaries, and nonbeneficiaries of the intervention, and was interpreted by 4 independent researchers using reflexive thematic analysis to identify facilitators and barriers to implementation. Results: The interrupted time series analysis showed a significant negative impact on health care utilization, indicating a reduction in health care–seeking behavior after the end of the cash transfer intervention. The effect was stronger in the slope change of patient numbers per month (defined as P<.05), which significantly decreased in 39 of 55 (70%) models compared to the step change at the end of the intervention, which showed a significant but lower change (P <.05) in 40% (22/55) of models. The changes were most pronounced in surgical and pediatric care. The key factors that influenced the success of the implementation were grouped across three levels. At the community level, outreach conducted to inform potential beneficiaries about the project by community health workers and using the radio was a decisive factor for success. At participating facilities, high intrinsic staff motivation and strong digital literacy among facility staff positively influenced the intervention. Confusion regarding previous activities by the same implementing NGO and perceptions of unfair bonus payments for health care providers included in the project negatively affected the intervention. Finally, at the NGO-level, the staff present at each facility and the speed and efficiency of administrative processes during the intervention were decisive factors that influenced the intervention. Conclusions: The conditional cash transfer intervention was overarchingly successful in increasing health care utilization in southern Madagascar in a humanitarian setting. However, this success was conditional on key implementation factors at the community, facility, and NGO levels. In the future, similar interventions should proactively consider the key factors identified in this study to optimize the impact. 
%R 10.2196/60811
%U https://mhealth.jmir.org/2025/1/e60811
%U https://doi.org/10.2196/60811

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e58841
%T Challenges to Rehabilitation Services in Sub-Saharan Africa From a User, Health System, and Service Provider Perspective: Scoping Review
%A Cyuzuzo,Callixte
%A Dukuzimana,Marie Josee
%A Muhire,Clement
%A Sheldon Ames,Mathew
%A Ngwakongnwi,Emmanuel
%K challenges
%K users
%K health system
%K service providers
%K Sub-Saharan Africa
%K scoping review
%K rehabilitation service
%D 2025

%7 28.2.2025
%9 
%J JMIR Hum Factors
%G English
                
%X Background: Rehabilitation aims to restore and optimize the functioning of impaired systems for people with disabilities. It is an integral part of universal health coverage, and access to it is a human right. Objective: We aimed to identify the key challenges to rehabilitation services in Sub-Saharan Africa from a user, health system, and service provider perspective. Methods: This scoping review was conducted in accordance with the 5-stage framework proposed by Arksey and O’Malley. A comprehensive electronic search was run to identify published articles on rehabilitation services in Sub-Saharan Africa. Of the 131 articles retrieved, 83 articles were assessed for eligibility and 15 papers that met the inclusion criteria were considered. Results: The results show that people with disabilities in Sub-Saharan Africa face multifactorial challenges to access rehabilitation services. Poor access to rehabilitation services is associated with less attention given to rehabilitation by governments, which leads to less funding, negative cultural and social beliefs, fewer rehabilitation centers, poorly equipped rehabilitation units, failure of health systems, lack of training to rehabilitation practitioners, and logistical and financial constraints. This review also reveals that digital rehabilitation reduces costs and improves access to services in hard-to-reach geographical areas. However, digital rehabilitation faces challenges as well, including connectivity issues, inaccessibility to technology, a lack of technical knowledge, a lack of privacy, and ethical concerns. Conclusions: People with disabilities face multifactorial challenges to access rehabilitation services in Sub-Saharan Africa. It is therefore critical to address these challenges to optimize patients’ health outcomes and offer better rehabilitation services. 
%R 10.2196/58841
%U https://humanfactors.jmir.org/2025/1/e58841
%U https://doi.org/10.2196/58841

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 11
%N 
%P e63309
%T Exploring the Use of Digital Educational Tools for Sexual and Reproductive Health in Sub-Saharan Africa: Systematic Review
%A Abdul Hamid Alhassan,Ramatu Hajia
%A Haggerty,Catherine L
%A Fapohunda,Abimbola
%A Affan,Nabeeha Jabir
%A Anto-Ocrah,Martina
%+ Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Pittsburgh, PA, 15213, United States, 1 000 000 0000, maa509@pitt.edu
%K digital health
%K adolescents
%K Africa
%K sexual health
%K reproductive health
%K human-centered design
%D 2025

%7 26.2.2025
%9 Review
%J JMIR Public Health Surveill
%G English
                
%X Background: Adolescents, particularly those in Sub-Saharan Africa, experience major challenges in getting accurate and comprehensive sexual and reproductive health (SRH) information because of sociocultural norms, stigma, and limited SRH educational resources. Digital educational tools, leveraging the widespread use of mobile phones and internet connectivity, present a promising avenue to overcome these barriers and enhance SRH education among adolescents in Sub-Saharan Africa. Objective: We conducted a systematic review to describe (1) the geographic and demographic distributions (designated objectives 1a and 1b, respectively, given their interrelatedness) and (2) the types and relevant impacts of digital educational tools (objective 2). Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using databases, such as Ovid-MEDLINE, Google Scholar, PubMed, and ERIC, to conduct literature searches. The selection criteria focused on studies that specifically addressed digital educational tools used to assess or deliver SRH education, their implementation, and their effectiveness among the adolescent population in Sub-Saharan Africa. We used the JBI critical appraisal tools for the quality assessment of papers included in the review. Results: The review identified 22 studies across Sub-Saharan Africa that met the inclusion criteria. The 22 studies spanned populations in West, Central, East, and South Africa, with an emphasis on youth and adolescents aged 10-24 years, reflecting the critical importance of reaching these age groups with effective, accessible, and engaging health education (objectives 1a and 1b). There was a diverse range of digital tools used, including social media platforms, mobile apps, and gamified learning experiences, for a broad age range of adolescent youth. These methods were generally successful in engaging adolescents by providing them with accessible and relevant SRH information (objective 2). However, challenges, such as the digital divide, the cultural sensitivity of the material, and the necessity for a thorough examination of the long-term influence of these tools on behavior modification, were noted. Conclusions: Digital educational tools provide great potential to improve SRH education among adolescents in Sub-Saharan Africa. These technologies can help enhance relevant health outcomes and accessibility by delivering information that is easy to understand, interesting, and tailored to their needs. Future research should focus on addressing the identified challenges, including bridging the digital divide, ensuring cultural and contextual relevance of content, and assessing the long-term impact of digital SRH education on adolescent behavior and health outcomes. Policymakers and educators are encouraged to integrate digital tools into SRH educational strategies that target adolescents in order to improve the SRH of this age group and contribute to improving public health in Sub-Saharan Africa. 
%M 40009849
%R 10.2196/63309
%U https://publichealth.jmir.org/2025/1/e63309
%U https://doi.org/10.2196/63309
%U http://www.ncbi.nlm.nih.gov/pubmed/40009849

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e63364
%T A Health Professional Mentorship Platform to Improve Equitable Access to Abortion: Development, Usability, and Content Evaluation
%A Abdulai,Abdul-Fatawu
%A Duong,Cam
%A Stroulia,Eleni
%A Czerniak,Efrat
%A Chiu,Rachel
%A Mehta,Aashay
%A Koike,Ken
%A Norman,Wendy V
%K medication abortion
%K mifepristone
%K web-based platform
%K user-centered design
%K underserved populations
%K abortion
%K equitable
%K accessibility
%K open-access website
%K gender-affirming
%K user-centered
%K Canada
%K unwanted pregnancy
%K framework
%D 2025

%7 19.2.2025
%9 
%J JMIR Hum Factors
%G English
                
%X Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are overrepresented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help health care and allied helping professionals provide culturally competent and gender-affirming abortion care to such a population group. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations. Methods: We drew on a user-centered design framework to redesign the web platform in 5 iterative phases. Health care and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, review of the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) web-based platform containing comprehensive information and resources on abortion care for health care providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip health care professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of health care professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to accessing care. 
%R 10.2196/63364
%U https://humanfactors.jmir.org/2025/1/e63364
%U https://doi.org/10.2196/63364

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e67452
%T Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study
%A Shamebo,Dessalegn
%A Derseh Mebratie,Anagaw
%A Arsenault,Catherine
%+ Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 2029941011, catherine.arsenault@gwu.edu
%K mobile phone surveys
%K patient satisfaction
%K interactive voice response
%K global health
%K surveys
%K Ethiopia
%K IVR
%K Africa
%D 2025

%7 13.2.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys. Objective: In this study, we tested the feasibility of using an IVR system to assess patient satisfaction with primary care services in Addis Ababa, Ethiopia. We described the methodology, response rates, and survey costs and identified factors associated with survey participation, completion, and duration. Methods: Patients were recruited in person from 18 public and private health facilities in Addis Ababa. Patients’ sex, age, education, reasons for seeking care, and mobile phone numbers were collected. The survey included 15 questions that respondents answered using their phone keypad. We used a Heckman probit regression model to identify factors influencing the likelihood of IVR survey participation (picking up and answering at least 1 question) and completion (answering all survey questions) and a Weibull regression model to identify factors influencing the survey completion time. Results: A total of 3403 individuals were approached across 18 health facilities. Nearly all eligible patients approached (2985/3167, 94.3%) had a functioning mobile phone, and 89.9% (2415/2685) of those eligible agreed to be enrolled in the study. Overall, 92.6% (2236/2415) picked up the call, 65.6% (1584/2415) answered at least 1 survey question, and 42.9% (1037/2415) completed the full survey. The average survey completion time was 8.1 (SD 1.7) minutes for 15 Likert-scale questions. We found that those aged 40-49 years and those aged 50+ years were substantially less likely to participate in (odds ratio 0.63, 95% CI 0.53-0.74) and complete the IVR survey (odds ratio 0.77, 95% CI 0.65-0.90) compared to those aged 18-30 years. Higher education levels were also strongly associated with survey participation and completion. In adjusted models, those enrolled in private facilities were less likely to participate and complete the survey compared to those in public health centers. Being male, younger, speaking Amharic, using a private hospital, and being called after 8 PM were associated with a shorter survey duration. The average survey costs were US $7.90 per completed survey. Conclusions: Our findings reveal that an IVR survey is a feasible, low-cost, and rapid solution to assess patient satisfaction in an urban context in Ethiopia. However, survey implementation must be carefully planned and tailored to local challenges. Governments and health facilities should consider IVR to routinely collect patient satisfaction data to inform quality improvement strategies. 
%R 10.2196/67452
%U https://formative.jmir.org/2025/1/e67452
%U https://doi.org/10.2196/67452

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e66702
%T A Comparison of Mobile Social Media Promotion and Volunteer-Driven Strategies for Community Organizations Recruiting Men Who Have Sex with Men for HIV Testing in Zhejiang Province, China: Cross-Sectional Study Based on a Large-Scale Survey
%A He,Lin
%A Jiang,Shaoqiang
%A Jiang,Tingting
%A Chen,Wanjun
%A Zheng,Jinlei
%A Wang,Hui
%A Chai,Chengliang
%+ , Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou, 310051, China, 86 87115193, chlchai@cdc.zj.cn
%K men who have sex with men
%K MSM
%K internet
%K recruit
%K HIV testing
%K community organization
%K strategy
%K China
%K mobile phone
%D 2025

%7 13.2.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: China has recently implemented a strategy to promote and facilitate community organization involvement in HIV prevention among men who have sex with men (MSM). Although community-based strategies have been shown to increase HIV testing uptake, the relative effectiveness of mobile social media promotion compared with volunteer-driven recruitment remains underexplored. Limited research has investigated how these strategies differentially affect MSM who have not undergone previous HIV testing. Objective: This study aimed to compare the differences between a mobile social media promotion strategy and a volunteer-driven strategy for community organizations to recruit MSM for HIV testing. Methods: A cross-sectional study was conducted from July to December 2023 among MSM in Zhejiang Province, China. Participants aged 16 years with an HIV-negative or unknown status were recruited either through a mobile social media promotion strategy or through a volunteer-driven strategy by a community organization. They completed a questionnaire that collected information on demographics, sexual behavior, and HIV testing history. All participants were tested for HIV after completing the questionnaire. A multivariate logistic regression model was used to identify factors associated with recruitment through mobile social media promotion. Results: The study included 4600 MSM, of whom 3035 (66%) were recruited through the mobile social media strategy. Overall, 1.4% (66/4600) of participants tested positive for HIV, and 18.8% (865/4600) underwent HIV testing for the first time. Recruitment via the mobile social media promotion strategy was significantly associated with several factors: having only gay sexual partners (adjusted OR [aOR] 1.23, 95% CI 1.05-1.45), having more than 2 sexual partners in the past 3 months (aOR 1.74, 95% CI 1.42-2.11), frequently using rush poppers during sex (aOR 1.39, 95% CI 1.14-1.99), having a history of sexually transmitted infections (aOR 1.56, 95% CI 1.02-2.39), having awareness of pre-exposure prophylaxis (aOR 1.42, 95% CI 1.19-1.71), having awareness of postexposure prophylaxis (PEP; aOR 1.49, 95% CI 1.24-1.79), using mail-in HIV self-testing kits (aOR 2.02, 95% CI 1.77-2.31), testing HIV-positive (aOR 2.02, 95% CI 1.10-3.72), and first-time HIV testing (aOR 1.28, 95% CI 1.09-1.52). Conclusions: Community organizations play a critical role in expanding HIV testing and identifying undiagnosed individuals infected with HIV. Compared to the volunteer-driven outreach, mobile social media promotion strategies had a higher proportion of first-time testers and a higher rate of HIV positivity. We recommend prioritizing mobile social media strategies in regions with limited LGBTQ+ organizations or HIV health services to increase HIV testing coverage and interventions among MSM. 
%M 39946712
%R 10.2196/66702
%U https://www.jmir.org/2025/1/e66702
%U https://doi.org/10.2196/66702
%U http://www.ncbi.nlm.nih.gov/pubmed/39946712

%0 Journal Article
        
%@ 2373-6658
%I JMIR Publications
%V 9
%N 
%P e66852
%T Evaluating the Quality, Content Accuracy, and User Suitability of mHealth Prenatal Care Apps for Expectant Mothers: Critical Assessment Study
%A Asadollahi,Fateme
%A Ebrahimzadeh Zagami,Samira
%A Eslami,Saeid
%A Latifnejad Roudsari,Robab
%+ Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Qarashi Building, Central Office of the University, Daneshgah Street, Mashhad, 91388-13944, Iran, 98 9370400607, rlatifnejad@yahoo.com
%K pregnancy
%K prenatal care
%K mobile health apps
%K mHealth
%K women’s health
%K health care providers
%K quality assessment
%K content evaluation
%K suitability assessment
%K digital health
%K smartphones
%K eHealth
%K telehealth
%K telemedicine
%K health promotion
%K technology
%K functionality
%K systematic search
%D 2025

%7 13.2.2025
%9 Original Paper
%J Asian Pac Isl Nurs J
%G English
                
%X Background: The proliferation of health apps in the digital health landscape has created significant opportunities for health promotion, particularly during pregnancy. However, despite the widespread distribution and popularity of pregnancy mobile apps, there are limited data on their quality and content. Objective: This study aimed to evaluate the quality, content accuracy, and suitability of the most popular and freely available Persian mobile health (mHealth) apps for prenatal care in expectant mothers. Methods: Through a systematic search, a total of 199 apps were screened from available app stores using the search term “pregnancy app” until July 2023. Inclusion criteria were apps in the Farsi language, freely available, downloaded more than 10,000 times, and designed for pregnant women. Ultimately, 9 apps met these criteria. These apps were downloaded onto mobile phones and assessed by 2 independent reviewers using the Mobile App Rating Scale (MARS), the Coverage and Depth of Information Checklist, and the Suitability Assessment of Materials (SAM). Statistical analyses explored relationships between app quality metrics and user ratings. Results: The 9 apps evaluated had an average MARS score of 3.55 (SD 0.61) out of 5. Aesthetics (mean 4.02, SD 0.45) and Functionality (mean 4.11, SD 0.36) scored the highest, followed by Engagement (mean 3.29, SD 0.53) and Information (mean 3.09, SD 0.48). User star ratings did not strongly correlate with MARS scores (r=0.38, P>.05). Regarding health information coverage, 6 out of 9 (66.7%) apps were rated as poor, and 3 (33.3%) as adequate. For SAM, 4 (44.4%) apps were rated as superior and 5 (55.6%) as adequate. No app received a poor score. Conclusions: The study underscores the need for improved standards in pregnancy app development to enhance educational efficacy and user satisfaction. Health care providers should recommend high-quality pregnancy apps with appropriate content to ensure effective health promotion. These findings contribute to understanding the current landscape of pregnancy apps and highlight areas for future research and regulatory attention. Trial Registration: PROSPERO CRD42023461605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=461605 
%M 39946714
%R 10.2196/66852
%U https://apinj.jmir.org/2025/1/e66852
%U https://doi.org/10.2196/66852
%U http://www.ncbi.nlm.nih.gov/pubmed/39946714

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 13
%N 
%P e58858
%T Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned
%A Muliokela,Rosemary K
%A Banda,Kuwani
%A Hussen,Abdulaziz Mohammed
%A Malumo,Sarai Bvulani
%A Kashoka,Andrew
%A Mwiche,Angel
%A Chiboma,Innocent
%A Barreix,Maria
%A Nyirenda,Muyereka
%A Sithole,Zvanaka
%A Ratanaprayul,Natschja
%A Endehabtu,Berhanu Fikadie
%A Telake,Hanna Abayneh
%A Weldeab,Adane
%A Probert,William J M
%A Tunçalp,Ӧzge
%A Maya,Ernest
%A Woldetsadik,Mulatu
%A Tilahun,Binyam
%A Guure,Chris
%A Senya,Kafui
%A Say,Lale
%A Tamrat,Tigest
%K guidelines
%K reproductive health
%K maternal health
%K antenatal care
%K clinical decision support
%K clinical decision support systems
%K digital health
%K HIV/AIDS
%K family planning
%K electronic medical records
%K electronic health record
%K standards
%K interoperability
%K system uptake
%K digital health governance
%D 2025

%7 7.2.2025
%9 
%J JMIR Med Inform
%G English
                
%X Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. 
%R 10.2196/58858
%U https://medinform.jmir.org/2025/1/e58858
%U https://doi.org/10.2196/58858

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e53483
%T Status of Digital Health Technology Adoption in 5 Vietnamese Hospitals: Cross-Sectional Assessment
%A Tran,Duc Minh
%A Thanh Dung,Nguyen
%A Minh Duc,Chau
%A Ngoc Hon,Huynh
%A Minh Khoi,Le
%A Phuc Hau,Nguyen
%A Thi Thu Huyen,Duong
%A Thi Le Thu,Huynh
%A Van Duc,Tran
%A ,
%A Minh Yen,Lam
%A Thwaites,C Louise
%A Paton,Chris
%+ Oxford University Clinical Research Unit, 764 Vo Van Kiet Street, Ward 1, District 5, Ho Chi Minh City, Vietnam, 84 2839237954, ductm@oucru.org
%K electronic health record
%K electronic medical record
%K digital maturity
%K clinical decision support
%K digital infrastructure
%K Vietnam
%K health information technology
%K digital health technology
%K low- and middle-income country
%D 2025

%7 6.2.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Digital health technologies (DHTs) have been recognized as a key solution to help countries, especially those in the low- and middle-income group, to achieve the Sustainable Development Goals (SDGs) and the World Health Organization’s (WHO) Triple Billion Targets. In hospital settings, DHTs need to be designed and implemented, considering the local context, to achieve usability and sustainability. As projects such as the Vietnam ICU Translational Applications Laboratory are seeking to integrate new digital technologies in the Vietnamese critical care settings, it is important to understand the current status of DHT adoption in Vietnamese hospitals. Objective: We aimed to explore the current digital maturity in 5 Vietnamese public hospitals to understand their readiness in implementing new DHTs. Methods: We assessed the adoption of some key DHTs and infrastructure in 5 top-tier public hospitals in Vietnam using a questionnaire adapted from the Vietnam Health Information Technology (HIT) Maturity Model. The questionnaire was answered by the heads of the hospitals’ IT departments, with follow-up for clarifications and verifications on some answers. Descriptive statistics demonstrated on radar plots and tile graphs were used to visualize the data collected. Results: Hospital information systems (HIS), laboratory information systems (LIS), and radiology information systems–picture archiving and communication systems (RIS-PACS) were implemented in all 5 hospitals, albeit at varied digital maturity levels. At least 50% of the criteria for LIS in the Vietnam HIT Maturity Model were satisfied by the hospitals in the assessment. However, this threshold was only met by 80% and 60% of the hospitals with regard to HIS and RIS-PACS, respectively. Two hospitals were not using any electronic medical record (EMR) system or fulfilling any extra digital capability, such as implementing clinical data repositories (CDRs) and clinical decision support systems (CDSS). No hospital reported sharing clinical data with other organizations using Health Level Seven (HL7) standards, such as Continuity of Care Document (CCD) and Clinical Document Architecture (CDA), although 2 (40%) reported their systems adopted these standards. Of the 5 hospitals, 4 (80%) reported their RIS-PACS adopted the Digital Imaging and Communications in Medicine (DICOM) standard. Conclusions: The 5 major Vietnamese public hospitals in this assessment have widely adopted information systems, such as HIS, LIS, and RIS-PACS, to support administrative and clinical tasks. Although the adoption of EMR systems is less common, their implementation revolves around data collection, management, and access to clinical data. Secondary use of clinical data for decision support through the implementation of CDRs and CDSS is limited, posing a potential barrier to the integration of external DHTs into the existing systems. However, the wide adoption of international standards, such as HL7 and DICOM, is a facilitator for the adoption of new DHTs in these hospitals. 
%M 39913927
%R 10.2196/53483
%U https://formative.jmir.org/2025/1/e53483
%U https://doi.org/10.2196/53483
%U http://www.ncbi.nlm.nih.gov/pubmed/39913927

%0 Journal Article
        
%@ 2369-1999
%I JMIR Publications
%V 11
%N 
%P e50124
%T Barriers and Facilitators to the Preadoption of a Computer-Aided Diagnosis Tool for Cervical Cancer: Qualitative Study on Health Care Providers’ Perspectives in Western Cameroon
%A Jonnalagedda-Cattin,Magali
%A Moukam Datchoua,Alida Manoëla
%A Yakam,Virginie Flore
%A Kenfack,Bruno
%A Petignat,Patrick
%A Thiran,Jean-Philippe
%A Schönenberger,Klaus
%A Schmidt,Nicole C
%+ Signal Processing Laboratory LTS5, Swiss Federal Institute of Technology Lausanne (EPFL), EPFL-STI-IEL-LTS5, Station 11, Lausanne, 1015, Switzerland, 41 21 693 97 77, magali.cattin@epfl.ch
%K qualitative research
%K technology acceptance
%K cervical cancer
%K diagnosis
%K computer-assisted
%K decision support systems
%K artificial intelligence
%K health personnel attitudes
%K Cameroon
%K mobile phone
%D 2025

%7 5.2.2025
%9 Original Paper
%J JMIR Cancer
%G English
                
%X Background: Computer-aided detection and diagnosis (CAD) systems can enhance the objectivity of visual inspection with acetic acid (VIA), which is widely used in low- and middle-income countries (LMICs) for cervical cancer detection. VIA’s reliance on subjective health care provider (HCP) interpretation introduces variability in diagnostic accuracy. CAD tools can address some limitations; nonetheless, understanding the contextual factors affecting CAD integration is essential for effective adoption and sustained use, particularly in resource-constrained settings. Objective: This study investigated the barriers and facilitators perceived by HCPs in Western Cameroon regarding sustained CAD tool use for cervical cancer detection using VIA. The aim was to guide smooth technology adoption in similar settings by identifying specific barriers and facilitators and optimizing CAD’s potential benefits while minimizing obstacles. Methods: The perspectives of HCPs on adopting CAD for VIA were explored using a qualitative methodology. The study participants included 8 HCPs (6 midwives and 2 gynecologists) working in the Dschang district, Cameroon. Focus group discussions were conducted with midwives, while individual interviews were conducted with gynecologists to comprehend unique perspectives. Each interview was audio-recorded, transcribed, and independently coded by 2 researchers using the ATLAS.ti (Lumivero, LLC) software. The technology acceptance lifecycle framework guided the content analysis, focusing on the preadoption phases to examine the perceived acceptability and initial acceptance of the CAD tool in clinical workflows. The study findings were reported adhering to the COREQ (Consolidated Criteria for Reporting Qualitative Research) and SRQR (Standards for Reporting Qualitative Research) checklists. Results: Key elements influencing the sustained use of CAD tools for VIA by HCPs were identified, primarily within the technology acceptance lifecycle’s preadoption framework. Barriers included the system’s ease of use, particularly challenges associated with image acquisition, concerns over confidentiality and data security, limited infrastructure and resources such as the internet and device quality, and potential workflow changes. Facilitators encompassed the perceived improved patient care, the potential for enhanced diagnostic accuracy, and the integration of CAD tools into routine clinical practices, provided that infrastructure and training were adequate. The HCPs emphasized the importance of clinical validation, usability testing, and iterative feedback mechanisms to build trust in the CAD tool’s accuracy and utility. Conclusions: This study provides practical insights from HCPs in Western Cameroon regarding the adoption of CAD tools for VIA in clinical settings. CAD technology can aid diagnostic objectivity; however, data management, workflow adaptation, and infrastructure limitations must be addressed to avoid “pilotitis”—the failure of digital health tools to progress beyond the pilot phase. Effective implementation requires comprehensive technology management, including regulatory compliance, infrastructure support, and user-focused training. Involving end users can ensure that CAD tools are fully integrated and embraced in LMICs to aid cervical cancer screening. 
%M 39908553
%R 10.2196/50124
%U https://cancer.jmir.org/2025/1/e50124
%U https://doi.org/10.2196/50124
%U http://www.ncbi.nlm.nih.gov/pubmed/39908553

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e58338
%T Challenges and Opportunities for Data Sharing Related to Artificial Intelligence Tools in Health Care in Low- and Middle-Income Countries: Systematic Review and Case Study From Thailand
%A Kaushik,Aprajita
%A Barcellona,Capucine
%A Mandyam,Nikita Kanumoory
%A Tan,Si Ying
%A Tromp,Jasper
%+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 6516 4988, jasper_tromp@nus.edu.sg
%K artificial intelligence
%K data sharing
%K health care
%K low- and middle-income countries
%K AI tools
%K systematic review
%K case study
%K Thailand
%K computing machinery
%K academic experts
%K technology developers
%K health care providers
%K internet connectivity
%K data systems
%K low health data literacy
%K cybersecurity
%K standardized data formats
%K AI development
%K PRISMA
%D 2025

%7 4.2.2025
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Health care systems in low- and middle-income countries (LMICs) can greatly benefit from artificial intelligence (AI) interventions in various use cases such as diagnostics, treatment, and public health monitoring but face significant challenges in sharing data for developing and deploying AI in health care. Objective: This study aimed to identify barriers and enablers to data sharing for AI in health care in LMICs and to test the relevance of these in a local context. Methods: First, we conducted a systematic literature search using PubMed, SCOPUS, Embase, Web of Science, and ACM using controlled vocabulary. Primary research studies, perspectives, policy landscape analyses, and commentaries performed in or involving an LMIC context were included. Studies that lacked a clear connection to health information exchange systems or were not reported in English were excluded from the review. Two reviewers independently screened titles and abstracts of the included articles and critically appraised each study. All identified barriers and enablers were classified according to 7 categories as per the predefined framework—technical, motivational, economic, political, legal and policy, ethical, social, organisational, and managerial. Second, we tested the local relevance of barriers and enablers in Thailand through stakeholder interviews with 15 academic experts, technology developers, regulators, policy makers, and health care providers. The interviewers took notes and analyzed data using framework analysis. Coding procedures were standardized to enhance the reliability of our approach. Coded data were reverified and themes were readjusted where necessary to avoid researcher bias. Results: We identified 22 studies, the majority of which were conducted across Africa (n=12, 55%) and Asia (n=6, 27%). The most important data-sharing challenges were unreliable internet connectivity, lack of equipment, poor staff and management motivation, uneven resource distribution, and ethical concerns. Possible solutions included improving IT infrastructure, enhancing funding, introducing user-friendly software, and incentivizing health care organizations and personnel to share data for AI-related tools. In Thailand, inconsistent data systems, limited staff time, low health data literacy, complex and unclear policies, and cybersecurity issues were important data-sharing challenges. Key solutions included building a conducive digital ecosystem—having shared data input platforms for health facilities to ensure data uniformity and to develop easy-to-understand consent forms, having standardized guidelines for data sharing, and having compensation policies for data breach victims. Conclusions: Although AI in LMICs has the potential to overcome health inequalities, these countries face technical, political, legal, policy, and organizational barriers to sharing data, which impede effective AI development and deployment. When tested in a local context, most of these barriers were relevant. Although our findings might not be generalizable to other contexts, this study can be used by LMICs as a framework to identify barriers and strengths within their health care systems and devise localized solutions for enhanced data sharing. Trial Registration: PROSPERO CRD42022360644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=360644 
%M 39903508
%R 10.2196/58338
%U https://www.jmir.org/2025/1/e58338
%U https://doi.org/10.2196/58338
%U http://www.ncbi.nlm.nih.gov/pubmed/39903508

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e66132
%T Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study
%A Puttkammer,Nancy
%A Dunbar,Elizabeth
%A Germanovych,Myroslava
%A Rosol,Mariia
%A Golden,Matthew
%A Hubashova,Anna
%A Fedorchenko,Vladyslav
%A Hetman,Larisa
%A Legkostup,Liudmyla
%A Flowers,Jan
%A Nesterova,Olena
%+ Digital Initiatives Group at I-TECH, Department of Global Health, University of Washington, 325 Ninth Ave, Box # 359932, Seattle, WA, 98104, United States, 1 206 898 5892, nputt@uw.edu
%K human-centered design
%K mobile health
%K mHealth
%K Ukraine
%K HIV testing
%K war and humanitarian settings
%D 2025

%7 30.1.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)–Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking. Objective: The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability. Methods: This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study’s formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative  HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients. Results: The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine’s wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload. Conclusions: It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing. 
%M 39883930
%R 10.2196/66132
%U https://formative.jmir.org/2025/1/e66132
%U https://doi.org/10.2196/66132
%U http://www.ncbi.nlm.nih.gov/pubmed/39883930

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 11
%N 
%P e56820
%T Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach
%A Januraga,Pande Putu
%A Lukitosari,Endang
%A Luhukay,Lanny
%A Hasby,Rizky
%A Sutrisna,Aang
%+ Center for Public Health Innovation, Faculty of Medicine, Udayana University, Jl PB Sudirman, Denpasar, 80232, Indonesia, 62 81246180389, januraga@unud.ac.id
%K Indonesia
%K key population
%K mapping
%K pandemic
%K HIV
%K AIDS
%K hotspot
%D 2025

%7 30.1.2025
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Indonesia’s vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting interventions and allocating resources to address the changing dynamics of the epidemic. Objective: We examine the 2022 mapping of Indonesia’s KPs to develop improved HIV and AIDS interventions. Methods: In 2022, a district-based mapping of KPs was conducted across 201 districts and cities chosen for their HIV program intensity. This multiphase process included participatory workshops for hotspot identification, followed by direct hotspot observation, then followed by a second direct observation in selected hotspots for quality control. Data from 49,346 informants (KPs) were collected and analyzed. The results from individual hotspots were aggregated at the district or city level, and a formula was used to estimate the population size. Results: The mapping initiative identified 18,339 hotspots across 201 districts and cities, revealing substantial disparities in hotspot distribution. Of the 18,339 hotspots, 16,964 (92.5%) were observed, of which 1822 (10.74%) underwent a second review to enhance data accuracy. The findings mostly aligned with local stakeholders’ estimates, but showed a lower median. Interviews indicated a shift in KP dynamics, with a median decline in hotspot attendance since the pandemic, and there was notable variation in mapping results across district categories. In “comprehensive” areas, the average results for men who have sex with men (MSM), people who inject drugs, transgender women, and female sex workers (FSWs) were 1008 (median 694, IQR 317-1367), 224 (median 114, IQR 59-202), 196 (median 167, IQR 81-265), and 775 (median 573, IQR 352-1131), respectively. “Medium” areas had lower averages: MSM at 381 (median 199, IQR 91-454), people who inject drugs at 51 (median 54, IQR 15-63), transgender women at 101 (median 55, IQR 29-127), and FSWs at 304 (median 231, IQR 118-425). “Basic” areas showed the lowest averages: MSM at 161 (median 73, IQR 49-285), people who inject drugs at 7 (median 7, IQR 7-7), transgender women at 59 (median 26, IQR 12-60), and FSWs at 161 (median 131, IQR 59-188). Comparisons with ongoing outreach programs revealed substantial differences: the mapped MSM population was >50% lower than program coverage; the estimates for people who inject drugs were twice as high as the program coverage. Conclusions: The mapping results highlight significant variations in hotspots and KPs across districts and cities and underscore the necessity of adaptive HIV prevention strategies. The findings informed programmatic decisions, such as reallocating resources to underserved districts and recalibrating outreach strategies to better match KP dynamics. Developing strategies beyond identified hotspots, integrating mapping data into planning, and adopting a longitudinal approach to understand KP behavior over time are critical for effective HIV and AIDS prevention and control. 
%M 39883483
%R 10.2196/56820
%U https://publichealth.jmir.org/2025/1/e56820
%U https://doi.org/10.2196/56820
%U http://www.ncbi.nlm.nih.gov/pubmed/39883483

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e59916
%T The Application of Machine Learning Algorithms to Predict HIV Testing in Repeated Adult Population–Based Surveys in South Africa: Protocol for a Multiwave Cross-Sectional Analysis
%A Jaiteh,Musa
%A Phalane,Edith
%A Shiferaw,Yegnanew A
%A Phaswana-Mafuya,Refilwe Nancy
%+ South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, Faculty of Health Sciences, University of Johannesburg, 40 Bunting Road, Auckland Park, Johannesburg, 2092, South Africa, 27 791850627, mjaiteh1993@gmail.com
%K predictive modelling
%K testing
%K support vector machines
%K random forest
%K supervised machine learning
%K decision trees
%K adult
%K population-based
%K South Africa
%K protocol
%K HIV/AIDS
%K HIV testing
%K retrospective analysis
%K cross-sectional survey
%K chi-square test
%K logistic regression
%K public health
%K epidemiology
%K infectious disease
%D 2025

%7 27.1.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: HIV testing is the cornerstone of HIV prevention and a pivotal step in realizing the Joint United Nations Program on HIV/AIDS (UNAIDS) goal of ending AIDS by 2030. Despite the availability of relevant survey data, there exists a research gap in using machine learning (ML) to analyze and predict HIV testing among adults in South Africa. Further investigation is needed to bridge this knowledge gap and inform evidence-based interventions to improve HIV testing. Objective: This study aims to determine consistent predictors of HIV testing by applying supervised ML algorithms in repeated adult population-based surveys in South Africa. Methods: A retrospective analysis of multiwave cross-sectional survey data will be conducted to determine the predictors of HIV testing among South African adults aged 18 years and older. A supervised ML technique will be applied across the five cycles of the South African National HIV Prevalence, Incidence, Behavior, and Communication Survey (SABSSM) surveys. The Human Science Research Council (HSRC) conducted the SABSSM surveys in 2002, 2005, 2008, 2012, and 2017. The available SABSSM datasets will be imported to RStudio (version 4.3.2; Posit Software, PBC) to clean and remove outliers. A chi-square test will be conducted to select important predictors of HIV testing. Each dataset will be split into 80% training and 20% test samples. Logistic regression, support vector machines, random forests, and decision trees will be used. A cross-validation technique will be used to divide the training sample into k-folds, including a validation set, and models will be trained on each fold. The models’ performance will be evaluated on the validation set using evaluation metrics such as accuracy, precision, recall, F1-score, area under curve-receiver operating characteristics, and confusion matrix. Results: The SABSSM datasets are open access datasets available on the HSRC database. Ethics approval for this study was obtained from the University of Johannesburg Research and Ethics Committee on April 23, 2024 (REC-2725-2024). The authors were given access to all five SABSSM datasets by the HSRC on August 20, 2024. The datasets were explored to identify the independent variables likely influencing HIV testing uptake. The findings of this study will determine consistent variables predicting HIV testing uptake among the South African adult population over the course of 20 years. Furthermore, this study will evaluate and compare the performance metrics of the 4 different ML algorithms, and the best model will be used to develop an HIV testing predictive model. Conclusions: This study will contribute to existing knowledge and deepen understanding of factors linked to HIV testing beyond traditional methods. Consequently, the findings would inform evidence-based policy recommendations that can guide policy makers to formulate more effective and targeted public health approaches toward strengthening HIV testing. International Registered Report Identifier (IRRID): DERR1-10.2196/59916 
%M 39870368
%R 10.2196/59916
%U https://www.researchprotocols.org/2025/1/e59916
%U https://doi.org/10.2196/59916
%U http://www.ncbi.nlm.nih.gov/pubmed/39870368

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e60843
%T Characterizing Telehealth Barriers and Preferences to Promote Acceptable Implementation Strategies in Central Uganda: Multilevel Formative Evaluation
%A Kizito,Michael
%A Mugabi,Erina Nabunjo
%A Ford,Sabrina
%A Holtz,Bree
%A Hirko,Kelly
%K telehealth
%K telemedicine
%K health care
%K disparities
%K technology
%K barriers
%K resource-limited
%K preferences
%K Uganda
%K Africa
%K barrier
%K formative evaluation
%K health service provider
%K primary care
%K satisfaction
%K Sub-Saharan Africa
%K survey
%K utility
%D 2025

%7 23.1.2025
%9 
%J JMIR Form Res
%G English
                
%X Background: Telehealth approaches can address health care access barriers and improve care delivery in resource-limited settings around the globe. Yet, telehealth adoption in Africa has been limited, due in part to an insufficient understanding of effective strategies for implementation. Objective: This study aimed to conduct a multi-level formative evaluation identifying barriers and facilitators for implementing telehealth among health service providers and patients in Central Uganda. Methods: We collected surveys characterizing telehealth perceptions, barriers, and preferences from health care providers and patients seeking primary care in the Central Region of Uganda from January 2022 to July 2022. Survey development was informed by the technology acceptance model and evaluated predictors of technology acceptance (ie, perceived usefulness, ease of use, and attitudes). We used descriptive statistics to characterize telehealth perceptions and examined differences according to provider and patient characteristics using Student t tests. Results: Nearly 79% (n=48) of 61 providers surveyed had used telehealth, and perceptions were generally favorable. While 93.4% (n=57) reported that telehealth adds value to clinical practice, less than half (n=30, 49.2%) felt telehealth was more efficient than in-person visits. Provider-reported barriers to telehealth included technology challenges for the patient (34/132, 26%), low patient engagement (25/132, 19%), and lack of implementation support (24/132, 18%). Telehealth use was lower among the 91 surveyed patients, with only 19.8% (n=18) having used telehealth. Although 89% (n=81) of patients reported saving time with telehealth approaches, 33.3% (n=30) of patients reported that telehealth made them feel uncomfortable, and 43.8% (n=39) reported concerns about confidentiality. Over 72% (n=66) of patients who had used telehealth previously reported satisfaction with the telehealth services they received. Several differences in perceptions of telehealth according to patient’s self-reported health status were observed. Conclusions: Perceptions of telehealth were generally favorable, although higher among providers than patients. Barriers impeding telehealth use include technology challenges and the lack of infrastructure and implementation support. Findings from this study can inform the implementation of acceptable telehealth approaches to address disparities propagated by health care access barriers in Sub-Saharan Africa. 
%R 10.2196/60843
%U https://formative.jmir.org/2025/1/e60843
%U https://doi.org/10.2196/60843

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 13
%N 
%P e57991
%T Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial
%A Sekandi,Juliet Nabbuye
%A Buregyeya,Esther
%A Zalwango,Sarah
%A Nakkonde,Damalie
%A Kaggwa,Patrick
%A Quach,Trang Ho Thu
%A Asiimwe,David
%A Atuyambe,Lynn
%A Dobbin,Kevin
%+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 7065425257, jsekandi@uga.edu
%K tuberculosis
%K digital adherence technologies
%K video-observed treatment
%K video directly observed treatment
%K directly observed therapy
%K adherence
%K mHealth
%K Uganda
%K Africa
%D 2025

%7 16.1.2025
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives. Objective: This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT). Methods: Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ≥80% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group. Results: The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P<.001). When using a FEDO cutoff of ≥80% to define optimal adherence, 63 of 142 (44%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79% vs 7/71, 10%, P<.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ≥80% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone. Conclusions: Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. This evidence highlights the potential of digital technologies to improve treatment adherence monitoring and support in high TB burden settings with limited human resources. Trial Registration: ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689 
%M 39715573
%R 10.2196/57991
%U https://mhealth.jmir.org/2025/1/e57991
%U https://doi.org/10.2196/57991
%U http://www.ncbi.nlm.nih.gov/pubmed/39715573

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 14
%N 
%P e64316
%T Interventions to Maintain HIV/AIDS, Tuberculosis, and Malaria Service Delivery During Public Health Emergencies in Low- and Middle-Income Countries: Protocol for a Systematic Review
%A Kabwama,Steven Ndugwa
%A Wanyenze,Rhoda K.
%A Lindgren,Helena
%A Razaz,Neda
%A Ssenkusu,John M
%A Alfvén,Tobias
%+ Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, Solna, Stockholm, 17177, Sweden, 46 707578093, steven.ndugwa.kabwama@ki.se
%K service availability
%K emergencies
%K tuberculosis
%K malaria
%K systematic reviews
%K health services
%K emergencies
%K HIV
%K AIDS
%K public health emergency
%K low- and middle-income countries
%K qualitative reviews
%K qualitative
%K policies
%K communities
%K health facilities
%K emergency
%K implement
%K implementation
%D 2025

%7 15.1.2025
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies. Objective: This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries. Methods: The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility–level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation—Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries. Results: The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025. Conclusions: The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies. Trial Registration: PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408967 International Registered Report Identifier (IRRID): PRR1-10.2196/64316 
%M 39813677
%R 10.2196/64316
%U https://www.researchprotocols.org/2025/1/e64316
%U https://doi.org/10.2196/64316
%U http://www.ncbi.nlm.nih.gov/pubmed/39813677

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e58460
%T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial
%A Leung,May May
%A Mateo,Katrina F
%A Dublin,Marlo
%A Harrison,Laura
%A Verdaguer,Sandra
%A Wyka,Katarzyna
%+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu
%K childhood obesity
%K preadolescents
%K racial and ethnic minority populations
%K dietary behaviors
%K BMI
%K digital health
%D 2025

%7 15.1.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of <US $20,000. Participants were randomly assigned to the experimental group (45/89, 50% received the web-based comic tool), or the comparison group (44/89, 50% received web-based nutrition newsletters). Primary measures included feasibility and usability at intervention midpoint (T2) and intervention end (T3). Semistructured interviews were conducted at the same time to assess acceptability and satisfaction. Secondary measures, collected at baseline (T1), T2, T3, and at T4, included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar, and junk food intake. Descriptive analyses were conducted for use and usability data. Interviews were systematically analyzed to facilitate identification of patterns and themes. Secondary data were analyzed using descriptive statistics. Within- and between-group effect sizes were reported. Results: In total, 72% (33/45) and 60% (27/44) of the experimental and comparison groups, respectively, accessed their tool weekly. The mean total usability score was high and moderately high for the experimental and comparison groups, respectively (mean 4.01, SD 0.37 and mean 3.81, SD 0.51; P=.048), based on a 5-point Likert scale). Children in both groups found the tool acceptable, and few reported difficulties logging in or accessing content. Between-group effect sizes for beliefs and attitudes related to dietary intake, while favoring the experimental group at T3, were in the small range. These improvements in both groups were largely diminished by T4. However, between-group effect sizes for behaviors related to fruit, vegetable, and water intake, favoring the experimental group, were medium to large and were maintained at T4. Conclusions: This pilot feasibility study suggests that an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in racial and ethnic minority preadolescents. However, further research, including a full-scale randomized controlled trial, is warranted to determine the effectiveness of Intervention INC. Trial Registration: ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/study/NCT03165474 International Registered Report Identifier (IRRID): RR2-10.2196/10682 
%M 39813083
%R 10.2196/58460
%U https://formative.jmir.org/2025/1/e58460
%U https://doi.org/10.2196/58460
%U http://www.ncbi.nlm.nih.gov/pubmed/39813083

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 9
%N 
%P e53460
%T Development and Beta Validation of an mHealth-Based Hearing Screener (SRESHT) for Young Children in Resource-Limited Countries: Pilot Validation Study
%A Ramkumar,Vidya
%A Joshi B,Deepashree
%A Prabhakar,Anil
%A Hall,James W
%A Vaidyanath,Ramya
%+ Faculty of Audiology and Speech Language Pathology, Sri Ramachandra Institute of Higher Education and Research, Sri Ramachandra Nagar, Porur, Chennai, 600116, India, 91 9894170609, deepasrijoshi25@sriramachandra.edu.in
%K audiometry
%K mHealth
%K devices
%K wireless
%K tablet-based screening
%K childhood hearing loss
%K early hearing detection and intervention
%K tablets
%K children
%K neonates
%K hearing loss
%K infants
%K development
%K validation
%K mobile phones
%D 2025

%7 13.1.2025
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The prevalence of hearing loss in infants in India varies between 4 and 5 per 1000. Objective-based otoacoustic emissions and auditory brainstem response have been used in high-income countries for establishing early hearing screening and intervention programs. Nevertheless, the use of objective screening tests in low- and middle-income countries (LMICs) such as India is not feasible. Mobile health (mHealth) solutions have been demonstrated to be a viable option for hearing screening in LMICs. Objective: This study aims to develop and beta-validate an affordable hearing screener for children younger than 6 years of age to identify moderately severe or higher degrees of hearing loss. Methods: In phase 1, a mHealth-based hearing screener (SRESHT) was developed using a single board computer with wireless commercial headphones and speakers as transducers, which were calibrated according to the standard procedure. Three subjective hearing screening modules were conceptualized and developed for different age groups: (1) behavioral observation audiometry–screening for infants aged from 0 to 1 year; (2) speech spectrum awareness task–screening for children 1 to 3 years old; and (3) speech recognition task–screening for children 3 to 6 years old. Different auditory stimuli for the screening modules were generated and suitability was assessed: (1) noisemakers, animal sounds, and environmental sounds for infants (birth to 1 year old); (2) animal sounds and nonsense syllables for children (1 to 3 years old); and (3) eighteen picturable spondee words for children (3 to 6 years old). In phase 2, the SRESHT screener was beta-validated in children aged below 6 years to establish the agreement between SRESHT modules and the gold-standard procedure in identifying moderately severe and higher degrees of hearing loss. Results: Off-the-shelf commercial speakers and headphones were selected and calibrated. On comparison of stimuli for behavioral observation audiometry on 15 children, Noisemaker stimuli were found suitable based on the average minimum response levels. On comparison of different stimuli for speech spectrum awareness task on 15 children, animal sounds were found to be suitable. On familiarity check of 18 spondee words for speech recognition task among 20 children, 12 spondee words had the eligibility cutoff (85%) and a presentation level of 5 dB SL (re-pure tone threshold) was sufficient to achieve 80% psychometric function. In phase 2, a total of 55 children aged 0 to 6 years (31 normal hearing and 24 hearing impairment) underwent SRESHT screening for beta validation. Cohen κ indicated that the overall SRESHT screener had a very good agreement (κ=0.82) with gold-standard audiometric screening for identifying moderately severe and higher degrees of hearing loss. Conclusions: The development and beta validation of the SRESHT screener using the selected auditory stimuli showed that the stimuli were suitable for screening children. 
%M 39805111
%R 10.2196/53460
%U https://formative.jmir.org/2025/1/e53460
%U https://doi.org/10.2196/53460
%U http://www.ncbi.nlm.nih.gov/pubmed/39805111

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e52591
%T Global Use, Adaptation, and Sharing of Massive Open Online Courses for Emergency Health on the OpenWHO Platform: Survey Study
%A Johnston,Jamie Sewan
%A Skinner,Nadine Ann
%A Tokar,Anna
%A Arabi,Elham
%A Ndiaye,Ngouille Yabsa
%A Strehlow,Matthew Charles
%A Utunen,Heini
%+ Stanford Center for Health Education, Stanford University, 408 Panama Mall, Stanford, CA, 94305, United States, 1 650 647 0501, jamiejs@stanford.edu
%K MOOCs
%K online learning
%K global health education
%K digital health
%K health worker training
%K health emergencies
%K outbreak
%K COVID-19
%D 2025

%7 10.1.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The COVID-19 pandemic demonstrated the global need for accessible content to rapidly train health care workers during health emergencies. The massive open access online course (MOOC) format is a broadly embraced strategy for widespread dissemination of trainings. Yet, barriers associated with technology access, language, and cultural context limit the use of MOOCs, particularly in lower-resource communities. There is tremendous potential for MOOC developers to increase the global scale and contextualization of learning; however, at present, few studies examine the adaptation and sharing of health MOOCs to address these challenges. Objective: The World Health Organization’s Health Emergencies Programme Learning and Capacity Development Unit and the Stanford Center for Health Education collaborated to survey learners from 4 emergency health MOOCs on the OpenWHO platform to examine differences in course use by World Bank country income classification across three dimensions: (1) how health education MOOCs are used and shared, (2) how health workers adapt MOOC content to meet local training and information needs, and (3) how content adaptations help frontline health workers overcome barriers to using MOOCs. Methods: This study draws upon two sources of data: (1) course enrollment data collected from the 4 emergency health MOOCs (N=96,395) and (2) survey data collected from learners who participated in at least 1 of the 4 MOOCs (N=926). Descriptive statistics are used to summarize learner characteristics. Differences in enrollment, sharing, and adaptation by country income classification are examined using Pearson chi-square test. Results: Of the enrollees who indicated their country of residence, half were from lower-middle-income countries (LMICs; 43,168/85,882, 50%) and another 9% (7146/85,882) from low-income countries. The majority of all respondents shared content (819/926, 88%) and used content in official trainings (563/926, 61%). Respondents were more likely to share and use content for trainings in LMICs than in high-income countries (91% vs 81%; P=.001). Learners in LMICs also shared content with more people on average compared with high-income country learners although the difference is not statistically significant (9.48 vs 6.73 people; P=.084). Compared with learners in high-income countries, learners in LMICs were more likely to adapt materials to distribute via offline formats or technologies, such as WhatsApp or text message (31% vs 8%; P<.001); to address cultural, linguistic, or other contextual needs (20% vs 12%; P=.076); and to meet local guidelines (20% vs 9%; P=.010). Learners in LMICs indicated greater accessibility challenges due to technological and linguistic barriers. Conclusions: Learners commonly share content from MOOCs about public health emergencies; this is especially true in low-income countries and LMICs. However, content is often adapted and shared via alternative formats. Our findings identify a critical opportunity to improve MOOC design and dramatically scale the impact of MOOCs to better meet diverse global needs. 
%M 39792445
%R 10.2196/52591
%U https://www.jmir.org/2025/1/e52591
%U https://doi.org/10.2196/52591
%U http://www.ncbi.nlm.nih.gov/pubmed/39792445

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 12
%N 
%P e63653
%T Satisfaction and Usability of a Commercially Available Medication Adherence App (Medisafe) Among Medically Underserved Patients With Chronic Illnesses: Survey Study
%A Hartch,Christa
%A Dietrich,Mary S
%A Lancaster,B Jeanette
%A Mulvaney,Shelagh A
%A Stolldorf,Deonni P
%+ School of Nursing and Health Sciences, Manhattanville University, 2900 Purchase Street, Purchase, NY, 10577, United States, 1 914 323 5365, christa.hartch@mville.edu
%K medication adherence
%K mHealth
%K mobile phone
%K app
%K medically underserved
%K chronic disease
%K satisfaction
%K usage
%K health disparities
%D 2025

%7 7.1.2025
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Research supports the use of mobile phone apps to promote medication adherence, but the use of and satisfaction with these apps among medically underserved patients with chronic illnesses remain unclear. Objective: This study reports on the overall use of and satisfaction with a medication adherence app (Medisafe) in a medically underserved population. Methods: Medically underserved adults who received care for one or more chronic illnesses at a federally qualified health center (FQHC) were randomized to an intervention group in a larger randomized controlled trial and used the app for 1 month (n=30), after which they completed a web-based survey. Objective data on app usage were provided as secondary data by the app company. Results: The participants were very satisfied with the app, with all participants (30/30, 100%) somewhat or strongly agreeing that they would recommend the app to family and friends. Participants strongly agreed (28/30, 93%) that the reminders helped them remember to take their medications at the correct time each day, and they (28/30, 93%) found the app easy to use. Additional features accessed by some included educational features and the adherence report. Participants noted the helpfulness of having a medication list on their phones, and some used it during medication reconciliation at doctor visits. Use of the Medfriend feature, which alerts a social support person if a medication is missed, was low (n=2), but those who used it were very positive about the feature. Conclusions: A commercially available medication adherence app was found to be useful by participants, and they were satisfied with the app and the additional features provided. The use of medication adherence mobile phone apps has the potential to positively influence chronic disease management in a medically underserved population on a large scale. Trial Registration: ClinicalTrials.gov NCT05098743; https://clinicaltrials.gov/study/NCT05098743 
%M 39773694
%R 10.2196/63653
%U https://humanfactors.jmir.org/2025/1/e63653
%U https://doi.org/10.2196/63653
%U http://www.ncbi.nlm.nih.gov/pubmed/39773694

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 27
%N 
%P e60324
%T Urban-Suburban Differences in Public Perspectives on Digitalizing Pediatric Research: Cross-Sectional Survey Study
%A Fang,Heping
%A Xian,Ruoling
%A Li,Juan
%A Li,Yingcun
%A Liu,Enmei
%A Zhao,Yan
%A Hu,Yan
%+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, No. 20 Jinyu Avenue, Liangjiang New Area, Chongqing, 401122, China, 86 02368370551, hy420@126.com
%K pediatrics
%K pediatric research
%K digital health
%K public opinion
%K research
%K patient participation
%K urban
%K rural
%K caregiver attitudes
%K social media
%K mobile phone
%D 2025

%7 7.1.2025
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Recruiting and retaining participants in pediatric research has always been challenging, particularly in healthy populations and remote areas, leading to selection bias and increased health disparities. In the digital age, medical research has been transformed by digital tools, offering new opportunities to enhance engagement in clinical research. However, public perspectives on digitalizing pediatric research and potential differences between urban and suburban areas remain unclear. Objective: This study aimed to investigate public perspectives on digitalizing pediatric research and compare differences between urban and suburban areas to help diversify participants and address health disparities. Methods: A cross-sectional web-based survey targeting caregivers of kindergarten children (aged 2-7 years) in Chongqing was conducted between June and December 2023. A total of 4231 valid questionnaires were analyzed, with 25.1% (n=1064) of the children residing in urban areas and 74.9% (n=3167) in suburban areas. Descriptive statistics and intergroup comparisons were used for data analysis. Results: Approximately 59.8% (n=2531) of the caregivers had first impressions of pediatric research, with 36.9% (n=1561) being positive and 22.9% (n=970) being negative. A total of 38.3% (n=1621) of caregivers recognized the growing popularity of digital tools, and 36.7% (n=1552) supported their use in pediatric research, but only 25.2% (n=1068) favored online-only research methods. The main concerns regarding the use of software in pediatric research were privacy issues (n=3273, 77.4%) and potential addiction (n=2457, 58.1%). Public accounts of research institutions (n=3400, 80.4%) were the most favored for online recruitment. Telephones (1916/3076, 62.3%) and social media apps (1801/3076, 58.6%) were the most popular for regular contact. Intergroup comparisons revealed that suburban caregivers had more positive first impressions of pediatric research (38.6% vs 32%; P<.001; adjusted odds ratio [aOR] 1.27, 95% CI 1.09-1.47) and faced fewer participation barriers: “worry about being an experimental subject” (70.9% vs 76.6%; P<.001; aOR 0.79, 95% CI 0.67-0.93), “pose a risk to children’s health” (58.6% vs 67.8%; P<.001; aOR 0.71, 95% CI 0.61-0.83), “do not have enough background information” (55.2% vs 61.6%; P<.001; aOR 0.78, 95% CI 0.67-0.89), and “worry about recommending other products” (48.2% vs 55%; P<.001; aOR 0.78, 95% CI 0.67-0.89). They also showed greater support for online-only research methods (26% vs 22.9%; P=.045; aOR 1.19, 95% CI 1.01-1.41) and greater openness to unofficial online recruitment sources (social media friends: 24.7% vs 18.9%; P<.001; aOR 1.33, 95% CI 1.11-1.59; moments on social media: 15.5% vs 11.1%; P<.001; aOR 1.35, 95% CI 1.09-1.67). Conclusions: In the digital age, enhancing recruitment and retention in pediatric research can be achieved by integrating both official and unofficial social media strategies, implementing a hybrid online-offline follow-up approach, and addressing privacy concerns. 
%M 39773676
%R 10.2196/60324
%U https://www.jmir.org/2025/1/e60324
%U https://doi.org/10.2196/60324
%U http://www.ncbi.nlm.nih.gov/pubmed/39773676

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e58389
%T Evaluation of the Development, Implementation, Maintenance, and Impact of 3 Digital Surveillance Tools Deployed in Malawi During the COVID-19 Pandemic: Protocol for a Modified Delphi Expert Consensus Study
%A Denny,Alanna
%A Ndemera,Isaach
%A Chirwa,Kingston
%A Wu,Joseph Tsung Shu
%A Chirambo,Griphin Baxter
%A Yosefe,Simeon
%A Chilima,Ben
%A Kagoli,Matthew
%A Lee,Hsin-yi
%A Yu,Kwong Leung Joseph
%A O'Donoghue,John
%+ Research Department, Luke International, PO Box 1088, Mzuzu, 105200, Malawi, 265 999 210 38, wcsg@lukeinternational.no
%K delphi study
%K COVID-19
%K Malawi
%K surveillance
%K digital health
%K delphi
%K mobile health
%K mHealth
%K development
%K implementation
%K maintenance
%K impact
%K consensus
%K protocol
%K survey
%K expert
%K purposive sampling
%K epidemiology
%K descriptive statistics
%D 2024

%7 31.12.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The COVID-19 pandemic has highlighted the importance of strengthening national monitoring systems to safeguard a globally connected society, especially those in low- and middle-income countries. Africa’s rapid adoption of digital technological interventions created a new frontier of digital advancement during crises or pandemics. The use of digital tools for disease surveillance can assist with rapid outbreak identification and response, handling duties such as diagnosis, testing, contact tracing, and risk communication. Malawi was one of the first countries in the region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Objective: The aim of this study is to seek expert consensus using the Delphi methodology to examine Malawi’s COVID-19 digital surveillance response strategy and to assess the digital tools using the World Health Organization mHealth (mobile health) Assessment and Planning for Scale (MAPS) toolkit. Methods: This protocol follows the Guidance on Conducting and REporting DElphi Studies. Participants must have first-hand experience on the design, implementation or maintenance with COVID-19 digital surveillance systems. There will be no restrictions on the level of expertise or years of experience. The panel will consist of approximately 40 participants. We will use a modified Delphi process whereby rounds 1 and 2 will be hosted online by Qualtrics and round 3 will encompass a face-to-face workshop held in Malawi. Consensus will be defined as ≥70% of participants strongly disagree, disagree, or somewhat disagree, or strongly agree, agree, or somewhat agree. During round 3, the face-to-face workshop, participants will be asked to complete, the MAPS toolkit assessment on the digital tool on which they are experts. The MAPS toolkit will enable the panel members to assess the digital tools from a sustainable perspective from six distinct, yet complementary axes: (1) groundwork, (2) partnerships, (3) financial health, (4) technology and architecture, (5) operations, and (6) monitoring and evaluation. Results: The ability of a country to collate, diagnose, monitor, and analyze data forms the cornerstone of an efficient surveillance system, allowing countries to plan and implement appropriate control actions. Malawi was one of the first countries in the African region to launch a government-led coordinated effort to harmonize and streamline the necessary COVID-19 digital health implementation through an integrated system architecture. Conclusions: We anticipate findings from this Delphi study will provide insights into how and why Malawi was successful in deploying digital surveillance systems. In addition, findings should produce recommendations and guidance for the rapid development, implementation, maintenance, and impact of digital surveillance tools during a health crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/58389 
%M 39740220
%R 10.2196/58389
%U https://www.researchprotocols.org/2024/1/e58389
%U https://doi.org/10.2196/58389
%U http://www.ncbi.nlm.nih.gov/pubmed/39740220

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e60838
%T Exploring Molecular Genetics Research on Obesity in Malaysia: Protocol for a Scoping Review
%A Ahmad Zamri,Liyana
%A Abu Seman,Norhashimah
%A Zainal Abidin,Nur Azlin
%A Hamzah,Siti Sarah
%+ Endocrine and Metabolic Unit, Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Jalan Setia Murni U13/52, Seksyen U13 Setia Alam, Selangor, 40170, Malaysia, 60 333627825, sitisarah.h@moh.gov.my
%K genetics
%K biomarkers
%K molecular
%K obesity
%K Malaysia
%K scoping review
%K protocol
%D 2024

%7 30.12.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Obesity presents a growing challenge to public health, and its intricate association with genetics continues to be a compelling field of study. In countries such as Malaysia, where diverse genetic backgrounds converge, exploring the molecular genetics of obesity is even more imperative. Objective: This scoping review aimed to explore the literature on molecular genetics of obesity in Malaysia. Specifically, we sought to characterize existing studies, identify the genetic determinants of obesity, and assess their association with obesity predisposition in the population. Methods: This scoping review followed the methodology of the Joanna Briggs Institute and used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist as its guiding framework. Searches were conducted using electronic databases such as PubMed, ScienceDirect, and Scopus, filtering for human studies published until March 2024. Eligible studies included peer-reviewed articles on the Malaysian population irrespective of age or sex. This review excluded review articles, book chapters, non–peer-reviewed conference proceedings, gray literature, and preclinical studies, and the reference lists of the retrieved studies were manually examined to ensure thorough inclusion. The articles were subjected to a 2-stage screening process (title/abstract and full text) conducted by 2 reviewers to assess eligibility. Eligible articles were then extracted following a data extraction framework and organized into a charting table. Only studies investigating the genetics of obesity in Malaysian populations were included. Results: As of March 2024, our extensive search strategy has yielded 572 records. After removing 153 duplicates, 419 records were screened by title and abstract, resulting in 47 selected for full-text review. Of these, 34 were chosen for data extraction and detailed analysis. These studies predominantly involved participants from major ethnic groups (Malay, Chinese, and Indian) recruited from local health centers and university communities. The articles primarily explored the relationship between specific gene variants and obesity or obesity-related health parameters. This ongoing research is expected to be completed with a comprehensive scoping review by April 2025. Conclusions: This review provides valuable insights into the genetic determinants of obesity in Malaysia, despite limitations such as no quality appraisal being conducted for the included studies and the search strategy being restricted to selected databases, potentially omitting relevant studies. However, this review ensured reliability and reproducibility by adhering to the Joanna Briggs Institute and PRISMA-ScR guidelines. Ultimately, this study advances the understanding of local research and sets the foundation for future molecular genetic studies to improve obesity risk prediction and management in Malaysia’s multiethnic population. International Registered Report Identifier (IRRID): DERR1-10.2196/60838 
%M 39753227
%R 10.2196/60838
%U https://www.researchprotocols.org/2024/1/e60838
%U https://doi.org/10.2196/60838
%U http://www.ncbi.nlm.nih.gov/pubmed/39753227

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e42774
%T Identification of Gender Differences in Acute Myocardial Infarction Presentation and Management at Aga Khan University Hospital-Pakistan: Natural Language Processing Application in a Dataset of Patients With Cardiovascular Disease
%A Ngaruiya,Christine
%A Samad,Zainab
%A Tajuddin,Salma
%A Nasim,Zarmeen
%A Leff,Rebecca
%A Farhad,Awais
%A Pires,Kyle
%A Khan,Muhammad Alamgir
%A Hartz,Lauren
%A Safdar,Basmah
%+ Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite #260, New Haven, CT, 06519, United States, 1 2037852353, christine.ngaruiya@yale.edu
%K natural language processing
%K gender-based differences
%K acute coronary syndrome
%K global health
%K Pakistan
%K gender
%K data
%K dataset
%K clinical
%K research
%K management
%K patient
%K medication
%K women
%K tool
%D 2024

%7 20.12.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Ischemic heart disease is a leading cause of death globally with a disproportionate burden in low- and middle-income countries (LMICs). Natural language processing (NLP) allows for data enrichment in large datasets to facilitate key clinical research. We used NLP to assess gender differences in symptoms and management of patients hospitalized with acute myocardial infarction (AMI) at Aga Khan University Hospital-Pakistan. Objective: The primary objective of this study was to use NLP to assess gender differences in the symptoms and management of patients hospitalized with AMI at a tertiary care hospital in Pakistan. Methods: We developed an NLP-based methodology to extract AMI symptoms and medications from 5358 discharge summaries spanning the years 1988 to 2018. This dataset included patients admitted and discharged between January 1, 1988, and December 31, 2018, who were older than 18 years with a primary discharge diagnosis of AMI (using ICD-9 [International Classification of Diseases, Ninth Revision], diagnostic codes). The methodology used a fuzzy keyword-matching algorithm to extract AMI symptoms from the discharge summaries automatically. It first preprocesses the free text within the discharge summaries to extract passages indicating the presenting symptoms. Then, it applies fuzzy matching techniques to identify relevant keywords or phrases indicative of AMI symptoms, incorporating negation handling to minimize false positives. After manually reviewing the quality of extracted symptoms in a subset of discharge summaries through preliminary experiments, a similarity threshold of 80% was determined. Results: Among 1769 women and 3589 men with AMI, women had higher odds of presenting with shortness of breath (odds ratio [OR] 1.46, 95% CI 1.26-1.70) and lower odds of presenting with chest pain (OR 0.65, 95% CI 0.55-0.75), even after adjustment for diabetes and age. Presentation with abdominal pain, nausea, or vomiting was much less frequent but consistently more common in women (P<.001). “Ghabrahat,” a culturally distinct term for a feeling of impending doom was used by 5.09% of women and 3.69% of men as presenting symptom for AMI (P=.06). First-line medication prescription (statin and β-blockers) was lower in women: women had nearly 30% lower odds (OR 0.71, 95% CI 0.57-0.90) of being prescribed statins, and they had 40% lower odds (OR 0.67, 95% CI 0.57-0.78) of being prescribed β-blockers. Conclusions: Gender-based differences in clinical presentation and medication management were demonstrated in patients with AMI at a tertiary care hospital in Pakistan. The use of NLP for the identification of culturally nuanced clinical characteristics and management is feasible in LMICs and could be used as a tool to understand gender disparities and address key clinical priorities in LMICs. 
%M 39705071
%R 10.2196/42774
%U https://formative.jmir.org/2024/1/e42774
%U https://doi.org/10.2196/42774
%U http://www.ncbi.nlm.nih.gov/pubmed/39705071

%0 Journal Article
        
%@ 2291-9279
%I JMIR Publications
%V 12
%N 
%P e59381
%T A Narrative-Gamified Mental Health App (Kuamsha) for Adolescents in Uganda: Mixed Methods Feasibility and Acceptability Study
%A R Pozuelo,Julia
%A Nabulumba,Christine
%A Sikoti,Doreen
%A Davis,Meghan
%A Gumikiriza-Onoria,Joy Louise
%A Kinyanda,Eugene
%A Moffett,Bianca
%A van Heerden,Alastair
%A O'Mahen,Heather A
%A Craske,Michelle
%A ,
%A Sulaiman,Munshi
%A Stein,Alan
%+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, Oxford, OX3 7JX, United Kingdom, 44 01865618200, julia_ruizpozuelo@hms.harvard.edu
%K adolescents
%K mental health
%K Uganda
%K gamified app
%K digital interventions
%K mobile phone
%K user-centered design
%K low- and middle-income countries
%D 2024

%7 19.12.2024
%9 Original Paper
%J JMIR Serious Games
%G English
                
%X Background: Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited. Objective: This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda. Methods: A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants’ mental health before and after the intervention. Results: A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ≥80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI –0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10). Conclusions: This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents’ mental health. 
%M 39700489
%R 10.2196/59381
%U https://games.jmir.org/2024/1/e59381
%U https://doi.org/10.2196/59381
%U http://www.ncbi.nlm.nih.gov/pubmed/39700489

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e55189
%T Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review
%A Greenall-Ota,Josephine
%A Yapa,H Manisha
%A Fox,Greg J
%A Negin,Joel
%K mHealth
%K implementation
%K LMIC
%K infectious diseases
%K Tailored Implementation for Chronic Diseases
%K mobile phone
%K interventions
%K short messaging service
%K chronic disease
%K narrative review
%K implementation
%K barrier
%K mHealth intervention
%K infectious disease
%K screening
%K community
%K design
%K health system
%K SMS
%K app
%D 2024

%7 13.12.2024
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs. Objective: We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework. Results: We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use. Conclusions: Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs. 
%R 10.2196/55189
%U https://mhealth.jmir.org/2024/1/e55189
%U https://doi.org/10.2196/55189

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e60650
%T Testing 3 Modalities (Voice Assistant, Chatbot, and Mobile App) to Assist Older African American and Black Adults in Seeking Information on Alzheimer Disease and Related Dementias: Wizard of Oz Usability Study
%A Bosco,Cristina
%A Shojaei,Fereshtehossadat
%A Theisz,Alec Andrew
%A Osorio Torres,John
%A Cureton,Bianca
%A Himes,Anna K
%A Jessup,Nenette M
%A Barnes,Priscilla A
%A Lu,Yvonne
%A Hendrie,Hugh C
%A Hill,Carl V
%A Shih,Patrick C
%+ Luddy School of Informatics, Computing, and Engineering, Indiana University, 700 N Woodlawn Ave, Bloomington, IN, 47408, United States, 1 (812) 856 5754, cribosco@iu.edu
%K older African American and Black adults
%K Alzheimer disease and related dementias
%K health literacy
%K Wizard of Oz
%K voice assistant
%K chatbot
%K mobile app
%K dementia
%K geriatric
%K aging
%K Alzheimer disease
%K artificial intelligence
%K AI
%K mHealth
%K digital tools
%D 2024

%7 9.12.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Older African American and Black adults are twice as likely to develop Alzheimer disease and related dementias (ADRD) and have the lowest level of ADRD health literacy compared to any other ethnic group in the United States. Low health literacy concerning ADRD negatively impacts African American and Black people in accessing adequate health care. Objective: This study explored how 3 technological modalities—voice assistants, chatbots, and mobile apps—can assist older African American and Black adults in accessing ADRD information to improve ADRD health literacy. By testing each modality independently, the focus could be kept on understanding the unique needs and challenges of this population concerning the use of each modality when accessing ADRD-related information. Methods: Using the Wizard of Oz usability testing method, we assessed the 3 modalities with a sample of 15 older African American and Black adults aged >55 years. The 15 participants were asked to interact with the 3 modalities to search for information on local events happening in their geographical area and search for ADRD-related health information. Results: Our findings revealed that, across the 3 modalities, the content should avoid convoluted and complex language and give the possibility to save, store, and share it to be fully accessible by this population. In addition, content should come from credible sources, including information tailored to the participants’ cultural values, as it has to be culturally relevant for African American and Black communities. Finally, the interaction with the tool must be time efficient, and it should be adapted to the user’s needs to foster a sense of control and representation. Conclusions: We conclude that, when designing ADRD-related interventions for African American and Black older adults, it proves to be crucial to tailor the content provided by the technology to the community’s values and construct an interaction with the technology that is built on African American and Black communities’ needs and demands. 
%R 10.2196/60650
%U https://formative.jmir.org/2024/1/e60650
%U https://doi.org/10.2196/60650

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e58482
%T Exploring Pregnancy-Related Information-Sharing Behavior Among First-Time Southeast Asian Fathers: Qualitative Semistructured Interview Study
%A Ageng,Kidung
%A Inthiran,Anushia
%+ Department of Accounting and Information Systems, University of Canterbury, Meremere building, University Drive, Ilam, Christchurch, 8041, New Zealand, 64 274118469, kidung.ageng@pg.canterbury.ac.nz
%K pregnancy
%K first-time fathers
%K information sharing
%K Southeast Asia
%K information-seeking behavior
%K cultural factors
%D 2024

%7 9.12.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: While the benefits of fathers’ engagement in pregnancy are well researched, little is known about first-time expectant fathers’ information-seeking practices in Southeast Asia regarding pregnancy. In addition, there is a notable gap in understanding their information-sharing behaviors during the pregnancy journey. This information is important, as cultural norms are prevalent in Southeast Asia, and this might influence their information-sharing behavior, particularly about pregnancy. Objective: This study aims to explore and analyze the pregnancy-related information-sharing behavior of first-time expectant fathers in Southeast Asia. This study specifically aims to investigate whether first-time fathers share pregnancy information, with whom they share it, through what means, and the reasons behind the decisions to share the information or not. Methods: We conducted semistructured interviews with first-time Southeast Asian fathers in Indonesia, a sample country in the Southeast Asian region. We analyzed the data using quantitative descriptive analysis and qualitative content theme analysis. A total of 40 first-time expectant fathers were interviewed. Results: The results revealed that 90% (36/40) of the participants shared pregnancy-related information with others. However, within this group, more than half (22/40, 55%) of the participants shared the information exclusively with their partners. Only a small proportion, 10% (4/40), did not share any information at all. Among those who did share, the most popular approach was face-to-face communication (36/40, 90%), followed by online messaging apps (26/40, 65%). The most popular reason for sharing was to validate information (14/40, 35%), while the most frequent reason for not sharing with anyone beyond their partner was because of the preference for asking for information rather than sharing (12/40, 30%). Conclusions: This study provides valuable insights into the pregnancy-related information-sharing behaviors of first-time fathers in Southeast Asia. It enhances our understanding of how first-time fathers share pregnancy-related information and how local cultural norms and traditions influence these practices. In contrast to first-time fathers in high-income countries, the information-sharing behavior of first-time Southeast Asian fathers is defined by cultural nuances. Culture plays a crucial role in their daily decision-making processes. Therefore, this emphasizes the importance of cultural considerations in future discussions and the development of intervention programs related to pregnancy for first-time Southeast Asian fathers. In addition, this study sheds light on the interaction processes that first-time fathers engage in with others, highlighting areas where intervention programs may be necessary to improve their involvement during pregnancy. For example, first-time fathers actively exchange new information found with their partners; therefore, creating features or platforms that facilitate this process could improve their overall experience. Furthermore, health practitioners should take a more proactive approach in engaging with first-time fathers, as currently there is a communication gap between them. 
%M 39652862
%R 10.2196/58482
%U https://pediatrics.jmir.org/2024/1/e58482
%U https://doi.org/10.2196/58482
%U http://www.ncbi.nlm.nih.gov/pubmed/39652862

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e58076
%T Web-Based Respondent-Driven Sampling to Assess Biobehavioral Factors Among Men Who Have Sex With Men in Thailand: Cross-Sectional Study
%A Srinor,Watcharapol
%A Tanpradech,Suvimon
%A Thiengtham,Panupit
%A Karuchit,Samart
%A Naksuk,Charif
%A Yingyong,Thitipong
%A Naiwatanakul,Thananda
%A Northbrook,Sanny
%A Hladik,Wolfgang
%K online respondent-driven sampling
%K HIV
%K men who have sex with men
%K MSM
%K Bangkok
%K health clinic
%K public health
%K testing
%K stigma
%K online testing
%K HIV prevention
%K research data collection
%D 2024

%7 6.12.2024
%9 
%J JMIR Public Health Surveill
%G English
                
%X Background: Respondent-driven sampling (RDS) is the current standard for sampling key populations at risk for HIV infections but is usually limited to local implementation in single towns or cities. Web-based sampling eliminates this spatial constraint but often relies on self-selected convenience samples. We piloted a web-based RDS survey with biomarker collection among men who have sex with men (MSM) in Thailand. Objective: This study aimed to evaluate and demonstrate the feasibility of implementing a web-based RDS survey as a routine surveillance system in Thailand. The goal was to enhance surveillance efforts targeting hard-to-reach populations in the country. Methods: We developed a website to fully function like a conventional RDS survey office, including coupon verification, eligibility screening, consenting, interviewing (self-administered), peer recruitment training, coupon issuance, compensation, and recruitment tracking. All functions were automated; data managers monitored recruitment, data collection, and payment and could be contacted by recruits as needed. Eligible participants were male, older than 15 years, resided in Thailand, and had anal sex with a man in the past 6 months. Recruits who resided in Bangkok were additionally invited to physically attend a participating health clinic of their choice for an HIV-related blood draw. Data were weighted to account for the complex sampling design. Results: The survey was implemented from February to June 2022; seeds (21 at start, 14 added later) were identified mostly through targeted web-based banner ads; coupon uptake was 45.1%. Of 2578 candidate recruits screened for eligibility, 2151 (83.4%) were eligible and 2142 (83.1%) enrolled. Almost all (2067/2578, 80.2%) completed the questionnaire; however, 318 survey records were removed from analysis as fraudulent enrollments. The final sample size was 1749, the maximum number of waves achieved was 191, and sampling covered all 6 geographic regions and 75 of 77 (97.4%) provinces; convergence was reached for several salient variables. The mean age was 20.5 (SD 4.0) years, and most (69.8%) had never tested for HIV before, with fear of stigma as the biggest reason (97.1%) for not having tested. Most (76.9%) had visited gay-focused physical venues several times a week. A condom was used in 97.6% of the last sex acts, 11.0% had purchased sex from other men (past 12 mo), 4.5% had sold sex to men (past 12 mo), and 95.3% had 3+ male sex partners (last 3 mo). No participant in Bangkok presented for a blood draw. Conclusions: We successfully conducted a web-based RDS survey among MSM in Thailand, covering nearly the entire country, although, as in physical RDS surveys, sampling was dominated by younger MSM. The survey also failed to collect biomarkers in Bangkok. Public health interventions should aim at increasing testing and addressing (the perception of) stigma. 
%R 10.2196/58076
%U https://publichealth.jmir.org/2024/1/e58076
%U https://doi.org/10.2196/58076

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e63454
%T Essential Coaching for Every Mother Tanzania (ECEM-TZ): Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial
%A Dol,Justine
%A Mselle,Lilian Teddy
%A Campbell-Yeo,Marsha
%A Mbekenga,Columba
%A Kohi,Thecla
%A McMillan,Douglas
%A Dennis,Cindy-Lee
%A Tomblin Murphy,Gail
%A Aston,Megan
%+ IWK Health, 5850 University Avenue, Halifax, NS, B3K 6R8, Canada, 1 9024707706, Justine.dol@dal.ca
%K mobile health
%K maternal health
%K randomized controlled trial
%K parenting self-efficacy
%K self-efficacy
%K maternal
%K RCT
%K mother
%K text message
%K coaching
%K postnatal
%K newborn
%K child
%K low-income country
%K middle-income country
%K Africa
%K newborn care education
%K nurse midwife
%K Tanzania
%D 2024

%7 5.12.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Despite global goals to improve maternal, newborn, and child health outcomes, mortality and morbidity continue to be a concern, particularly during the postnatal period in low- and middle-income countries. While mothers have the responsibility of providing ongoing care for newborns at home, they often receive insufficient newborn care education in Tanzania. Mobile health via text messaging is an ever-growing approach that may address this gap and provide timely education. Objective: We aim to evaluate a text message intervention called Essential Coaching for Every Mother Tanzania (ECEM-TZ) to improve maternal access to essential newborn care education during the immediate 6-week postnatal period. Methods: ECEM-TZ consists of standardized text messages from birth to 6 weeks post partum that provide evidence-based information on caring for their newborn and recognizing danger signs. Messages were developed and then reviewed by Tanzanian mothers and nurse midwives before implementation. A hybrid type 1 randomized controlled trial will compare ECEM-TZ to standard care among mothers (n=124) recruited from 2 hospitals in Dar es Salaam. The effectiveness outcomes include newborn care knowledge, maternal self-efficacy, breastfeeding self-efficacy, maternal mental health, attendance at the 6-week postnatal checkup, and newborn morbidity and mortality. The implementation outcomes include the reach and quality of implementation of the ECEM-TZ intervention. Results: Recruitment for this study occurred between June 13, 2024, and July 22, 2024. A total of 143 participants were recruited, 71 in the control and 72 in the intervention. The 6-week follow-up data collection began on July 30, 2024, and was completed on September 21, 2024. Conclusions: This study will generate evidence about the effectiveness of implementing text messaging during the early postnatal period and the feasibility of doing so in 2 hospitals in Dar es Salaam. The intervention has been designed in collaboration with mothers and nurse midwives in Tanzania. Trial Registration: ClinicalTrials.gov NCT05362305; https://clinicaltrials.gov/study/NCT05362305 International Registered Report Identifier (IRRID): DERR1-10.2196/63454 
%M 39636672
%R 10.2196/63454
%U https://www.researchprotocols.org/2024/1/e63454
%U https://doi.org/10.2196/63454
%U http://www.ncbi.nlm.nih.gov/pubmed/39636672

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 9
%N 
%P e55677
%T Health and eHealth Literacy of Patients With Diabetes in Low-Income Countries: Perspective From Guinea and Burkina Faso
%A Ouedraogo,Ismaila
%A Some,Borlli Michel J
%A Benedikter,Roland
%A Diallo,Gayo
%K health literacy
%K eHealth literacy
%K diabetic patients
%K Guinea
%K Burkina Faso
%K patients with diabetes
%K diabetes
%D 2024

%7 3.12.2024
%9 
%J JMIR Diabetes
%G English
                
%X Background: Diabetes is a significant health concern in sub-Saharan Africa, emphasizing the importance of assessing the health literacy and eHealth skills of hospitalized patients with diabetes. This study evaluated the health literacy and eHealth literacy of patients with diabetes at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mobile health (mHealth) solutions to improve self-management and treatment outcomes. Objective: The aim of this study is to evaluate the levels of health literacy and eHealth literacy among patients at Sanou Sourou Hospital in Burkina Faso and Donka Hospital in Guinea. Methods: The study included 45 participants from Donka Hospital and 47 from Sanou Sourou Hospital. Data collection took place in May 2022, focusing on variables such as gender, age, education, income, and technology access. Health literacy and eHealth literacy were measured using the Brief Health Literacy Screen (BHLS) and the eHealth Literacy Scale (eHEALS), respectively. Statistical analysis was performed using SPSS 28. Results: The results indicated that 64% (64/99) of participants at Donka Hospital and 57% (57/99) at Sanou Sourou Hospital were female. The majority of participants (48/98, 49% in both hospitals) fell within the age range of 25-50 years. High rates of illiteracy were observed (62/100, 62% in Donka Hospital and 59/100, 59% in Sanou Sourou Hospital). Smartphone ownership was prevalent (62/99, 62% at Donka Hospital and 64/100, 64% at Sanou Sourou Hospital). Participants reported occasional use of technology for basic purposes and frequent internet usage for accessing health information. However, a significant proportion of participants demonstrated low health literacy (73/99, 73% at Donka Hospital; 79/101, 78% at Sanou Sourou Hospital) and inadequate eHealth literacy (57/100, 57% at Donka Hospital; 62/100, 62% at Sanou Sourou Hospital). Education was observed to positively correlate with health literacy, while age displayed a moderate negative correlation. Weak correlations were observed between gender, income, and health literacy, but these were not statistically significant. No significant correlation was found between the scores of the BHLS and the eHEALS in either hospital. Conclusions: This study highlights the importance of targeted educational interventions and mHealth solutions aimed at enhancing health and eHealth literacy among hospitalized patients with diabetes. Addressing both health literacy and eHealth literacy is paramount for improving diabetes management and treatment outcomes in Guinea and Burkina Faso. Targeted interventions and mHealth solutions have the potential to empower patients, enabling their active involvement in health care decisions and ultimately improving overall health outcomes. 
%R 10.2196/55677
%U https://diabetes.jmir.org/2024/1/e55677
%U https://doi.org/10.2196/55677

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53685
%T Technology-Based Interventions for Substance Use Treatment Among People Who Identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native: Scoping Review
%A Moore,Sarah K
%A Boggis,Jesse S
%A Gauthier,Phoebe R
%A Lambert-Harris,Chantal A
%A Hichborn,Emily G
%A Bell,Kathleen D
%A Saunders,Elizabeth C
%A Montgomery,LaTrice
%A Murphy,Eilis I
%A Turner,Avery M
%A Agosti,Nico
%A McLeman,Bethany M
%A Marsch,Lisa A
%+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, United States, 1 19176789280, sarah.k.moore@dartmouth.edu
%K technology-based interventions
%K substance use
%K treatment
%K health equity
%K underrepresented
%K scoping review
%K mobile phone
%D 2024

%7 3.12.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. Objective: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. Methods: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups. Results: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. Conclusions: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity. 
%M 39626234
%R 10.2196/53685
%U https://www.jmir.org/2024/1/e53685
%U https://doi.org/10.2196/53685
%U http://www.ncbi.nlm.nih.gov/pubmed/39626234

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e57009
%T The Role of Health in the Technology Acceptance Model Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis
%A DeLange Martinez,Pauline
%A Tancredi,Daniel
%A Pavel,Misha
%A Garcia,Lorena
%A Young,Heather M
%+ Betty Irene Moore School of Nursing, University of California, Davis, 2750 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu
%K aged
%K older adults
%K Asian American
%K immigrant
%K vulnerable populations
%K internet
%K information and communications technology
%K ICT
%K digital divide
%K technology acceptance model
%K mobile phone
%D 2024

%7 3.12.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Self-rated health is associated with information and communications technology (ICT) use among older adults. Non–US born, older Asian American individuals are more inclined to rate their health as fair or poor compared to individuals from other racial and ethnic backgrounds. This population is also less likely to use ICTs as compared to White older Americans. Furthermore, cognitive decline may impact technology acceptance. In a previous adaptation of the technology acceptance model for low-income, Asian American older adults, perceived usefulness (PU), perceived ease of use (PEOU), age, educational attainment, ethnicity, and English proficiency were significant predictors of ICT use. However, the association between health and technology acceptance has not been explored among Asian American older adults. Objective: This study examined the role of self-rated health and subjective cognitive decline in the acceptance and use of ICTs among low-income, Asian American older adults. Methods: This cross-sectional survey included Asian American individuals aged ≥62 years living in affordable housing for older adults (N=392). Using hierarchical multiple regression, we explored the association between self-rated health and ICT use and technology acceptance model mediators (PU and PEOU) while adjusting for demographics, English proficiency, and subjective cognitive decline. Contrast statements were used to estimate contrasts of interest. To further examine the separate and joint association between age and subjective cognitive decline and the dependent variables, we examined scatterplots with locally estimated scatterplot smoothing lines, revealing that the relationship between subjective cognitive decline and ICT use varied in 3 age segments, which led to updating our analysis to estimate differences in ICT use among age categories with and without subjective cognitive decline. Results: Self-rated health was not significantly associated with ICT use (β=.087; P=.13), PU (β=.106; P=.10), or PEOU (β=.062; P=.31). However, the interaction terms of subjective cognitive decline and age significantly improved the model fit for ICT use (ΔR2=0.011; P=.04). In reviewing scatterplots, we determined that, in the youngest age group (62-74 years), ICT use increased with subjective cognitive decline, whereas in the older age groups (75-84 and ≥85 years), ICT use decreased with subjective cognitive decline, more so in the oldest age category. Through regression analysis, among participants with subjective cognitive decline, ICT use significantly decreased in the middle and older age groups as compared to the youngest age group. However, among participants without subjective cognitive decline, the difference in use among age groups was not significant. Conclusions: This study contributes to the understanding of the complex relationship between health and ICT acceptance among low-income, Asian American older adults and suggests the need for tailored interventions to promote digital engagement and quality of life for this population. 
%M 39625744
%R 10.2196/57009
%U https://formative.jmir.org/2024/1/e57009
%U https://doi.org/10.2196/57009
%U http://www.ncbi.nlm.nih.gov/pubmed/39625744

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e64380
%T Public Perception on Artificial Intelligence–Driven Mental Health Interventions: Survey Research
%A Varghese,Mahima Anna
%A Sharma,Poonam
%A Patwardhan,Maitreyee
%+ Department of Social Science and Language, Vellore Institute of Technology, Vellore Campus, Tiruvalam Road, Vellore, 632014, India, 91 9702872251, poonam.sharma@vit.ac.in
%K public perception
%K artificial intelligence
%K AI
%K AI-driven
%K human-driven
%K mental health inteventions
%K mental health stigma
%K trust in AI
%K public perception
%K digital health
%K India
%K mobile phone
%D 2024

%7 28.11.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Artificial intelligence (AI) has become increasingly important in health care, generating both curiosity and concern. With a doctor-patient ratio of 1:834 in India, AI has the potential to alleviate a significant health care burden. Public perception plays a crucial role in shaping attitudes that can facilitate the adoption of new technologies. Similarly, the acceptance of AI-driven mental health interventions is crucial in determining their effectiveness and widespread adoption. Therefore, it is essential to study public perceptions and usage of existing AI-driven mental health interventions by exploring user experiences and opinions on their future applicability, particularly in comparison to traditional, human-based interventions. Objective: This study aims to explore the use, perception, and acceptance of AI-driven mental health interventions in comparison to traditional, human-based interventions. Methods: A total of 466 adult participants from India voluntarily completed a 30-item web-based survey on the use and perception of AI-based mental health interventions between November and December 2023. Results: Of the 466 respondents, only 163 (35%) had ever consulted a mental health professional. Additionally, 305 (65.5%) reported very low knowledge of AI-driven interventions. In terms of trust, 247 (53%) expressed a moderate level of Trust in AI-Driven Mental Health Interventions, while only 24 (5.2%) reported a high level of trust. By contrast, 114 (24.5%) reported high trust and 309 (66.3%) reported moderate Trust in Human-Based Mental Health Interventions; 242 (51.9%) participants reported a high level of stigma associated with using human-based interventions, compared with only 50 (10.7%) who expressed concerns about stigma related to AI-driven interventions. Additionally, 162 (34.8%) expressed a positive outlook toward the future use and social acceptance of AI-based interventions. The majority of respondents indicated that AI could be a useful option for providing general mental health tips and conducting initial assessments. The key benefits of AI highlighted by participants were accessibility, cost-effectiveness, 24/7 availability, and reduced stigma. Major concerns included data privacy, security, the lack of human touch, and the potential for misdiagnosis. Conclusions: There is a general lack of awareness about AI-driven mental health interventions. However, AI shows potential as a viable option for prevention, primary assessment, and ongoing mental health maintenance. Currently, people tend to trust traditional mental health practices more. Stigma remains a significant barrier to accessing traditional mental health services. Currently, the human touch remains an indispensable aspect of human-based mental health care, one that AI cannot replace. However, integrating AI with human mental health professionals is seen as a compelling model. AI is positively perceived in terms of accessibility, availability, and destigmatization. Knowledge and perceived trustworthiness are key factors influencing the acceptance and effectiveness of AI-driven mental health interventions. 
%M 39607994
%R 10.2196/64380
%U https://formative.jmir.org/2024/1/e64380
%U https://doi.org/10.2196/64380
%U http://www.ncbi.nlm.nih.gov/pubmed/39607994

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e57612
%T Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia
%A Yi,Siyan
%A Yam,Esabelle Lo Yan
%A Cheruvettolil,Kochukoshy
%A Linos,Eleni
%A Gupta,Anshika
%A Palaniappan,Latha
%A Rajeshuni,Nitya
%A Vaska,Kiran Gopal
%A Schulman,Kevin
%A Eggleston,Karen N
%+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 6914, siyan@nus.edu.sg
%K digital health innovations
%K public health
%K South and Southeast Asia
%K health care challenges
%K low- and middle-income countries
%K LMICs
%K global health
%K health AI
%K artificial intelligence
%K public health responses
%K global health contexts
%K digital health
%D 2024

%7 25.11.2024
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or “marketplace” of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia—including the importance of local partnerships—may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts.
%M 39586089
%R 10.2196/57612
%U https://www.jmir.org/2024/1/e57612
%U https://doi.org/10.2196/57612
%U http://www.ncbi.nlm.nih.gov/pubmed/39586089

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e52498
%T Technology Acceptance Among Low-Income Asian American Older Adults: Cross-Sectional Survey Analysis
%A DeLange Martinez,Pauline
%A Tancredi,Daniel
%A Pavel,Misha
%A Garcia,Lorena
%A Young,Heather M
%+ Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th St, Sacramento, CA, 95817, United States, 1 916 426 2862, pdmartinez@ucdavis.edu
%K aged
%K older adults
%K Asian American
%K immigrant
%K vulnerable populations
%K internet
%K information and communications technology
%K ICT
%K digital divide
%K technology acceptance model
%K mobile phone
%D 2024

%7 22.11.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Studies show that the use of information and communications technologies (ICTs), including smartphones, tablets, computers, and the internet, varies by demographic factors such as age, gender, and educational attainment. However, the connections between ICT use and factors such as ethnicity and English proficiency, especially among Asian American older adults, remain less explored. The technology acceptance model (TAM) suggests that 2 key attitudinal factors, perceived usefulness (PU) and perceived ease of use (PEOU), influence technology acceptance. While the TAM has been adapted for older adults in China, Taiwan, Singapore, and Korea, it has not been tested among Asian American older adults, a population that is heterogeneous and experiences language barriers in the United States. Objective: This study aims to examine the relationships among demographics (age, gender, educational attainment, ethnicity, and English proficiency), PU, PEOU, and ICT use among low-income Asian American older adults. Two outcomes were examined: smartphone use and ICT use, each measured by years of experience and current frequency of use. Methods: This was a secondary data analysis from a cross-sectional baseline survey of the Lighthouse Project, which provided free broadband, ICT devices, and digital literacy training to residents living in 8 affordable senior housing communities across California. This analysis focused on Asian participants aged ≥62 years (N=392), specifically those of Korean, Chinese, Vietnamese, Filipino, and other Asian ethnicities (eg, Hmong and Japanese). Hypotheses were examined using descriptive statistics, correlation analysis, and hierarchical regression analysis. Results: Younger age, higher education, and greater English proficiency were positively associated with smartphone use (age: β=–.202; P<.001; education: β=.210; P<.001; and English proficiency: β=.124; P=.048) and ICT use (age: β=–.157; P=.002; education: β=.215; P<.001; and English proficiency: β=.152; P=.01). Male gender was positively associated with PEOU (β=.111; P=.047) but not with PU (β=–.031; P=.59), smartphone use (β=.023; P=.67), or ICT use (β=.078; P=.16). Ethnicity was a significant predictor of PU (F4,333=5.046; P<.001), PEOU (F4,345=4.299; P=.002), and ICT use (F4,350=3.177; P=.01), with Chinese participants reporting higher levels than Korean participants, who were the reference group (β=.143; P=.007). PU and PEOU were positively correlated with each other (r=0.139, 95% CI=0.037-0.237; P=.007), and both were significant predictors of smartphone use (PU: β=.158; P=.002 and PEOU: β=.166; P=.002) and ICT use (PU: β=.117; P=.02 and PEOU: β=0.22; P<.001), even when controlling for demographic variables. Conclusions: The findings support the use of the TAM among low-income Asian American older adults. In addition, ethnicity and English proficiency are significant predictors of smartphone and ICT use among this population. Future interventions should consider heterogeneity and language barriers of this population to increase technology acceptance and use. 
%M 39576987
%R 10.2196/52498
%U https://www.jmir.org/2024/1/e52498
%U https://doi.org/10.2196/52498
%U http://www.ncbi.nlm.nih.gov/pubmed/39576987

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e47311
%T Cybersecurity Interventions in Health Care Organizations in Low- and Middle-Income Countries: Scoping Review
%A Hasegawa,Kaede
%A O'Brien,Niki
%A Prendergast,Mabel
%A Ajah,Chris Agape
%A Neves,Ana Luisa
%A Ghafur,Saira
%+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk
%K computer security
%K internet security
%K network security
%K digital health
%K digital health technology
%K cybersecurity
%K health data
%K global health
%K security
%K data science
%K LMIC
%K low income
%K low resource
%K scoping review
%K review methodology
%K implementation
%K barrier
%K facilitator
%D 2024

%7 20.11.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. 
%M 39566062
%R 10.2196/47311
%U https://www.jmir.org/2024/1/e47311
%U https://doi.org/10.2196/47311
%U http://www.ncbi.nlm.nih.gov/pubmed/39566062

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e58873
%T The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial
%A Jing,Shu
%A Wu,Yijin
%A Dai,Zhenwei
%A Tang,Shenglan
%A Su,Xiaoyou
%A Qiao,Youlin
%+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China, 86 65105830, suxiaoyou@hotmail.com
%K human papillomavirus
%K HPV
%K HPV vaccine
%K vaccine hesitancy
%K information-motivation-behavioral skills model
%K HPV vaccination rate
%K randomized controlled trial
%K vaccination rate
%K China
%D 2024

%7 19.11.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. Objective: This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. Methods: A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. Results: The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. Conclusions: This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9 International Registered Report Identifier (IRRID): PRR1-10.2196/58873 
%M 39560975
%R 10.2196/58873
%U https://www.researchprotocols.org/2024/1/e58873
%U https://doi.org/10.2196/58873
%U http://www.ncbi.nlm.nih.gov/pubmed/39560975

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e58624
%T Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia
%A Reynolds,Christopher W
%A Lee,HaEun
%A Sieka,Joseph
%A Perosky,Joseph
%A Lori,Jody R
%+ University of Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, United States, 1 302 377 9925, chwre@med.umich.edu
%K mHealth
%K mobile triage
%K referral pathways
%K Liberia
%K LMIC
%K low- income country
%K obstetric triage
%K third delay
%K mobile health
%K mobile application
%K digital health
%K digital intervention
%K smartphone
%K middle-income country
%D 2024

%7 13.11.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61%), nurses (20/62, 32%), physicians assistants (3/62, 5%), and physicians (1/62, 2%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92%), increasing health worker attentiveness (39/62, 63%), and contributing to improved patient care (34/62, 55%). MORES was perceived as sustainable and scalable (62/62, 100%), particularly if technological barriers (21/62, 34%) and staff training (19/62, 31%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89%), feedback mechanisms for hospitals and RHFs (48/62, 77%), interprofessional teamwork (21/62, 34%), longitudinal follow-up care (20/62, 32%), creating a record of care delays (17/62, 27%), and electronic health record infrastructure (13/62, 21%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. 
%M 39536307
%R 10.2196/58624
%U https://mhealth.jmir.org/2024/1/e58624
%U https://doi.org/10.2196/58624
%U http://www.ncbi.nlm.nih.gov/pubmed/39536307

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e48664
%T Using School-Based Teleconsultation Services to Make Community Health Services Accessible in Semirural Settings of Pakistan: Sequential Explanatory Mixed Methods Study
%A Gulzar,Saleema
%A Rahim,Shirin
%A Dossa,Khadija
%A Saeed,Sana
%A Agha,Insiyah
%A Khoja,Shariq
%A Karmaliani,Rozina
%+ School of Nursing and Midwifery, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3332356678, saleema.gulzar@aku.edu
%K teleconsultation
%K digital health
%K school health
%K child health
%K information technology
%K eConsultation
%K telehealth
%D 2024

%7 12.11.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: In Pakistan’s remote areas, quality health care and experienced professionals are scarce. Telehealth can bridge this gap by offering innovative services like teleconsultations. Schools can serve as effective platforms for introducing these services, significantly improving health service access in semirural communities. Objective: This study aims to explore the feasibility of introducing school-based teleconsultation services (TCS) to strengthen community health in a semirural area of Karachi, Pakistan. Methods: This study used a mixed methods design. A total of 393 students were enrolled for the quantitative component, while 35 parents, teachers, and community stakeholders participated in the qualitative arm (focused group discussion). Proportional computation for the quantitative data was done using SPSS (version 24; IBM Corp), while qualitative data underwent thematic analysis. Results: A total of 1046 successful teleconsultations were provided for 393 students over 28 months. The demographic data showed that the mean age of the students availing TCS was 9.24 (SD 3.25) years, with the majority being males (59.3%, 233/393). Only 1.24% (13/1046) of cases required referrals. The qualitative analysis yielded three themes: (1) transformation of the health care experience, (2) escalating demands for teleconsultation, and (3) the psychological aspect of care. Conclusions: This study demonstrated the efficacy of integrating TCS in a semiurban school in Karachi to address health care accessibility gaps. Implementing TCS through the school platform improved the overall health status of school children while reducing school absences and financial burdens on families. The study highlighted TCS’s cost-effectiveness, time efficiency, and quality, with community support for 24/7 availability, expansion to adults, and a reimbursement model. School health nurse-led TCS offers a scalable solution to health care challenges, enhancing health outcomes for school-going children in Pakistan and globally, particularly in low- and middle-income countries, where accessibility is a major issue. 
%M 39531262
%R 10.2196/48664
%U https://formative.jmir.org/2024/1/e48664
%U https://doi.org/10.2196/48664
%U http://www.ncbi.nlm.nih.gov/pubmed/39531262

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59873
%T The CHALO! 2.0 mHealth-Based Multilevel Intervention to Promote HIV Testing and Linkage-to-Care Among Men Who Have Sex with Men in Mumbai, India: Protocol for a Randomized Controlled Trial
%A Chaudary,Jatin
%A Rawat,Shruta
%A Dange,Alpana
%A Golub,Sarit A
%A Kim,Ryung S
%A Chakrapani,Venkatesan
%A Mayer,Kenneth H
%A Arnsten,Julia
%A Patel,Viraj V
%+ Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 111 E 210th Street, Bronx, NY, 10467, United States, 1 718 920 4321, viraj.patel@einsteinmed.edu
%K Keywords: digital health
%K HIV prevention
%K social media
%K stigma
%K gay
%K men who have sex with men
%K MSM
%D 2024

%7 5.11.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Current programs to engage marginalized populations such as gay and bisexual individuals and other men who have sex with men (MSM) in HIV prevention interventions do not often reach all MSM who may benefit from them. To reduce the global burden of HIV, far-reaching strategies are needed to engage MSM in HIV prevention and treatment. Globally, including low- and middle-income countries, MSM are now widely using internet-based social and mobile technologies (SMTs; eg, dating apps, social media, and WhatsApp [Meta]), which provides an unprecedented opportunity to engage unreached and underserved groups, such as MSM for HIV prevention and care. Objective: This study aimed to assess the effectiveness of a multilevel mobile health (mHealth)–based intervention to improve HIV testing uptake and status neutral linkage-to-care among sexually active MSM reached through internet-based platforms in Mumbai, India. Methods: In this randomized controlled trial, we will determine whether CHALO! 2.0 (a theory-based multilevel intervention delivered in part through WhatsApp) results in increased HIV testing and linkage-to-care (prevention or treatment). This study is being conducted among 1000 sexually active MSM who are unaware of their HIV status (never tested or tested >6 months ago) and are recruited through SMTs in Mumbai, India. We will conduct a 12-week, 3-arm randomized trial comparing CHALO! 2.0 to 2 control conditions—an attention-matched SMT-based control (also including a digital coupon for free HIV testing) and a digital coupon–only control. The primary outcomes will be HIV testing and status neutral linkage-to-care by 6 months post enrollment. Participants will be followed up for a total of 18 months to evaluate the long-term impact. Results: The study was funded in 2020, with recruitment having started in April 2022 due to delays from the COVID-19 pandemic. Baseline survey data collection began in April 2022, with follow-up surveys starting in July 2022. As of April 2022, we enrolled 1004 participants in the study. The completion of follow-up data collection is expected in January 2025, with results to be published thereafter. Conclusions: While global health agencies have called for internet-based interventions to engage populations vulnerable to HIV who are not being reached, few proven effective and scalable models exist and none is in India, which has one of the world’s largest HIV epidemics. This study will address this gap by testing a multicomponent mHealth intervention to reach and engage MSM at high priority for HIV interventions and link them to HIV testing and prevention or treatment. Trial Registration: ClinicalTrials.gov NCT04814654; https://clinicaltrials.gov/study/NCT04814654. Clinical Trial Registry of India CTRI/2021/03/032280 International Registered Report Identifier (IRRID): DERR1-10.2196/59873 
%M 39499921
%R 10.2196/59873
%U https://www.researchprotocols.org/2024/1/e59873
%U https://doi.org/10.2196/59873
%U http://www.ncbi.nlm.nih.gov/pubmed/39499921

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e51527
%T Implementation of a Mobile Health Approach to a Long-Lasting Insecticidal Net Uptake Intervention for Malaria Prevention Among Pregnant Women in Tanzania: Process Evaluation of the Hati Salama (HASA) Randomized Controlled Trial Study
%A Vey,Trinity
%A Kinnicutt,Eleonora
%A West,Nicola
%A Sleeth,Jessica
%A Nchimbi,Kenneth Bernard
%A Yeates,Karen
%+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3P5, Canada, 1 6135332000, 16tv7@queensu.ca
%K mHealth
%K short message service
%K behavior change communication
%K pregnancy
%K long-lasting insecticidal nets
%K malaria
%K protozoan infections
%K parasitic diseases
%K vector borne diseases
%K insecticide
%K intervention
%K malaria prevention
%D 2024

%7 5.11.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Malaria infection is associated with many adverse outcomes for pregnant women and neonates, yet pregnant women in East and Southern Africa remain frequently exposed to malaria. Long-lasting insecticidal nets (LLINs) can help prevent malarial infections and the associated adverse events. The Hati Salama (HASA) study was a cluster-randomized controlled trial implemented in 100 antenatal health facilities in urban and rural settings of Tanzania that provided pregnant women in both intervention and control groups with e-vouchers to redeem for LLINs for malaria prevention. The intervention group received behavior change communication mobile messages across a 14-day period while the e-voucher was active, and no significant difference between the rates of e-voucher redemption was found across the two groups. Objective: This study was a process evaluation of the HASA randomized controlled trial to determine barriers and facilitators to e-voucher reception and LLIN acquisition for pregnant women enrolled in the trial, as well as challenges and lessons learned by nurses who worked at the antenatal health facilities supporting the trial. Methods: Following the e-voucher’s expiration at 14 days, voluntary phone follow-up surveys were conducted for nurses who supported the trial, as well as participants in both intervention and control groups of the trial who did not redeem their e-vouchers. Survey questions asked nurses about workflow, training sessions, network connectivity, proxy phone use, and more. Surveys asked participants about reasons for not redeeming e-vouchers. Both surveys provided lists of preset answers to questions, as well as the option to provide open-ended responses. Nurses and trial participants were contacted between January and June 2016 on up to three occasions. Results: While nurses who supported the HASA trial seemed to recognize the value of the program in their communities, some barriers identified by nurses included network connectivity, workload increase, inadequate training and on-the-ground support, and difficulty following the workflow. Several barriers identified by trial participants included personal obligations preventing them from redeeming the e-voucher on time, network connectivity issues, losing the e-voucher number, no stock of LLINs at retailers when attended, inadequate explanation of where or how to redeem the e-voucher, or not receiving an SMS text message with the e-voucher number promptly or at all. Conclusions: Large-scale e-voucher platforms for health-related commodity interventions, such as LLIN distribution in sub-Saharan Africa, are feasible, but challenges, including network connectivity, must be addressed. Nurses identified issues to be considered in a future scale-up, such that the number of nurses trained should be increased and the e-voucher issuance workflow should be simplified. To address some of the key barriers impacting e-voucher redemption for trial participants, the network of retailers could be expanded and the e-voucher expiration period should be extended. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 
%M 39499551
%R 10.2196/51527
%U https://www.jmir.org/2024/1/e51527
%U https://doi.org/10.2196/51527
%U http://www.ncbi.nlm.nih.gov/pubmed/39499551

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e52557
%T Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island
%A Reynaud,Danielle
%A Bouscaren,Nicolas
%A Cartron,Emmanuelle
%A Marimoutou,Catherine
%K sexual health
%K adolescent
%K young adults
%K web application
%K contraception prescription
%K contraception
%K teleconsultation
%K telemedicine
%K youth
%K usage
%K e-consultation
%K web based
%D 2024

%7 1.11.2024
%9 
%J JMIR Pediatr Parent
%G English
                
%X Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. 
%R 10.2196/52557
%U https://pediatrics.jmir.org/2024/1/e52557
%U https://doi.org/10.2196/52557

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e51376
%T Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review
%A Wani,Carolina
%A McCann,Lisa
%A Lennon,Marilyn
%A Radu,Caterina
%+ Department of Computer and Information Sciences, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3189, carolina.wani@strath.ac.uk
%K adolescents
%K mental health
%K low- and middle-income countries
%K LMICs
%K digital mental health interventions
%K DMHIs
%K cultural appropriateness
%K implementation
%K design
%K evaluation
%K mobile phone
%D 2024

%7 29.10.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations’ Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. Objective: This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. Methods: The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. Results: We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. Conclusions: While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this. 
%M 39471371
%R 10.2196/51376
%U https://www.jmir.org/2024/1/e51376
%U https://doi.org/10.2196/51376
%U http://www.ncbi.nlm.nih.gov/pubmed/39471371

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e54710
%T Implications of Big Data Analytics, AI, Machine Learning, and Deep Learning in the Health Care System of Bangladesh: Scoping Review
%A Alam,Md Ashraful
%A Sajib,Md Refat Uz Zaman
%A Rahman,Fariya
%A Ether,Saraban
%A Hanson,Molly
%A Sayeed,Abu
%A Akter,Ema
%A Nusrat,Nowrin
%A Islam,Tanjeena Tahrin
%A Raza,Sahar
%A Tanvir,K M
%A Chisti,Mohammod Jobayer
%A Rahman,Qazi Sadeq-ur
%A Hossain,Akm
%A Layek,MA
%A Zaman,Asaduz
%A Rana,Juwel
%A Rahman,Syed Moshfiqur
%A Arifeen,Shams El
%A Rahman,Ahmed Ehsanur
%A Ahmed,Anisuddin
%+ Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset 751 85, Uppsala, 751 85, Sweden, 46 73 041 98 48, anisuddin.ahmed@kbh.uu.se
%K machine learning
%K deep learning
%K artificial intelligence
%K big data analytics
%K public health
%K health care
%K mobile phone
%K Bangladesh
%D 2024

%7 28.10.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: The rapid advancement of digital technologies, particularly in big data analytics (BDA), artificial intelligence (AI), machine learning (ML), and deep learning (DL), is reshaping the global health care system, including in Bangladesh. The increased adoption of these technologies in health care delivery within Bangladesh has sparked their integration into health care and public health research, resulting in a noticeable surge in related studies. However, a critical gap exists, as there is a lack of comprehensive evidence regarding the research landscape; regulatory challenges; use cases; and the application and adoption of BDA, AI, ML, and DL in the health care system of Bangladesh. This gap impedes the attainment of optimal results. As Bangladesh is a leading implementer of digital technologies, bridging this gap is urgent for the effective use of these advancing technologies. Objective: This scoping review aims to collate (1) the existing research in Bangladesh’s health care system, using the aforementioned technologies and synthesizing their findings, and (2) the limitations faced by researchers in integrating the aforementioned technologies into health care research. Methods: MEDLINE (via PubMed), IEEE Xplore, Scopus, and Embase databases were searched to identify published research articles between January 1, 2000, and September 10, 2023, meeting the following inclusion criteria: (1) any study using any of the BDA, AI, ML, and DL technologies and health care and public health datasets for predicting health issues and forecasting any kind of outbreak; (2) studies primarily focusing on health care and public health issues in Bangladesh; and (3) original research articles published in peer-reviewed journals and conference proceedings written in English. Results: With the initial search, we identified 1653 studies. Following the inclusion and exclusion criteria and full-text review, 4.66% (77/1653) of the articles were finally included in this review. There was a substantial increase in studies over the last 5 years (2017-2023). Among the 77 studies, the majority (n=65, 84%) used ML models. A smaller proportion of studies incorporated AI (4/77, 5%), DL (7/77, 9%), and BDA (1/77, 1%) technologies. Among the reviewed articles, 52% (40/77) relied on primary data, while the remaining 48% (37/77) used secondary data. The primary research areas of focus were infectious diseases (15/77, 19%), noncommunicable diseases (23/77, 30%), child health (11/77, 14%), and mental health (9/77, 12%). Conclusions: This scoping review highlights remarkable progress in leveraging BDA, AI, ML, and DL within Bangladesh’s health care system. The observed surge in studies over the last 5 years underscores the increasing significance of AI and related technologies in health care research. Notably, most (65/77, 84%) studies focused on ML models, unveiling opportunities for advancements in predictive modeling. This review encapsulates the current state of technological integration and propels us into a promising era for the future of digital Bangladesh. 
%M 39466315
%R 10.2196/54710
%U https://www.jmir.org/2024/1/e54710
%U https://doi.org/10.2196/54710
%U http://www.ncbi.nlm.nih.gov/pubmed/39466315

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e56693
%T Brief Mobile App–Based Mindfulness Intervention for Indonesian Senior High School Teachers: Protocol for a Pilot Randomized Controlled Trial
%A Dantes,Gede Rasben
%A Asril,Nice Maylani
%A Liem,Andrian
%A Suwastini,Ni Komang Arie
%A Keng,Shian-Ling
%A Mahayanti,Ni Wayan Surya
%+ Faculty of Education, Universitas Pendidikan Ganesha, Jalan Udayana No 11, Singaraja, Bali, 81116, Indonesia, 62 82145158155, nicemaylani.asril@undiksha.ac.id
%K digital mental health
%K telemedicine
%K anxiety
%K stress
%K self-efficacy
%K life satisfaction
%K self-compassion
%K mindfulness
%K feasibility study
%K mobile app
%K mindfulness-based stress reduction
%K stress management
%D 2024

%7 23.10.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The COVID-19 pandemic has increased the level of anxiety among Indonesian senior high school teachers, who face challenges to treat their mental disorder symptoms that arise during their working hours, as mental health services in Indonesia are limited. Therefore, it is vital to equip schoolteachers in Indonesia with early interventions that are easily available, private, and affordable, and 1 feasible approach is to deploy a smartphone mobile app. Objective: The objectives of this study are (1) to evaluate the feasibility of a brief mindfulness–based mobile app (BM-MA) for Indonesian senior high school teachers experiencing anxiety and stress and (2) to examine the effects of using the BM-MA on anxiety, stress, life satisfaction, self-efficacy, trait mindfulness, self-compassion, and physical and social dysfunction among the participants. Methods: We followed the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement for this feasibility randomized controlled trial (RCT) protocol. A total of 60 Indonesian senior high school teachers were recruited for this study and randomly assigned to either the intervention group (BM-MA) or a wait-list control group (CG) in a 1:1 ratio. The BM-MA group was required to engage in mindfulness practices using the app for 10-20 minutes per day for 3 weeks. All participants were assessed with a battery of self-report measures at baseline, postintervention, and at 1-month follow-up. Validated scales used to measure the outcome variables of interest included the Satisfaction With Life Scale (SLS), the Teachers’ Sense of Efficacy Scale (TSES), the Self-Compassion Scale—Short Form (SCS-SF), Generalized Anxiety Disorder-7 (GAD-7), General Health Questionnaire-12 (GHQ-12), and the Five Facet Mindfulness Questionnaire (FFMQ). The practicality and acceptability of the app will be evaluated using the Client Satisfaction Questionnaire-8 (CSQ-8) and structured qualitative interviews. Data from the interviews will be analyzed with the deductive thematic analysis framework as a process of qualitative inquiry. Repeated measures ANOVA with groups (intervention vs control) as a between-subject factor and time as a within-subject factor (baseline, postintervention, and 1-month follow-up) will be used to examine the effects of the BM-MA on the outcome variables. The data will be analyzed using an intent-to-treat approach and published in accordance with CONSORT (Consolidated Standards of Reporting Trials) recommendations. Results: Participants were recruited in December 2023, and this pilot RCT was conducted from January through March 2024. Data analysis was conducted from March through May 2024. The results of this study are expected to be published in December 2024. The trial registration of this protocol was submitted to the Chinese Clinical Trial Registry. Conclusions: This study aims to determine the feasibility and efficacy of the BM-MA, a digital mental health intervention developed using an existing mindfulness-based app, and assess its potential for widespread use. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300068085; https://tinyurl.com/2d2x4bxk International Registered Report Identifier (IRRID): DERR1-10.2196/56693 
%M 39442169
%R 10.2196/56693
%U https://www.researchprotocols.org/2024/1/e56693
%U https://doi.org/10.2196/56693
%U http://www.ncbi.nlm.nih.gov/pubmed/39442169

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e58720
%T Toward a Clinical Decision Support System for Monitoring Therapeutic Antituberculosis Medical Drugs in Tanzania (Project TuberXpert): Protocol for an Algorithm' Development and Implementation
%A Thoma,Yann
%A Cathignol,Annie E
%A Pétermann,Yuan J
%A Sariko,Margaretha L
%A Said,Bibie
%A Csajka,Chantal
%A Guidi,Monia
%A Mpagama,Stellah G
%+ School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, route de Cheseaux 1, Yverdon-les-Bains, 1401, Switzerland, 41 245576273, yann.thoma@heig-vd.ch
%K TDM
%K therapeutic drug monitoring
%K pharmacometrics
%K tuberculosis
%K model-informed precision dosing software
%K clinical pharmacology
%K clinical decision support system
%K Tanzania
%K mobile phone
%D 2024

%7 21.10.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The end tuberculosis (TB) strategy requires a novel patient treatment approach contrary to the one-size-fits-all model. It is well known that each patient’s physiology is different and leads to various rates of drug elimination. Therapeutic drug monitoring (TDM) offers a way to manage drug dosage adaptation but requires trained pharmacologists, which is scarce in resource-limited settings. Objective: We will develop an automated clinical decision support system (CDSS) to help practitioners with the dosage adaptation of rifampicin, one of the essential medical drugs targeting TB, that is known for large pharmacokinetic variability and frequent suboptimal blood exposure. Such an advanced system will encourage the spread of a dosage-individualization culture, including among practitioners not specialized in pharmacology. Thus, the objectives of this project are to (1) develop the appropriate population pharmacokinetic (popPK) model for rifampicin for Tanzanian patients, (2) optimize the reporting of relevant information to practitioners for drug dosage adjustment, (3) automate the delivery of the report in line with the measurement of drug concentration, and (4) validate and implement the final system in the field. Methods: A total of 3 teams will combine their efforts to deliver the first automated TDM CDSS for TB. A cross-sectional study will be conducted to define the best way to display information to clinicians. In parallel, a rifampicin popPK model will be developed taking advantage of the published literature, complemented with data provided by existing literature data from the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (panACEA), and samples collected within this project. A decision tree will be designed and implemented as a CDSS, and an automated report generation will be developed and validated through selected case studies. Expert pharmacologists will validate the CDSS, and finally, field implementation in Tanzania will occur, coupled with a prospective study to assess clinicians’ adherence to the CDSS recommendations. Results: The TuberXpert project started in November 2022. In July 2024, the clinical study in Tanzania was completed with the enrollment of 50 patients to gather the required data to build a popPK model for rifampicin, together with a qualitative study defining the report design, as well as the CDSS general architecture definition. Conclusions: At the end of the TuberXpert project, Tanzania will possess a new tool to help the practitioners with the adaptation of drug dosage targeting complicated TB cases (TB or HIV, TB or diabetes mellitus, and TB or malnutrition). This automated system will be validated and used in the field and will be proposed to other countries affected by endemic TB. In addition, this approach will serve as proof of concept regarding the feasibility and suitability of CDSS-assisted TDM for further anti-TB drugs in TB-burdened areas deprived of TDM experts, including second-line treatments considered important to monitor. International Registered Report Identifier (IRRID): DERR1-10.2196/58720 
%M 39432902
%R 10.2196/58720
%U https://www.researchprotocols.org/2024/1/e58720
%U https://doi.org/10.2196/58720
%U http://www.ncbi.nlm.nih.gov/pubmed/39432902

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59423
%T Development and Testing of a Mobile App for Management of Gestational Diabetes in Nepal: Protocol for a User-Centered Design Study and Exploratory Randomized Controlled Trial
%A Berube,Lauren T
%A Shrestha,Archana
%A Shrestha,Abha
%A Daneault,Jean-Francois
%A Shakya,Prabin Raj
%A Dhimal,Meghnath
%A Shrestha,Roman
%A Rawal,Shristi
%+ Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, 65 Bergen Street, Suite 157, Newark, NJ, 07107, United States, 1 9739722710, shristi.rawal@rutgers.edu
%K gestational diabetes mellitus
%K mobile health
%K mHealth
%K self-management
%K pregnancy
%K maternal and child health
%K South Asia
%K Nepal
%K low- and middle-income country
%K mobile phone
%D 2024

%7 21.10.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The prevalence of gestational diabetes mellitus (GDM) is increasing, particularly in low- and middle-income countries (LMICs) like Nepal. GDM self-management, including intensive dietary and lifestyle modifications and blood glucose monitoring, is critical to maintain glycemic control and prevent adverse outcomes. However, in resource-limited settings, several barriers hinder optimal self-management. Mobile health (mHealth) technology holds promise as a strategy to augment GDM treatment by promoting healthy behaviors and supporting self-management, but this approach has not yet been tested in any LMIC. Objective: This report describes the protocol to develop a culturally tailored mHealth app that supports self-management and treatment of GDM (GDM–Dhulikhel Hospital [GDM-DH] app, phase 1) and test its usability and preliminary efficacy (phase 2) among patients with GDM in a periurban hospital setting in Nepal. Methods: The study will be conducted at Dhulikhel Hospital in Dhulikhel, Nepal. In the development phase (phase 1), a prototype of the GDM-DH app will be developed based on expert reviews and a user-centered design approach. To understand facilitators and barriers to GDM self-management and to gather feedback on the prototype, focus groups and in-depth interviews will be conducted with patients with GDM (n=12), health care providers (n=5), and family members (n=3), with plans to recruit further if saturation is not achieved. Feedback will be used to build a minimum viable product, which will undergo user testing with 18 patients with GDM using a think-aloud protocol. The final GDM-DH app will be developed based on user feedback and following an iterative product design and user testing process. In the randomized controlled trial phase (phase 2), newly diagnosed patients with GDM (n=120) will be recruited and randomized to either standard care alone or standard care plus the GDM-DH app from 24-30 weeks gestation until delivery. In this proof-of-concept trial, feasibility outcomes will be app usage, self-monitoring adherence, and app usability and acceptability. Exploratory treatment outcomes will be maternal glycemic control at 6 weeks post partum, birth weight, and rates of labor induction and cesarean delivery. Qualitative data obtained from phase 1 will be analyzed using thematic analysis. In phase 2, independent 2-tailed t tests or chi-square analyses will examine differences in outcomes between the 2 treatment conditions. Results: As of July 2024, we have completed phase 1. Phase 2 is underway. The first participant was enrolled in October 2021, with 99 participants enrolled as of July 2024. We anticipate completing recruitment by December 2024 and disseminating findings by December 2025. Conclusions: App-based lifestyle interventions for GDM management are not common in LMICs, where GDM prevalence is rapidly increasing. This proof-of-concept trial will provide valuable insights into the potential of leveraging mHealth app–based platforms for GDM self-management in LMICs. Trial Registration: ClinicalTrials.gov NCT04198857; https://clinicaltrials.gov/study/NCT04198857 International Registered Report Identifier (IRRID): DERR1-10.2196/59423 
%M 39432898
%R 10.2196/59423
%U https://www.researchprotocols.org/2024/1/e59423
%U https://doi.org/10.2196/59423
%U http://www.ncbi.nlm.nih.gov/pubmed/39432898

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e50745
%T Feasibility, Acceptability, Satisfaction, and Challenges of an mHealth App (e-ASCov) for Community-Based COVID-19 Screening by Community Health Workers in Rwanda: Mixed Methods Study
%A Omorou,Abdou Y
%A Ndishimye,Pacifique
%A Hoen,Bruno
%A Mutesa,Léon
%A Karame,Prosper
%A Nshimiyimana,Ladislas
%A Galmiche,Simon
%A Mugabo,Hassan
%A Murayire,Janvier
%A Mugisha,Muco
%A Umulisa,Marie Michele
%A Uwera,Yvonne Delphine Nsaba
%A Musanagabanwa,Clarisse
%A Bigirimana,Noella
%A Nsanzimana,Sabin
%A Guillemin,Francis
%A Rwabihama,Jean Paul
%K community health workers
%K COVID-19 screening tool
%K COVID-19
%K SARS-CoV-2
%K screening
%K acceptability
%K feasibility
%K satisfaction
%K community based
%K LMIC
%K Africa
%K challenges
%K barriers
%K smartphone
%K proof-of-concept
%K mHealth
%K mobile health
%K apps
%K COVID-19 screening
%D 2024

%7 14.10.2024
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Although at the base of the pyramid-shaped organization of the Rwandan health system, community health workers (CHWs) are central to the community-based management of disease outbreaks. Objective: This mixed methods study aimed to explore the feasibility, acceptability, satisfaction, and challenges of a mobile health (mHealth) tool for community-based COVID-19 screening in Rwanda. Methods: Two urban (Gasabo and Nyarugenge) and 2 rural (Rusizi and Kirehe) districts in Rwanda participated in the project (smartphone app for COVID-19 screening). A mixed methods approach was used to inform the feasibility (awareness and expectation), acceptability (use and perceived benefits), satisfaction, and challenges of the mHealth intervention. At the end of the project, CHWs were asked to complete a quantitative questionnaire on the use of and satisfaction with the app. Then, in-depth interviews and focus group discussions were organized with CHWs. A content analysis was performed on the transcripts. Results: Overall, 383 CHWs were recruited and trained; 378 CHWs participated in the study. The mean age of CHWs was 36.7 (SD 6.6) to 45.3 (SD 9.9) years and most were women (237/378, 62.7%). More than 7000 people were registered with the use of the app and 20% were referred to a local COVID-19 testing facility. According to CHW reporting, the median number of people screened by each CHW ranged from 152 (IQR 70-276) for Nyarugenge to 24 (IQR 16-90) for Rusizi. COVID-19 positivity rates were higher in urban than rural districts: more than half of the CHWs in Gasabo reported a confirmed positive case versus only 2.4% for Kirehe and 15.4% for Rusizi. Despite the app being a novel tool, CHWs were well aware of the use of such a tool and had appropriate expectations. Acceptability and satisfaction were very high, with differences between urban and rural districts. Satisfaction was higher in Nyarugenge (72.8/100) and Gasabo (80.7/100) than in Kirehe (61.6/100) and Rusizi (64.5/100). More than 80% of the CHWs were willing to continue using the e-ASCov app, with the exception of CHWs in Kirehe (56.7%). The app was perceived as a tool to generate information on COVID-19, inform on the status of the pandemic, and help curb the spread of the pandemic in Rwanda. CHWs were satisfied with the app at all stages of its implementation in their districts. Conclusions: In this proof-of-concept study, a smartphone app for screening COVID-19 was useful as an mHealth tool to be used by CHWs, with the potential to increase health system efficiency in an epidemic context. The context should be analyzed for generalization on a country-wide scale, both in case of an epidemic and to take into account certain conditions at the community level. Information is needed on the conditions of generalization and transferability of this type of app to other health conditions so that CHWs can be given their full place in a pyramidal health system. 
%R 10.2196/50745
%U https://mhealth.jmir.org/2024/1/e50745
%U https://doi.org/10.2196/50745

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e44294
%T Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review
%A Oluokun,Emmanuel Oluwatosin
%A Adedoyin,Festus Fatai
%A Dogan,Huseyin
%A Jiang,Nan
%+ Department of Computing and Informatics, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot, Poole, BH12 5BB, United Kingdom, 44 01202 524111, eoluokun@bournemouth.ac.uk
%K digital interventions
%K medications delivery
%K phone-based intervention
%K tele and e-based intervention
%K West Africa
%K management, technology
%K intervention
%K medication
%K tool
%K smartphone
%D 2024

%7 9.10.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. Objective: This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. Methods: In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Results: Out of 29 studies, 16 (55%) studies examined phone-based interventions, 9 (31%) studies focused on tele- and e-based interventions, and 4 (14%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Conclusions: Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa. 
%M 39383531
%R 10.2196/44294
%U https://www.jmir.org/2024/1/e44294
%U https://doi.org/10.2196/44294
%U http://www.ncbi.nlm.nih.gov/pubmed/39383531

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e55208
%T Influenza-Like Illness in Lesotho From July 2020 to July 2021: Population-Based Participatory Surveillance Results
%A Greenleaf,Abigail R
%A Francis,Sarah
%A Zou,Jungang
%A Farley,Shannon M
%A Lekhela,Tšepang
%A Asiimwe,Fred
%A Chen,Qixuan
%K surveillance
%K participatory surveillance
%K influenza-like illness
%K COVID-19
%K cell phone
%K sub-Saharan Africa
%K population-based
%K Lesotho
%K SARS-CoV-2
%K technology
%K epidemiology
%K adult
%K data collection
%K innovation
%K mobile phone
%K cellphone
%D 2024

%7 8.10.2024
%9 
%J JMIR Public Health Surveill
%G English
                
%X Background: Participatory surveillance involves at-risk populations reporting their symptoms using technology. In Lesotho, a landlocked country of 2 million people in Southern Africa, laboratory and case-based COVID-19 surveillance systems were complemented by a participatory surveillance system called “LeCellPHIA” (Lesotho Cell Phone Population-Based HIV Impact Assessment Survey). Objective: This report describes the person, place, and time characteristics of influenza-like illness (ILI) in Lesotho from July 15, 2020, to July 15, 2021, and reports the risk ratio of ILI by key demographic variables. Methods: LeCellPHIA employed interviewers to call participants weekly to inquire about ILI. The average weekly incidence rate for the year-long period was created using a Quasi-Poisson model, which accounted for overdispersion. To identify factors associated with an increased risk of ILI, we conducted a weekly data analysis by fitting a multilevel Poisson regression model, which accounted for 3 levels of clustering. Results: The overall response rate for the year of data collection was 75%, which resulted in 122,985 weekly reports from 1776 participants. ILI trends from LeCellPHIA mirrored COVID-19 testing data trends, with an epidemic peak in mid to late January 2021. Overall, any ILI symptoms (eg, fever, dry cough, and shortness of breath) were reported at an average weekly rate of 879 per 100,000 (95% CI 782‐988) persons at risk. Compared to persons in the youngest age group (15‐19 years), all older age groups had an elevated risk of ILI, with the highest risk of ILI in the oldest age group (≥60 years; risk ratio 2.6, 95% CI 1.7‐3.8). Weekly data were shared in near real time with the National COVID-19 Secretariat and other stakeholders to monitor ILI trends, identify and respond to increases in reports of ILI, and inform policies and practices designed to reduce COVID-19 transmission in Lesotho. Conclusions: LeCellPHIA, an innovative and cost-effective system, could be replicated in countries where cell phone ownership is high but internet use is not yet high enough for a web- or app-based surveilance system. 
%R 10.2196/55208
%U https://publichealth.jmir.org/2024/1/e55208
%U https://doi.org/10.2196/55208

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e57703
%T Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study
%A Musheghyan,Lusine
%A Harutyunyan,Nika M
%A Sikder,Abu
%A Reid,Mark W
%A Zhao,Daniel
%A Lulejian,Armine
%A Dickhoner,James W
%A Andonian,Nicole T
%A Aslanyan,Lusine
%A Petrosyan,Varduhi
%A Sargsyan,Zhanna
%A Shekherdimian,Shant
%A Dorian,Alina
%A Espinoza,Juan C
%+ Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, BOX 205, Chicago, IL, 60611-2605, United States, 1 3125037603, jespinozasalomon@luriechildrens.org
%K COVID-19
%K remote patient monitoring
%K Armenia
%K web platform
%K home oxygen therapy
%K pandemic
%K global health care
%K low and middle-income countries
%K health care infrastructure
%K Yerevan
%K home monitoring
%K resource-constrained
%D 2024

%7 30.9.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program’s success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. 
%M 39348686
%R 10.2196/57703
%U https://publichealth.jmir.org/2024/1/e57703
%U https://doi.org/10.2196/57703
%U http://www.ncbi.nlm.nih.gov/pubmed/39348686

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e54304
%T Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study
%A Mutale,Jacob
%A Sikombe,Kombatende
%A Mwale,Boroma
%A Lumpa,Mwansa
%A Simbeza,Sandra
%A Bukankala,Chama
%A Mukamba,Njekwa
%A Mody,Aaloke
%A Beres,Laura K
%A Holmes,Charles B
%A Bolton Moore,Carolyn
%A Geng,Elvin H
%A Sikazwe,Izukanji
%A Pry,Jake M
%+ School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA, 95817, United States, 1 916 734 4800, jmpry@ucdavis.edu
%K mHealth
%K mobile health
%K survey
%K incentives
%K HIV
%K Zambia
%K airtime
%K USSD
%K unstructured supplementary service data
%K HIV care
%K pilot study
%K mobile phone
%K public health service
%K mobile health
%K urban
%K rural
%K regression model
%K longitudinal
%K mobile
%K patient feedback
%D 2024

%7 30.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia’s prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa. Objective: This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia. Methods: Participants were recruited from 2 study clinics–1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US $0.16), and (3) 5 ZMW (US $0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels. Results: A total of 1006 participants were enrolled, with 72.3% (727/1006) from the urban HIV care facility and 62.4% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1% (637/1992), with significantly different survey completion between the first (40.5%, 95% CI 37.4-43.6%) and second (23.7%, 95% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US $0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US $0.42 (72.8 ZMW [US $5.82] per 1% increase in response). Conclusions: We observed a sharp decline of almost 50% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia. Trial Registration: Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613 
%M 39348170
%R 10.2196/54304
%U https://www.jmir.org/2024/1/e54304
%U https://doi.org/10.2196/54304
%U http://www.ncbi.nlm.nih.gov/pubmed/39348170

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e48794
%T Mobile Phones and HIV Testing: Multicountry Instrumental Variable Analysis From Sub-Saharan Africa
%A Iacoella,Francesco
%A Tirivayi,Nyasha
%+ UNICEF Evaluation Office, 3 United Nations Plaza, New York, NY, 10017, United States, 1 9296459846, iacoella@merit.unu.edu
%K information and knowledge
%K communication
%K health and economic development
%K public health
%K technological change
%K choices and consequences
%K mobile phone
%K connectivity
%K access
%K HIV
%K testing
%K Sub-Saharan Africa
%K women’s health
%D 2024

%7 27.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Sub-Saharan Africa has been a technological hothouse when it comes to mobile phone technology adoption. However, evidence on the role played by mobile technology on infectious disease prevention has been mostly limited to experimental studies. Objective: This observational study investigates the role of mobile phone connectivity on HIV testing in sub-Saharan Africa. Methods: We make use of the novel and comprehensive OpenCelliD cell tower database and Demographic and Health Survey geocoded information for over 400,000 women in 29 sub-Saharan African countries. We examine, through ordinary least square and instrumental variable regressions, whether women’s community distance from the closest cell tower influences knowledge about HIV testing facilities and the likelihood of ever being tested for HIV. Results: After finding a negative and significant impact of distance to the nearest cell tower on knowledge of HIV testing facility (–0.7 percentage points per unit increase in distance) and HIV testing (–0.5 percentage points per unit increase), we investigate the mechanisms through which such effects might occur. Our analysis shows that distance to a cell tower reduces HIV-related knowledge (–0.4 percentage points per unit increase) as well as reproductive health knowledge (–0.4 percentage points per unit increase). Similar results are observed when the analysis is performed at community level. Conclusions: Results suggest that the effect of mobile phone connectivity is channeled through increased knowledge of HIV, sexually transmittable infections, and modern contraceptive methods. Further analysis shows that cell phone ownership has an even larger impact on HIV testing and knowledge. This paper adds to the recent literature on the impact of mobile-based HIV prevention schemes by showing through large-scale analysis that better mobile network access is a powerful tool to spread reproductive health knowledge and increase HIV awareness. 
%M 39331953
%R 10.2196/48794
%U https://www.jmir.org/2024/1/e48794
%U https://doi.org/10.2196/48794
%U http://www.ncbi.nlm.nih.gov/pubmed/39331953

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53560
%T A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study
%A Sosanya,Mercy Eloho
%A Samuel,Folake Olukemi
%A Bashir,Sadia
%A Omoera,Victoria Osariemen
%A Freeland-Graves,Jeanne H
%+ Department of Nutritional Sciences, University of Texas at Austin, 200 W 24th Street, Austin, TX, 78712-1247, United States, 1 512 967 2026, mercysosanya@utexas.edu
%K mobile health
%K mHealth
%K mobile gaming app
%K validation
%K infant and young child feeding
%K teenage mother
%K Nigeria
%K mobile phone
%D 2024

%7 26.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. Objective: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. Methods: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country’s capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. Results: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). Conclusions: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria. 
%M 39326044
%R 10.2196/53560
%U https://www.jmir.org/2024/1/e53560
%U https://doi.org/10.2196/53560
%U http://www.ncbi.nlm.nih.gov/pubmed/39326044

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e60955
%T Implementing and Evaluating a Mobile Phone–Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0): Protocol for a Randomized Controlled Trial
%A Eriksson,Gunilla
%A Kamwesiga,Julius Tunga
%A Fors,Uno
%A Oyana,Tonny
%A von Koch,Lena
%A Ytterberg,Charlotte
%A Guidetti,Susanne
%+ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Stockholm, 171 77, Sweden, 46 702216924, gunilla.eriksson@ki.se
%K information and communication technology
%K ICT
%K mobile health
%K mHealth
%K telehealth
%K telemedicine
%K remote rehabilitation
%K activity of daily living
%K ADL
%K East Africa
%K sub-Saharan Africa
%K intervention
%K occupational therapy
%K physiotherapy
%D 2024

%7 25.9.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke. Objective: This study aims to implement F@ce 2.0, a mobile phone–supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0. Methods: A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process. Results: Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025. Conclusions: This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries. International Registered Report Identifier (IRRID): DERR1-10.2196/60955 
%M 39321459
%R 10.2196/60955
%U https://www.researchprotocols.org/2024/1/e60955
%U https://doi.org/10.2196/60955
%U http://www.ncbi.nlm.nih.gov/pubmed/39321459

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59917
%T Multicomponent Intervention to Improve Acute Myocardial Infarction Care in Tanzania: Protocol for a Pilot Implementation Trial
%A Hertz,Julian T
%A Sakita,Francis M
%A Rahim,Faraan O
%A Mmbaga,Blandina T
%A Shayo,Frida
%A Kaboigora,Vivian
%A Mtui,Julius
%A Bloomfield,Gerald S
%A Bosworth,Hayden B
%A Bettger,Janet P
%A Thielman,Nathan M
%+ Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 684 8111, julian.hertz@duke.edu
%K myocardial infarction
%K Tanzania
%K sub-Saharan Africa
%K implementation science
%K quality improvement
%D 2024

%7 24.9.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Although the incidence of acute myocardial infarction (AMI) is rising in sub-Saharan Africa, the uptake of evidence-based care for the diagnosis and treatment of AMI is limited throughout the region. In Tanzania, studies have revealed common misdiagnosis of AMI, infrequent administration of aspirin, and high short-term mortality rates following AMI. Objective: This study aims to evaluate the implementation and efficacy outcomes of an intervention, the Multicomponent Intervention to Improve Acute Myocardial Infarction Care (MIMIC), which was developed to improve the delivery of evidence-based AMI care in Tanzania. Methods: This single-arm pilot trial will be conducted in the emergency department (ED) at a referral hospital in northern Tanzania. The MIMIC intervention will be implemented by the ED staff for 1 year. Approximately 400 adults presenting to the ED with possible AMI symptoms will be enrolled, and research assistants will observe their care. Thirty days later, a follow-up survey will be administered to assess mortality and medication use. The primary outcome will be the acceptability of the MIMIC intervention, which will be measured by the Acceptability of Intervention Measurement (AIM) instrument. Acceptability will further be assessed via in-depth interviews with key stakeholders. Secondary implementation outcomes will include feasibility and fidelity. Secondary efficacy outcomes will include the following: the proportion of participants who receive electrocardiogram and cardiac biomarker testing, the proportion of participants with AMI who receive aspirin, 30-day mortality among participants with AMI, and the proportion of participants with AMI taking aspirin 30 days following enrollment. Results: Implementation of MIMIC began on September 1, 2023. Enrollment is expected to be completed by September 1, 2024, and the first results are expected to be published by December 31, 2024. Conclusions: This study will be the first to evaluate an intervention for improving AMI care in sub-Saharan Africa. If MIMIC is found to be acceptable, the findings from this study will inform a future cluster-randomized trial to assess effectiveness and scalability. Trial Registration: ClinicalTrials.gov NCT04563546; https://clinicaltrials.gov/study/NCT04563546 International Registered Report Identifier (IRRID): DERR1-10.2196/59917 
%M 39316783
%R 10.2196/59917
%U https://www.researchprotocols.org/2024/1/e59917
%U https://doi.org/10.2196/59917
%U http://www.ncbi.nlm.nih.gov/pubmed/39316783

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e53034
%T Digital Intervention to Improve Health Services for Young People in Zimbabwe: Process Evaluation of ‘Zvatinoda!’ (What We Want) Using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Framework
%A Mackworth-Young,Constance Ruth Sina
%A Charashika,Privillage
%A ,
%A Larsson,Leyla
%A Wilding-Davies,Olivia Jane
%A Simpson,Nikita
%A Kydd,Anna Sorrel
%A Chinyanga,Theonevus Tinashe
%A Ferrand,Rashida Abbas
%A Mangombe,Aveneni
%A Webb,Karen
%A Doyle,Aoife Margaret
%+ Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 20 7636 8636, constance.mackworth-young1@lshtm.ac.uk
%K adolescents
%K young people
%K digital health
%K mobile intervention
%K HIV
%K sexual and reproductive health
%K Zimbabwe
%D 2024

%7 24.9.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Youth in Southern Africa face a high burden of HIV and sexually transmitted infections, yet they exhibit low uptake of health care services. Objective: The Zvatinoda! intervention, co-designed with youth, aims to increase the demand for and utilization of health services among 18-24-year-olds in Chitungwiza, Zimbabwe. Methods: The intervention utilized mobile phone–based discussion groups, complemented by “ask the expert” sessions. Peer facilitators, supported by an “Auntie,” led youth in anonymous online chats on health topics prioritized by the participants. Feedback on youth needs was compiled and shared with health care providers. The intervention was tested in a 12-week feasibility study involving 4 groups of 7 youth each, totaling 28 participants (n=14, 50%, female participants), to evaluate feasibility and acceptability. Mixed methods process evaluation data included pre- and postintervention questionnaires (n=28), in-depth interviews with participants (n=15) and peer facilitators (n=4), content from discussion group chats and expert guest sessions (n=24), facilitators’ debrief meetings (n=12), and a log of technical challenges. Descriptive quantitative analysis and thematic qualitative analysis were conducted. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was adapted to analyze and present findings on (1) reach, (2) potential efficacy, (3) adoption, (4) implementation, and (5) maintenance. Results: Mobile delivery facilitated engagement with diverse groups, even during COVID-19 lockdowns (reach). Health knowledge scores improved from pre- to postintervention across 9 measures. Preintervention scores varied from 14% (4/28) for contraception to 86% (24/28) for HIV knowledge. After the intervention, all knowledge scores reached 100% (28/28). Improvements were observed across 10 sexual and reproductive health (SRH) self-efficacy measures. The most notable changes were in the ability to start a conversation about SRH with older adults in the family, which increased from 50% (14/28) preintervention to 86% (24/28) postintervention. Similarly, the ability to use SRH services even if a partner does not agree rose from 57% (16/28) preintervention to 89% (25/28) postintervention. Self-reported attendance at a health center in the past 3 months improved from 32% (9/28) preintervention to 86% (24/28) postintervention (potential efficacy). Chat participation varied, largely due to network challenges and school/work commitments. The key factors facilitating peer learning were interaction with other youth, the support of an older, knowledgeable “Auntie,” and the anonymity of the platform. As a result of COVID-19 restrictions, regular feedback to providers was not feasible. Instead, youth conveyed their needs to stakeholders through summaries of key themes from chat groups and a music video presented at a final in-person workshop (adoption and implementation). Participation in discussions decreased over time. To maintain engagement, introducing an in-person element was suggested (maintenance). Conclusions: The Zvatinoda! intervention proved both acceptable and feasible, showing promise for enhancing young people’s knowledge and health-seeking behavior. Potential improvements include introducing in-person discussions once the virtual group has established rapport and enhancing feedback and dialog with service providers. 
%M 39316784
%R 10.2196/53034
%U https://formative.jmir.org/2024/1/e53034
%U https://doi.org/10.2196/53034
%U http://www.ncbi.nlm.nih.gov/pubmed/39316784

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e55819
%T Evaluating the Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Systematic Review
%A Kachimanga,Chiyembekezo
%A Zaniku,Haules Robbins
%A Divala,Titus Henry
%A Ket,Johannes C.F
%A Mukherjee,Joia S
%A Palazuelos,Daniel
%A Kulinkina,Alexandra V
%A Abejirinde,Ibukun-Oluwa Omolade
%A Akker,Thomas van den
%+ Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 887247777, c.kachimanga@vu.nl
%K maternal health
%K antenatal care
%K postnatal care
%K facility-based births
%K sub-Saharan Africa
%K mobile health
%K mHealth
%K review
%K narrative synthesis
%K mobile phone
%D 2024

%7 24.9.2024
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Limited information exists on the impact of mobile health (mHealth) use by community health workers (CHWs) on improving the use of maternal health services in sub-Saharan Africa (SSA). Objective: This systematic review addresses 2 objectives: evaluating the impact of mHealth use by CHWs on antenatal care (ANC) use, facility-based births, and postnatal care (PNC) use in SSA; and identifying facilitators and barriers to mHealth use by CHWs in programs designed to increase ANC use, facility-based births, and PNC use in SSA using a sociotechnical system approach. Methods: We searched for articles in 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus) from inception up to September 2022, with additional articles identified from Google Scholar. After article selection, 2 independent reviewers performed title and abstract screening, full-text screening, and data extraction using Covidence software (Veritas Health Innovation Ltd). In addition, we manually screened the references lists of the included articles. Finally, we performed a narrative synthesis of the outcomes. Results: Among the 2594 records retrieved, 10 (0.39%) studies (n=22, 0.85% articles) met the inclusion criteria and underwent data extraction. The studies were published between 2012 and 2022 in 6 countries. Of the studies reporting on ANC outcomes, 43% (3/7) reported that mHealth use by CHWs increased ANC use. Similarly, of the studies reporting on facility-based births, 89% (8/9) demonstrated an increase due to mHealth use by CHWs. In addition, in the PNC studies, 75% (3/4) showed increased PNC use associated with mHealth use by CHWs. Many of the studies reported on the importance of addressing factors related to the social environment of mHealth-enabled CHWs, including the perception of CHWs by the community, trust, relationships, digital literacy, training, mentorship and supervision, skills, CHW program ownership, and the provision of incentives. Very few studies reported on how program goals and culture influenced mHealth use by CHWs. Providing free equipment, accessories, and internet connectivity while addressing ongoing challenges with connectivity, power, the ease of using mHealth software, and equipment maintenance support allowed mHealth-enabled CHW programs to thrive. Conclusions: mHealth use by CHWs was associated with an increase in ANC use, facility-based births, and PNC use in SSA. Identifying and addressing social and technical barriers to the use of mHealth is essential to ensure the success of mHealth programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 
%M 39316427
%R 10.2196/55819
%U https://mhealth.jmir.org/2024/1/e55819
%U https://doi.org/10.2196/55819
%U http://www.ncbi.nlm.nih.gov/pubmed/39316427

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e52670
%T Factors Associated With the Use of Digital Technology Among Youth in Zimbabwe: Findings From a Cross-Sectional Population-Based Survey
%A Martin,Kevin
%A Peh,Rachel Wei Chun
%A Tembo,Mandikudza
%A Mavodza,Constancia Vimbayi
%A Doyle,Aoife M
%A Dziva Chikwari,Chido
%A Dauya,Ethel
%A Bandason,Tsitsi
%A Azizi,Steven
%A Simms,Victoria
%A Ferrand,Rashida A
%+ Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2076368636, kevin.martin@lshtm.ac.uk
%K Zimbabwe
%K youth
%K digital technology
%K household wealth
%D 2024

%7 23.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Globally, the increasing use of digital technologies such as mobile phones and the internet has allowed for the development of innovative mobile health interventions, particularly for reaching and engaging with youth. However, there is a risk that using such technologies may exclude those who lack access to them. Objective: In this study, we investigated the sociodemographic factors associated with mobile phone ownership, internet use, and social media use among youth in Zimbabwe. Methods: A population-based prevalence survey was conducted in 24 urban and periurban communities across 3 provinces of Zimbabwe (Harare, Mashonaland East, and Bulawayo). Youths aged 18 to 24 years resident in randomly selected households in the study communities completed an interviewer-administered questionnaire. The primary outcomes were mobile phone ownership and current internet and social media use. A household wealth indicator was developed using principal components analysis, based on household asset ownership. Multivariable logistic regression was used to investigate the factors associated with each primary outcome. Age, sex, and province were considered a priori confounders. Household wealth, marital status, education level, employment status, time lived at current address, and HIV status were included in the final multivariable model if there was an age-, sex-, and province-adjusted association with a primary outcome on univariable analysis at a significance level of P<.10. Results: Of the 17,636 participants assessed for the primary outcome, 16,370 (92.82%) had access to a mobile phone, and 15,454 (87.63%) owned a mobile phone. Among participants with access to a mobile phone, 58.61% (9594/16,370) and 57.79% (9460/16,370), respectively, used internet and social media at least weekly. Older age (adjusted odds ratio [aOR] 1.76, 95% CI 1.55-2.00), increasing wealth (ranging from aOR 1.85, 95% CI 1.58-2.16, for wealth quintile 2 to aOR 3.80, 95% CI 3.00-4.80, for wealth quintile 5, with quintile 1 as reference), and higher education level (secondary: aOR 1.96, 95% CI 1.60-2.39; tertiary: aOR 8.36, 95% CI 5.29-13.20) were associated with mobile phone ownership. Older age, male sex, increasing wealth, having never been married, higher education level, being in education or formal employment, and having lived at the same address for ≥2 years were associated with higher levels of internet and social media use. Conclusions: While mobile phone ownership was near-universal, over one-third of youths in urban and periurban settings did not have access to the internet and social media. Access to the internet and social media use were strongly associated with household wealth and education level. Mobile health interventions must ensure that they do not amplify existing inequalities in access to health care. Such interventions must be accompanied by alternative strategies to engage and enroll individuals without internet or social media access to prevent the exclusion of young people by sex and socioeconomic status. 
%M 39312390
%R 10.2196/52670
%U https://www.jmir.org/2024/1/e52670
%U https://doi.org/10.2196/52670
%U http://www.ncbi.nlm.nih.gov/pubmed/39312390

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e49362
%T Comparing the Efficacy of 2 WeChat Mini Programs in Reducing Nonmarital Heterosexual Contact by Male Factory Workers: Randomized Controlled Trial
%A Zhang,Kechun
%A Cao,Bolin
%A Fang,Yuan
%A Liang,Xue
%A Ye,Danhua
%A Chen,Ya Qi
%A Zhong,Ruilan
%A Cao,He
%A Hu,Tian
%A Li,Ting
%A Cai,Yong
%A Zou,Huachun
%A Wang,Zixin
%+ Centre for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, 30-32 Ngan Shing Street, Hong Kong, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk
%K nonmarital heterosexual contacts
%K male factory workers
%K WeChat mini program
%K randomized controlled trial
%K China
%K mobile phone
%D 2024

%7 9.9.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Male factory workers in China are vulnerable to HIV transmission. Commercial and nonmarital noncommercial contacts are the driving forces of heterosexual HIV transmission among male factory workers in China. There is a lack of effective HIV interventions for male factory workers in China. Objective: The primary objective of this randomized controlled trial was to compare the efficacy of an enhanced versus the standard version of a WeChat mini program in reducing sexual intercourse with nonregular female sex partners and female sex workers among male factory workers in Shenzhen, China. Methods: A nonblinded 2-arm parallel randomized controlled trial was conducted between December 2021 and April 2023. Participants were adult male factory workers in Shenzhen who had access to a smartphone and WeChat. Those who had oral or anal sex with a man or self-reported as HIV positive were excluded. A total of 247 participants were randomly assigned to the intervention group (n=125, 50.6%) or the control group (n=122, 49.4%); 221 (89.5%) and 220 (89.1%) completed follow-up surveys at T1 (6 months after completion of the interventions) and T2 (6 months after T1). Participants in the control group had access to the standard WeChat mini program that provided basic HIV-related knowledge and information about local free HIV testing services. Participants in the intervention group had access to the enhanced WeChat mini program. The enhanced mini program covered all the information in the standard mini program. In addition, the enhanced mini program assessed users’ behaviors and invited users to watch different web-based videos on reducing nonmarital sexual contacts and promoting HIV testing based on their behavioral characteristics at months 0 and 1. The videos were developed based on in-depth interviews with male factory workers. Intention-to-treat analysis was used for outcome analyses. Multiple imputation was used to replace missing outcome values at T1 and T2. Results: At T1, fewer participants in the intervention group reported sexual intercourse with a nonregular female sex partner in the past 6 months compared with the control group (1/125, 0.8% vs 8/122, 6.6%; relative risk=0.12, 95% CI 0.02-0.96; P=.02). However, there were no between-group differences in sexual intercourse with a nonregular female sex partner at T2 (10/125, 8% vs 14/122, 11.5%; P=.36) or sexual intercourse with a female sex worker at T1 (2/125, 1.6% vs 2/122, 1.6%; P=.98) or T2 (8/125, 6.4% vs 8/122, 6.6%; P=.96). Conclusions: The enhanced WeChat mini program was more effective than the standard WeChat mini program in reducing sexual intercourse with nonregular female sex partners among male factory workers in the short term but not in the longer term. Improvements should be made to the WeChat mini program before implementation. Trial Registration: ClinicalTrials.gov NCT05811611; https://clinicaltrials.gov/study/NCT05811611 
%M 39250213
%R 10.2196/49362
%U https://www.jmir.org/2024/1/e49362
%U https://doi.org/10.2196/49362
%U http://www.ncbi.nlm.nih.gov/pubmed/39250213

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e56121
%T Quality and Accountability of ChatGPT in Health Care in Low- and Middle-Income Countries: Simulated Patient Study
%A Si,Yafei
%A Yang,Yuyi
%A Wang,Xi
%A Zu,Jiaqi
%A Chen,Xi
%A Fan,Xiaojing
%A An,Ruopeng
%A Gong,Sen
%+ School of Public Policy and Administration, Xi’an Jiaotong University, 28 West Xianning Road, Xi'an, 710049, China, 86 15891725861, emirada@163.com
%K ChatGPT
%K generative AI
%K simulated patient
%K health care
%K quality and safety
%K low- and middle-income countries
%K quality
%K LMIC
%K patient study
%K effectiveness
%K reliability
%K medication prescription
%K prescription
%K noncommunicable diseases
%K AI integration
%K AI
%K artificial intelligence
%D 2024

%7 9.9.2024
%9 Research Letter
%J J Med Internet Res
%G English
                
%X Using simulated patients to mimic 9 established noncommunicable and infectious diseases, we assessed ChatGPT’s performance in treatment recommendations for common diseases in low- and middle-income countries. ChatGPT had a high level of accuracy in both correct diagnoses (20/27, 74%) and medication prescriptions (22/27, 82%) but a concerning level of unnecessary or harmful medications (23/27, 85%) even with correct diagnoses. ChatGPT performed better in managing noncommunicable diseases than infectious ones. These results highlight the need for cautious AI integration in health care systems to ensure quality and safety.
%M 39250188
%R 10.2196/56121
%U https://www.jmir.org/2024/1/e56121
%U https://doi.org/10.2196/56121
%U http://www.ncbi.nlm.nih.gov/pubmed/39250188

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e57236
%T Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial
%A Mahtani,Sitara L
%A Viswanath,Kasisomayajula
%A Gupte,Himanshu A
%A Mandal,Gauri
%A Jagiasi,Dinesh
%A Chawla,Ratandeep
%A D'Costa,Marina
%A Xuan,Ziming
%A Minsky,Sara
%A Ramanadhan,Shoba
%+ Dana-Farber Cancer Institute, 450 Brookline Avenue, LW, 6th Floor, Boston, MA, 02215, United States, 1 617 582 9487, sitara_mahtani@dfci.harvard.edu
%K tobacco use Cessation
%K India
%K resource-limited settings
%K task-shifting
%K counseling
%K nonprofit organizations
%K dental health services
%K tuberculosis
%K social media
%K mobile app
%D 2024

%7 3.9.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. Objective: The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program—adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)—is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. Methods: This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco’s harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. Results: The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. Conclusions: It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. Trial Registration: ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983 International Registered Report Identifier (IRRID): DERR1-10.2196/57236 
%M 39225384
%R 10.2196/57236
%U https://www.researchprotocols.org/2024/1/e57236
%U https://doi.org/10.2196/57236
%U http://www.ncbi.nlm.nih.gov/pubmed/39225384

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e53211
%T Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review
%A Mudzengi,Don Lawrence
%A Chomutare,Herbert
%A Nagudi,Jeniffer
%A Ntshiqa,Thobani
%A Davis,J Lucian
%A Charalambous,Salome
%A Velen,Kavindhran
%+ The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa, 27 833697946, dmudzengi@auruminstitute.org
%K mobile health
%K mHealth
%K design thinking
%K tuberculosis
%K Ebola
%K HIV
%K COVID-19
%K infectious diseases
%K contact tracing
%K mobile phone
%D 2024

%7 26.8.2024
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes. Objective: We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth’s role in contact tracing, enhancing both the implementation and overall health outcomes. Methods: We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria. Results: We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively. Conclusions: Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively. 
%M 39186366
%R 10.2196/53211
%U https://mhealth.jmir.org/2024/1/e53211
%U https://doi.org/10.2196/53211
%U http://www.ncbi.nlm.nih.gov/pubmed/39186366

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e57742
%T Risk Index of Regional Infection Expansion of COVID-19: Moving Direction Entropy Study Using Mobility Data and Its Application to Tokyo
%A Ohsawa,Yukio
%A Sun,Yi
%A Sekiguchi,Kaira
%A Kondo,Sae
%A Maekawa,Tomohide
%A Takita,Morihito
%A Tanimoto,Tetsuya
%A Kami,Masahiro
%+ School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358417012, ohsawa@sys.t.u-tokyo.ac.jp
%K suppressing the spread of infection
%K index for risk assessment
%K local regions
%K diversity of mobility
%K mobility data
%K moving direction entropy
%K MDE
%K social network model
%K COVID-19
%K influenza
%K sexually transmitted diseases
%D 2024

%7 21.8.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Policies, such as stay home, bubbling, and stay with your community, recommending that individuals reduce contact with diverse communities, including families and schools, have been introduced to mitigate the spread of the COVID-19 pandemic. However, these policies are violated if individuals from various communities gather, which is a latent risk in a real society where people move among various unreported communities. Objective: We aimed to create a physical index to assess the possibility of contact between individuals from diverse communities, which serves as an indicator of the potential risk of SARS-CoV-2 spread when considered and combined with existing indices. Methods: Moving direction entropy (MDE), which quantifies the diversity of moving directions of individuals in each local region, is proposed as an index to evaluate a region’s risk of contact of individuals from diverse communities. MDE was computed for each inland municipality in Tokyo using mobility data collected from smartphones before and during the COVID-19 pandemic. To validate the hypothesis that the impact of intercommunity contact on infection expansion becomes larger for a virus with larger infectivity, we compared the correlations of the expansion of infectious diseases with indices, including MDE and the densities of supermarkets, restaurants, etc. In addition, we analyzed the temporal changes in MDE in municipalities. Results: This study had 4 important findings. First, the MDE values for local regions showed significant invariance between different periods according to the Spearman rank correlation coefficient (>0.9). Second, MDE was found to correlate with the rate of infection cases of COVID-19 among local populations in 53 inland regions (average of 0.76 during the period of expansion). The density of restaurants had a similar correlation with COVID-19. The correlation between MDE and the rate of infection was smaller for influenza than for COVID-19, and tended to be even smaller for sexually transmitted diseases (order of infectivity). These findings support the hypothesis. Third, the spread of COVID-19 was accelerated in regions with high-rank MDE values compared to those with high-rank restaurant densities during and after the period of the governmental declaration of emergency (P<.001). Fourth, the MDE values tended to be high and increased during the pandemic period in regions where influx or daytime movement was present. A possible explanation for the third and fourth findings is that policymakers and living people have been overlooking MDE. Conclusions: We recommend monitoring the regional values of MDE to reduce the risk of infection spread. To aid in this monitoring, we present a method to create a heatmap of MDE values, thereby drawing public attention to behaviors that facilitate contact between communities during a highly infectious disease pandemic. 
%M 39037745
%R 10.2196/57742
%U https://publichealth.jmir.org/2024/1/e57742
%U https://doi.org/10.2196/57742
%U http://www.ncbi.nlm.nih.gov/pubmed/39037745

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59266
%T Rationale, Design, and Intervention Development of a Mobile Health–Led Primary Care Program for Management of Type 2 Diabetes in Rural Thailand: Protocol for a SMARThealth Diabetes Study
%A Chanpitakkul,Methee
%A Praveen,Devarsetty
%A John,Renu
%A Ghosh,Arpita
%A Lekagul,Salyaveth
%A Kaewhiran,Malulee
%A Tungsanga,Kriang
%A Jha,Vivekanand
%+ The George Institute for Global Health, #401, 4th Floor, Shangrila Plaza, Plot No.14, Road No. 2, Banjara Hills, Hyderabad, 500034, India, 91 9959777623, dpraveen@georgeinstitute.org.in
%K health workforce
%K primary health care
%K diabetes
%K digital technology
%K Thailand
%K capacity building.
%D 2024

%7 16.8.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Noncommunicable diseases (NCDs), particularly diabetes and chronic kidney diseases, pose a significant health burden in Thailand, especially among socioeconomically disadvantaged populations. The existing primary health care system faces challenges in providing optimal care for NCDs due to inadequate primary care workforce. The SMARThealth program offers a technology-based solution to enhance NCD management through task-sharing among nonphysician health care workers. Objective: This study aims to adapt and implement the SMARThealth Diabetes program in rural Thailand to improve diabetes management. The main objectives are to (1) adapt, validate, and integrate the SMARThealth Diabetes program for improving the management of type 2 diabetes mellitus at the primary health care level; and (2) to determine the feasibility and acceptability of the SMARThealth Diabetes program in rural communities of Thailand. Methods: A pragmatic, type 2 hybrid effectiveness or implementation, parallel-group cluster randomized controlled trial of 12 months duration and involving 51 subdistrict health offices in rural communities of Kamphaeng Phet province, Thailand, will be conducted. The intervention arm will receive the SMARThealth Diabetes program, including workforce restructuring, clinical decision support system, and continuous performance monitoring, while the control arm will continue with usual practice. Data will be collected using the SMARThealth platform and will be stored on a server in Thailand. The primary outcome measure will be the change in mean hemoglobin A1c (HbA1c) measured at randomization and 12 months from randomization between the intervention and control clusters. Secondary outcomes will include the difference in change in albuminuria status, estimated glomerular filtration rate, systolic blood pressure, and low-density lipoprotein cholesterol level. The analysis for change in HbA1c between baseline and end of study will be performed using linear mixed models. Any imbalances between the 2 arms will be addressed by sensitivity analyses. Additionally, a mixed methods process evaluation will be conducted to assess the implementation process, that will include in-depth interviews and focus group discussions, in addition to the quantitative data collected during the implementation process. The qualitative data will be thematically analyzed to explore factors that promote or inhibit the implementation and maintenance of the program. Results: The data collection commenced in November 2022, and the results will be ready for publication by the first quarter of 2025. Effectiveness of the intervention package will be assessed by change in mean HbA1c measures, and detailed feasibility, barriers, and enablers for the implementation of the intervention will be documented through a detailed process evaluation. Conclusions: The study protocol outlines a novel approach to enhancing diabetes management in rural Thailand through digital technology–based interventions that will facilitate task-sharing among health care workers. This can help inform future strategies for improving NCD care in low-resource settings globally. Trial Registration: Thai Clinical Trials Registry TCTR20200322006; https://www.thaiclinicaltrials.org/show/TCTR20200322006 International Registered Report Identifier (IRRID): DERR1-10.2196/59266 
%M 39150766
%R 10.2196/59266
%U https://www.researchprotocols.org/2024/1/e59266
%U https://doi.org/10.2196/59266
%U http://www.ncbi.nlm.nih.gov/pubmed/39150766

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e56043
%T Leveraging Feedback From Families of Children With Autism to Create Digital Support for Service Navigation: Descriptive Study
%A Burke,Meghan
%A Li,Chak
%A Cheung,Waifong Catherine
%A Terol,Adriana Kaori
%A Johnston,Amanda
%A Schueller,Stephen M
%+ Department of Special Education, Vanderbilt University, 110 Magnolia Circle, Nashville, TN, 37203, United States, 1 6155851420, meghan.burke@vanderbilt.edu
%K human-centered design
%K autism
%K service access
%K families
%K digital support
%K autistic children
%K autistic
%K children
%K child
%K app
%K apps
%K application
%K applications
%K digital tool
%K tool
%K tools
%D 2024

%7 14.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: It is difficult for families to navigate and access services for their children with autism. Barriers to service access are compounded among families from low-resourced backgrounds. Objective: The purpose of our study was to explore the development of an app to facilitate access to services among families of children with autism from low-resourced backgrounds. Our specific aims were to explore feedback from an advisory board about the app and to explore feedback from navigators about the app. Methods: Via a multistage codevelopment process, we elicited feedback from 5 key parties: the research team, a community organization, the app development team, the advisory board, and family navigators. Collectively, 36 individuals provided feedback about the development of the app via individual interviews, focus groups, observations, and surveys. The key features of the app included a dashboard showing the service needs of the family and related resources, a messaging feature between the family, the navigator, and the supervisor, and a fidelity checklist and evaluation feature. Results: The advisory board provided feedback about the app to increase its user-friendliness, include the ability to develop an action plan, improve the identification of needed services, and add information about service providers. Navigators suggested that the app should connect navigators to one another, have a clearer purpose for the notes section, and reflect an easier log-in process. Navigators also wanted training to role-play using the app. After participating in a role play using the app, navigators reported significantly more satisfaction with the app and greater usefulness (P<.001). Conclusions: Our work sheds light on the importance of eliciting feedback from end users, especially users who are often overlooked by the research community and app developers. Further, it is important to elicit feedback in multiple ways to improve the app. 
%M 39141412
%R 10.2196/56043
%U https://formative.jmir.org/2024/1/e56043
%U https://doi.org/10.2196/56043
%U http://www.ncbi.nlm.nih.gov/pubmed/39141412

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e55822
%T Increased Risk of Influenza Infection During Cold Spells in China: National Time Series Study
%A Wang,Haitao
%A Geng,Mengjie
%A Schikowski,Tamara
%A Areal,Ashtyn Tracey
%A Hu,Kejia
%A Li,Wen
%A Coelho,Micheline de Sousa Zanotti Stagliorio
%A Saldiva,Paulo Hilário Nascimento
%A Sun,Wei
%A Zhou,Chengchao
%A Lu,Liang
%A Zhao,Qi
%A Ma,Wei
%K influenza
%K cold spell
%K definition
%K vulnerable population
%K modification effect
%K China
%D 2024

%7 13.8.2024
%9 
%J JMIR Public Health Surveill
%G English
                
%X Background: Studies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. Objective: We aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. Methods: This time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014‐2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. Results: The overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89‐3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44‐9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. Conclusions: Cold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells. 
%R 10.2196/55822
%U https://publichealth.jmir.org/2024/1/e55822
%U https://doi.org/10.2196/55822

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e56250
%T Adaptation of a Theory-Based Mobile App to Improve Access to HIV Prevention Services for Transgender Women in Malaysia: Focus Group Study
%A Gautam,Kamal
%A Shrestha,Roman
%A Dlamini,Sihlelelwe
%A Razali,Belle
%A Paudel,Kiran
%A Azwa,Iskandar
%A Saifi,Rumana
%A Toh,YuHang
%A Justin Lim,Hazriq
%A Sutherland,Ryan
%A Restar,Arjee
%A Phanuphak,Nittaya
%A Wickersham,Jeffrey A
%+ Department of Internal Medicine, Yale School of Medicine, 135 College Street, Suite 323, New Haven, CT, 06511, United States, 1 2037374158, jeffrey.wickersham@yale.edu
%K HIV
%K AIDS
%K pre-exposure prophylaxis
%K PrEP
%K mobile health
%K mHealth
%K transgender women
%K Malaysia
%K mobile phone
%D 2024

%7 13.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Globally, transgender women have been disproportionately affected by the HIV epidemic, including in Malaysia, where an estimated 11% of transgender women are living with HIV. Available interventions designed specifically to meet transgender women’s needs for HIV prevention are limited. Mobile health, particularly smartphone mobile apps, is an innovative and cost-effective strategy for reaching transgender women and delivering interventions to reduce HIV vulnerability. Objective: This study aims to adapt a theory-based mobile health HIV prevention smartphone app, HealthMindr, to meet the unique needs of transgender women in Malaysia. We conducted theater testing of the HealthMindr app with transgender women and key stakeholders and explored barriers to transgender women’s uptake of HIV pre-exposure prophylaxis (PrEP). Methods: From February to April 2022, a total of 6 focus group (FG) sessions were conducted with 29 participants: 4 FG sessions with transgender women (n=18, 62%) and 2 FG sessions with stakeholders (n=11, 38%) providing HIV prevention services to transgender women in Malaysia. Barriers to PrEP uptake and gender-affirming care services among transgender women in Malaysia were explored. Participants were then introduced to the HealthMindr app and provided a comprehensive tour of the app’s features and functions. Participants provided feedback on the app and on how existing features should be adapted to meet the needs of transgender women, as well as any features that should be removed or added. Each FG was digitally recorded and transcribed. Transcripts were coded inductively using Dedoose software (version 9.0.54; SocioCultural Research Consultants, LLC) and analyzed to identify and interpret emerging themes. Results: Six subthemes related to PrEP barriers were found: stigma and discrimination, limited PrEP knowledge, high PrEP cost, accessibility concerns, alternative prevention methods, and perceived adverse effects. Participants suggested several recommendations regarding the attributes and app features that would be the most useful for transgender women in Malaysia. Adaptation and refinement of the app were related to the attributes of the app (user interface, security, customizable colors, themes, and avatars), feedback, and requests for additional mobile app functional (appointment booking, e-consultation, e-pharmacy, medicine tracker, mood tracker, resources, and service site locator) and communication (peer support group, live chat, and discussion forum) features. Conclusions: The results reveal that multifaceted barriers hinder PrEP uptake and use among transgender women in Malaysia. The findings also provide detailed recommendations for successfully adapting the HealthMindr app to the context of Malaysian transgender women, with a potential solution for delivering tailored HIV prevention, including PrEP, and increasing accessibility to gender-affirming care services. 
%M 39137407
%R 10.2196/56250
%U https://formative.jmir.org/2024/1/e56250
%U https://doi.org/10.2196/56250
%U http://www.ncbi.nlm.nih.gov/pubmed/39137407

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e59975
%T Ameliorating Racial Disparities in HIV Prevention via a Nurse-Led, AI-Enhanced Program for Pre-Exposure Prophylaxis Utilization Among Black Cisgender Women: Protocol for a Mixed Methods Study
%A Zhang,Chen
%A Wharton,Mitchell
%A Liu,Yu
%+ School of Nursing, University of Rochester, 255 Crittenden Boulevard, Hellen Wood Hall, Room 2w-218, Rochester, NY, 14622, United States, 1 5852766495, chen_zhang@urmc.rochester.edu
%K artificial intelligence
%K PrEP care
%K PrEP
%K pre-exposure prophylaxis
%K nurse-led
%K AI
%K HIV prevention
%K HIV
%K prevention
%K AIDS
%K nurse
%K Black cisgender women
%K Black
%K cisgender
%K women
%K HIV pre-exposure prophylaxis
%K prophylaxis
%K biomedical
%K effectiveness
%K medical mistrust
%K Black women
%K nurse practitioners
%K chatbot
%K socioeconomic
%K HumanX technology
%K health care interventions
%D 2024

%7 13.8.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: HIV pre-exposure prophylaxis (PrEP) is a critical biomedical strategy to prevent HIV transmission among cisgender women. Despite its proven effectiveness, Black cisgender women remain significantly underrepresented throughout the PrEP care continuum, facing barriers such as limited access to care, medical mistrust, and intersectional racial or HIV stigma. Addressing these disparities is vital to improving HIV prevention outcomes within this community. On the other hand, nurse practitioners (NPs) play a pivotal role in PrEP utilization but are underrepresented due to a lack of awareness, a lack of human resources, and insufficient support. Equipped with the rapid evolution of artificial intelligence (AI) and advanced large language models, chatbots effectively facilitate health care communication and linkage to care in various domains, including HIV prevention and PrEP care. Objective: Our study harnesses NPs’ holistic care capabilities and the power of AI through natural language processing algorithms, providing targeted, patient-centered facilitation for PrEP care. Our overarching goal is to create a nurse-led, stakeholder-inclusive, and AI-powered program to facilitate PrEP utilization among Black cisgender women, ultimately enhancing HIV prevention efforts in this vulnerable group in 3 phases. This project aims to mitigate health disparities and advance innovative, technology-based solutions. Methods: The study uses a mixed methods design involving semistructured interviews with key stakeholders, including 50 PrEP-eligible Black women, 10 NPs, and a community advisory board representing various socioeconomic backgrounds. The AI-powered chatbot is developed using HumanX technology and SmartBot360’s Health Insurance Portability and Accountability Act–compliant framework to ensure data privacy and security. The study spans 18 months and consists of 3 phases: exploration, development, and evaluation. Results: As of May 2024, the institutional review board protocol for phase 1 has been approved. We plan to start recruitment for Black cisgender women and NPs in September 2024, with the aim to collect information to understand their preferences regarding chatbot development. While institutional review board approval for phases 2 and 3 is still in progress, we have made significant strides in networking for participant recruitment. We plan to conduct data collection soon, and further updates on the recruitment and data collection progress will be provided as the study advances. Conclusions: The AI-powered chatbot offers a novel approach to improving PrEP care utilization among Black cisgender women, with opportunities to reduce barriers to care and facilitate a stigma-free environment. However, challenges remain regarding health equity and the digital divide, emphasizing the need for culturally competent design and robust data privacy protocols. The implications of this study extend beyond PrEP care, presenting a scalable model that can address broader health disparities. International Registered Report Identifier (IRRID): PRR1-10.2196/59975 
%M 39137028
%R 10.2196/59975
%U https://www.researchprotocols.org/2024/1/e59975
%U https://doi.org/10.2196/59975
%U http://www.ncbi.nlm.nih.gov/pubmed/39137028

%0 Journal Article
        
%@ 2564-1891
%I JMIR Publications
%V 4
%N 
%P e50125
%T Collective Intelligence–Based Participatory COVID-19 Surveillance in Accra, Ghana: Pilot Mixed Methods Study
%A Marley,Gifty
%A Dako-Gyeke,Phyllis
%A Nepal,Prajwol
%A Rajgopal,Rohini
%A Koko,Evelyn
%A Chen,Elizabeth
%A Nuamah,Kwabena
%A Osei,Kingsley
%A Hofkirchner,Hubertus
%A Marks,Michael
%A Tucker,Joseph D
%A Eggo,Rosalind
%A Ampofo,William
%A Sylvia,Sean
%+ Department of Health Policy and Management, University of North Carolina, 1101D McGavran-Greenberg Hall, CB #7411 Chapel Hill, NC 27599-7411, Chapel Hill, NC, 27599, United States, 1 919 966 6328, sysylvia@email.unc.edu
%K information markets
%K participatory disease surveillance
%K collective intelligence
%K community engagement
%K the wisdom of the crowds
%K Ghana
%K mobile phone
%D 2024

%7 12.8.2024
%9 Original Paper
%J JMIR Infodemiology
%G English
                
%X Background: Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)–based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual “stocks” with payoffs tied to a future event. Objective: This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana. Methods: We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ≥18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19–related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant’s percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants’ user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once. Results: Of the 105 eligible participants invited, 21 (84%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19–related information mainly from television and radio was associated with less likelihood of trading (marginal effect: −0.184). Individuals aged <30 years traded 7.5 times more and earned GH ¢134.1 (US $11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers. Conclusions: Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use. 
%M 39133907
%R 10.2196/50125
%U https://infodemiology.jmir.org/2024/1/e50125
%U https://doi.org/10.2196/50125
%U http://www.ncbi.nlm.nih.gov/pubmed/39133907

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e56000
%T Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response
%A Palmer,Anna
%A Sharma,Shaishab
%A Nagpal,Jayesh
%A Kimani,Victor
%A Mai,Florence
%A Ahmed,Zara
%+ Imperial College School of Medicine, Imperial College London, South Kensington Campus, Exhibition Road, London, SW7 2AZ, United Kingdom, 44 7887691537, anna.palmer16@imperial.ac.uk
%K COVID-19
%K global health
%K public health
%K qualitative study
%K tracing
%K England
%K apps
%K effectiveness
%K contact tracing
%K barrier
%K digital health
%K thematic analysis
%K privacy
%K communication
%K social support
%K tracing app
%K digital illiteracy
%K technology
%K support
%D 2024

%7 12.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. 
%M 39133910
%R 10.2196/56000
%U https://formative.jmir.org/2024/1/e56000
%U https://doi.org/10.2196/56000
%U http://www.ncbi.nlm.nih.gov/pubmed/39133910

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 13
%N 
%P e50047
%T Requirements for and Barriers to Rehabilitation Services for Children With Disabilities in Middle- and High-Income Countries: Scoping Review
%A Xie,Yijun
%A Wu,Jing
%A Li,Yao
%A Liu,Hui
%A Peng,Yanyan
%A Zhou,Ping
%A Sun,Yizhou
%A Kang,Luyan
%A Jiang,Chenghua
%A Wu,Hengjing
%+ Clinical Center for Intelligent Rehabilitation Research, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, No.2209 Guangxing Road, Songjiang District, Shanghai, 201619, China, 86 15821525700, whjdata@126.com
%K children with disabilities
%K barriers
%K health services
%K middle- and high-income countries
%K child
%K low income
%K middle income
%K disability
%K children
%K disabilities
%K income
%K barrier
%K rehabilitation
%K suitability
%K availability
%K affordability
%K support system
%K support
%K awareness
%K policy
%D 2024

%7 7.8.2024
%9 Review
%J Interact J Med Res
%G English
                
%X Background: The rehabilitation of children with disabilities has received considerable attention from the United Nations. However, the state of rehabilitation services for children with disabilities worldwide remains far from optimistic, even in economically affluent middle- and high-income countries. Objective: This scoping review aimed to identify the rehabilitation needs of children with disabilities and their barriers to rehabilitation services in middle- and high-income countries. Methods: A systematic search was conducted using MEDLINE and Web of Science for papers published from January 2013 to December 2023. Studies were included if they were peer-reviewed, full-text articles related to children with disabilities, reporting on their access to rehabilitation services, and conducted in countries classified by the World Bank 2023 as middle- and high-income economies. Exclusion criteria included duplicates, unavailable full texts, and studies without distinct outcomes. A total of 27 studies were selected following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, focusing on children, their families, or service providers. Results: The suitability, availability, and affordability of rehabilitation services were identified as the major needs and barriers for children with disabilities in middle- and high-income countries. This included communication barriers, a need for more personnel and facilities, and the stagnation and inadequacy of economic subsidies. Conclusions: Middle- and high-income countries have relatively well-established rehabilitation infrastructure and support systems. They are nevertheless insufficient for meeting the needs of children with disabilities. More attention should be paid to these issues to improve the well-being of children with disabilities. The data provided by this review can help raise awareness of rehabilitation needs and barriers at the policy level. 
%M 39110502
%R 10.2196/50047
%U https://www.i-jmr.org/2024/1/e50047
%U https://doi.org/10.2196/50047
%U http://www.ncbi.nlm.nih.gov/pubmed/39110502

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e55650
%T Meeting the Needs of Emerging Adults With Type 1 Diabetes Living in a Rural Area With Mobile Health Interventions: Focus Group Study
%A Idalski Carcone,April
%A Holtz,Bree E
%A Reardon,Madeleine
%A Vesey,Dariane
%A Ellis,Deborah A
%A Parks,Michael
%+ Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, 3128 Integrative Biosciences Bldg, 6135 Woodward, Detroit, MI, 48202, United States, 1 3135771057, acarcone@med.wayne.edu
%K emerging adults
%K type 1 diabetes
%K intervention
%K qualitative
%K mHealth
%K mobile phone
%K smartphone
%D 2024

%7 7.8.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Emerging adults (EAs; age 18-30 years) with type 1 diabetes (T1D) have more challenges with diabetes management and glycemic control than other age groups. Living in a rural community introduces additional unique diabetes care challenges due to limited access to specialty care and ancillary support services. Yet, few interventions have been developed to improve diabetes management in rural-dwelling EAs with T1D. Objective: This study aimed to understand the diabetes management experiences of older adolescents and EAs (age 16-25 years) with T1D living in a rural area and to assess their perceptions of the acceptability of 4 fully automated mobile health (mHealth) interventions to support diabetes management. Methods: EAs were identified by clinical staff through convenience sampling. In total, 8 EAs participated in 1 focus group and 1 EA completed an individual interview; all data were collected over Zoom. Facilitators explored EAs’ experiences living in a rural community with T1D and discussed EAs’ impressions of, feedback on, and recommendations for improving 4 mHealth interventions to meet the specific needs of EAs with T1D living in rural communities. Discussions were transcribed and analyzed using conventional content analysis. Results: In total, 9 EAs (aged 18.8, SD 2.7 years; 5, 56% men; 8, 89% White) with a duration of diabetes of 8.6 (SD 4.3) years participated. They described experiences with diabetes stigma (attributing diabetes to poor lifestyle choices) and feelings of self-consciousness (hyperawareness) in their rural communities. They attributed these experiences to the small size of their communities (“everyone knows”) and community members’ lack of knowledge about diabetes (unable to differentiate between type 1 and type 2 diabetes). In contrast, EAs reported high levels of social support for diabetes and diabetes care from family, friends, and other community members, but low support for medical needs. The location of their diabetes care providers and the limited accessibility of diabetes-specific and general medical care services in their local community created a challenging medical care context. Overall, EAs found mHealth interventions appealing due to their digital delivery and highlighted features that increased accessibility (voiceovers and simple, jargon-free language), individualization (ability to tailor intervention content and delivery), and applicability to their own lives and other EAs with T1D (relatability of vignettes and other content). EAs suggestions for improving the interventions included more opportunities to tailor the interventions to their preferences (greater frequency and duration, ability to adapt content to emerging needs), increasing opportunities for peer support within the interventions (friend and significant other as identified support person, connecting with peers beyond their local community), and making the tone of intervention components more casual and engaging. Conclusions: mHealth interventions aligned with EAs’ needs and preferences are a promising strategy to support EAs in communities where social support and resources might be limited. Trial Registration: N/A, not a clinical trial 
%M 39110496
%R 10.2196/55650
%U https://formative.jmir.org/2024/1/e55650
%U https://doi.org/10.2196/55650
%U http://www.ncbi.nlm.nih.gov/pubmed/39110496

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e45242
%T Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review
%A Bostan,Sarah
%A Johnson,Owen A
%A Jaspersen,Lena J
%A Randell,Rebecca
%+ Leeds University Business School, University of Leeds, Maurice Keyworth Building, Woodhouse, Leeds, LS2 9JT, United Kingdom, s.bostan@leeds.ac.uk
%K implementation
%K open source
%K electronic health records
%K digital health
%K low- and lower-middle-income countries
%K barriers
%K global health care
%K scoping
%K review
%D 2024

%7 1.8.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. Objective: This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. Methods: We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. Results: This review included 13 studies that examined open-source EHRs’ adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. Conclusions: While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers’ experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline. 
%M 39088815
%R 10.2196/45242
%U https://www.jmir.org/2024/1/e45242
%U https://doi.org/10.2196/45242
%U http://www.ncbi.nlm.nih.gov/pubmed/39088815

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e51355
%T Expanding a Behavioral View on Digital Health Access: Drivers and Strategies to Promote Equity
%A Kepper,Maura M
%A Fowler,Lauren A
%A Kusters,Isabelle S
%A Davis,Jean W
%A Baqer,Manal
%A Sagui-Henson,Sara
%A Xiao,Yunyu
%A Tarfa,Adati
%A Yi,Jean C
%A Gibson,Bryan
%A Heron,Kristin E
%A Alberts,Nicole M
%A Burgermaster,Marissa
%A Njie-Carr,Veronica PS
%A Klesges,Lisa M
%+ Prevention Research Center, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu
%K digital health
%K health equity
%K mobile health
%K mHealth
%K health care access
%K digital divide
%K behavioral medicine
%K implementation
%K mobile phone
%D 2024

%7 1.8.2024
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science–based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.
%M 39088246
%R 10.2196/51355
%U https://www.jmir.org/2024/1/e51355
%U https://doi.org/10.2196/51355
%U http://www.ncbi.nlm.nih.gov/pubmed/39088246

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 11
%N 
%P e56758
%T Acceptability and Engagement of a Smartphone-Delivered Interpretation Bias Intervention in a Sample of Black and Latinx Adults: Open Trial
%A Ferguson,IreLee
%A George,Grace
%A Narine,Kevin O
%A Turner,Amari
%A McGhee,Zelda
%A Bajwa,Harris
%A Hart,Frances G
%A Carter,Sierra
%A Beard,Courtney
%+ Department of Psychiatry, McLean Hospital/Harvard Medical School, 115 Mill St, Belmont, MA, 02478, United States, 1 617 855 3557, cbeard@mclean.harvard.edu
%K interpretation bias
%K anxiety
%K depression
%K Black
%K Latinx
%K smartphone
%K mobile phone
%D 2024

%7 31.7.2024
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Access to evidence-based interventions is urgently required, especially for individuals of minoritized identities who experience unique barriers to mental health care. Digital mental health interventions have the potential to increase accessibility. Previous pilot studies testing HabitWorks, a smartphone app providing an interpretation bias intervention, have found strong engagement and adherence for HabitWorks; however, previous trials’ samples consisted of predominantly non-Hispanic, White individuals. Objective: This study conducted an open trial of HabitWorks in a community sample of adults who identified as Black, Hispanic or Latinx, or both. This study aims to test safety, acceptability, and engagement with the HabitWorks app for Black and Latinx adults. Methods: Black, Hispanic or Latinx adults (mean age 32.83, SD 11.06 y; 22/31, 71% women) who endorsed symptoms of anxiety or depression were asked to complete interpretation modification exercises via HabitWorks 3 times per week for 1 month. Interpretation bias and anxiety and depression symptoms were assessed at baseline and posttreatment assessments. Participants completed qualitative interviews to assess overall perceptions of HabitWorks. Results: Of the 31 participants that downloaded the app, 27 (87%) used HabitWorks all 4 weeks. On average, participants completed 15.74 (SD 7.43) exercises out of the 12 prescribed, demonstrating high engagement. Acceptability ratings met all a priori benchmarks except for relevancy. Qualitative interviews also demonstrated high acceptability and few negative experiences. Significant improvements were found in interpretation style (t30=2.29; P<.001), with a large effect size (Cohen d=1.53); anxiety symptoms (t30=2.29; P=.03), with a small effect size (Cohen d=0.41); and depression symptoms (t30=3.065; P=.005), with a medium effect size (Cohen d=0.55). Conclusions: This study adds to the literature evaluating digital mental health interventions in Black and Latinx adults. Preliminary results further support a future controlled trial testing the effectiveness of HabitWorks as an intervention. 
%M 39083330
%R 10.2196/56758
%U https://mental.jmir.org/2024/1/e56758
%U https://doi.org/10.2196/56758
%U http://www.ncbi.nlm.nih.gov/pubmed/39083330

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e47520
%T COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation
%A Basu,Saurav
%A Desai,Meghana
%A Karan,Anup
%A Bhardwaj,Surbhi
%A Negandhi,Himanshu
%A Jadhav,Nitin
%A Maske,Amar
%A Zodpey,Sanjay
%+ Department of Monitoring, Evaluation, and Learning, Bharatiya Jain Sangathana, Shantilal Muttha Foundation, Muttha Chambers II, Senapati Bapat Rd, Pune, 411016, India, 91 9822936922, megs1080@gmail.com
%K COVID-19
%K community intervention
%K COVID-19 vaccination
%K COVID-appropriate behavior
%K impact evaluation
%K rural health
%K community-based intervention
%K rural population
%K awareness
%K disease prevention
%K health literacy
%K public health
%K pandemic
%K digital health
%K community awareness
%K effectiveness
%K low- and middle-income countries
%K vaccination
%K infodemic
%D 2024

%7 29.7.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs. Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community–based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India. Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods. Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23% (95% CI 3%-45%) and masking was 17% (0%-38%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22% (95% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19–related stigma or discrimination in Pune was 68% (95% CI 0.133-0.191) lower than that in Satara. Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings. 
%M 39073851
%R 10.2196/47520
%U https://publichealth.jmir.org/2024/1/e47520
%U https://doi.org/10.2196/47520
%U http://www.ncbi.nlm.nih.gov/pubmed/39073851

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e52734
%T Connecting Female Entertainment Workers in Cambodia to Health Care Services Using mHealth: Economic Evaluation of Mobile Link
%A Avanceña,Anton L V
%A Brody,Carinne
%A Chhoun,Pheak
%A Tuot,Sovannary
%A Yi,Siyan
%+ Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, 2409 University Ave, PHR 2.112, Austin, TX, 78712, United States, 1 5124713146, antonlv@utexas.edu
%K female entertainment workers
%K Cambodia
%K mHealth
%K mobile health
%K economic evaluation
%K stigmatized populations
%K women's health
%K sexual health
%K STI
%K sexually transmitted infection
%K STD
%K sexually transmitted disease
%K economic
%K cost
%K costs
%K affordable
%K affordability
%K budget
%K finance
%K financial
%D 2024

%7 25.7.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile Link is a mobile phone–based intervention to increase access to, and use of, health care services among female entertainment workers in Cambodia who face higher risks for specific diseases and gender-based violence. A multisite randomized controlled trial showed that Mobile Link connected female entertainment workers with outreach workers for information and escorted referrals after 6 months but did not lead to statistically significant improvements in HIV and sexually transmitted infection testing, contraceptive use, and condom use. Objective: This study aims to conduct a 3-part economic evaluation of Mobile Link to understand its costs, value, and affordability. Methods: We conducted cost, cost-effectiveness, and budget impact analyses of Mobile Link using cost and outcomes data from the Mobile Link trial and other sources. For the cost analysis, we estimated the total, per-person, and incremental costs of Mobile Link compared with usual care. Using probabilistic decision-analytic models, we estimated the 1-year cost-effectiveness of Mobile Link from payer and combined payer and patient perspectives by converting selected primary and secondary outcomes from the trial to disability-adjusted life years (DALYs) averted. Finally, we estimated the financial costs of scaling up Mobile Link’s messaging and outreach services to 70% of female entertainment workers in 5 years. Results: The incremental costs of Mobile Link were US $199 from a payer perspective and US $195 per person from a combined payer and patient perspective. With an average of 0.018 (95% predicted interval –0.088 to 0.126) DALYs averted, Mobile Link’s cost-effectiveness was US $10,955 per DALY from a payer perspective (US $10,755 per DALY averted from a payer and patient perspective). The costs of Mobile Link would have to decrease by 85%, or its effectiveness would have to be 5.56 times higher, for the intervention to meet the upper limit of recommended cost-effectiveness thresholds in Cambodia (US $1671 per DALY averted). The 5-year cost of scaling Mobile Link to 34,790 female entertainment workers was estimated at US $1.64 million or US $46 per person per year. Conclusions: This study provided a comprehensive economic evaluation of Mobile Link. We found that Mobile Link is not likely to be cost-effective unless its costs decrease or its effectiveness increases. Scaling up Mobile Link to more female entertainment workers is estimated to cost less than the costs of the trial. Given the importance of linking female entertainment workers to essential services, future research should focus on enhancing the effectiveness of Mobile Link or developing new mobile health interventions for this population. Trial Registration: ClinicalTrials.gov NCT03117842; https://clinicaltrials.gov/study/NCT03117842 
%M 39052328
%R 10.2196/52734
%U https://formative.jmir.org/2024/1/e52734
%U https://doi.org/10.2196/52734
%U http://www.ncbi.nlm.nih.gov/pubmed/39052328

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e54117
%T Digital Adherence Technologies and Differentiated Care for Tuberculosis Treatment and Their Acceptability Among Persons With Tuberculosis, Health Care Workers, and Key Informants in the Philippines: Qualitative Interview Study
%A Leung,Chung Lam
%A Alacapa,Jason
%A Tasca,Bianca Gonçalves
%A Villanueva,Andre Daniel
%A Masulit,Saniata
%A Ignacio,Marvin Louie
%A Uy,Kathleen Nicole
%A Pell,Christopher
%A van Kalmthout,Kristian
%A Powers,Rachel
%A Fielding,Katherine
%A Jerene,Degu
%+ KNCV Tuberculosis Foundation, Maanweg 174, Den Haag, 2516AB, Netherlands, 31 070 416 7222, adrian.leung@kncvtbc.org
%K tuberculosis
%K digital adherence technologies
%K implementation
%K acceptability
%K qualitative research
%K Philippines
%K digital health
%K tuberculosis treatment
%K support strategy
%K support
%K medication adherence
%K health care workers
%K interview
%K interviews
%K user
%K user privacy
%K privacy
%K digital adherence
%D 2024

%7 23.7.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB. Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users. Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model. Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users’ technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users’ privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic. Conclusions: In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines. 
%M 39042889
%R 10.2196/54117
%U https://humanfactors.jmir.org/2024/1/e54117
%U https://doi.org/10.2196/54117
%U http://www.ncbi.nlm.nih.gov/pubmed/39042889

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e52395
%T Effectiveness of a Mobile Phone Messaging–Based Message Framing Intervention for Improving Maternal Health Service Uptake and Newborn Care Practice in Rural Jimma Zone, Ethiopia: Protocol for a Cluster Randomized Controlled Trial
%A Bulcha,Gebeyehu
%A Abdissa,Hordofa Gutema
%A Noll,Josef
%A Sori,Demisew Amenu
%A Koricha,Zewdie Birhanu
%+ Department of Health, Behavior, and Society, Faculty of Public Health, Institutes of Health, Jimma University, Aba Jifar Palas, 1000, Jimma, 16202, Ethiopia, 251 0911801923, gebeyehubulcha@gmail.com
%K message framing
%K mHealth
%K digital health
%K SMS
%K maternal health
%K newborn health
%K cluster randomized controlled trials
%K RCT
%K Ethiopia
%K mobile phone
%K effectiveness
%K SMS-based interventions
%K text messaging
%K maternal
%K newborn care practice
%K randomized
%K controlled trial
%K controlled trials
%K mobile phone messaging
%K phone-based intervention
%D 2024

%7 23.7.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Ethiopia has high rates of maternal and neonatal mortality. In 2019 and 2020, the maternal and newborn mortality rates were estimated at 412 per 1,000,000 births and 30 per 10,000 births, respectively. While mobile health interventions to improve maternal and neonatal health management have shown promising results, there are still insufficient scientific studies to assess the effectiveness of mobile phone messaging–based message framing for maternal and newborn health. Objective: This research aims to examine the effectiveness of mobile phone messaging–based message framing for improving the use of maternal and newborn health services in the Jimma Zone, Ethiopia. Methods: A 3-arm cluster-randomized trial design was used to evaluate the effects of mobile phone–based intervention on maternal and newborn health service usage. The trial arms were (1) gain-framed messages (2) loss-framed messages, and (3) usual care. A total of 21 health posts were randomized, and 588 pregnant women who had a gestational age of 16-20 weeks, irrespective of their antenatal care status, were randomly assigned to the trial arms. The intervention consisted of a series of messages dispatched from the date of enrolment until 6-8 months. The control group received existing care without messages. The primary outcomes were maternal health service usage and newborn care practice, while knowledge, attitude, self-efficacy, iron supplementation, and neonatal and maternal morbidity were secondary outcomes. The outcomes will be analyzed using a generalized linear mixed model and the findings will be reported according to the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement for randomized controlled trials. Results: Recruitment of participants was conducted and the baseline survey was administered in March 2023. The intervention was rolled out from May 2023 till December 2023. The end-line assessment was conducted in February 2024. Conclusions: This trial was carried out to understand how mobile phone–based messaging can improve maternal and newborn health service usage. It provides evidence for policy guidelines around mobile health strategies to improve maternal and newborn health. Trial Registration: Pan African Clinical Trials Registry PACTR202201753436676; https://tinyurl.com/ykhnpc49 International Registered Report Identifier (IRRID): DERR1-10.2196/52395 
%M 39042451
%R 10.2196/52395
%U https://www.researchprotocols.org/2024/1/e52395
%U https://doi.org/10.2196/52395
%U http://www.ncbi.nlm.nih.gov/pubmed/39042451

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54129
%T Evaluating the Preliminary Effectiveness of the Person-Centered Care Assessment Tool (PCC-AT) in Zambian Health Facilities: Protocol for a Mixed Methods Cross-Sectional Study
%A Posner,Jessica
%A Ndhlovu,Adamson Paxon
%A Musangulule,Jemmy Mushinka
%A Duffy,Malia
%A Casella,Amy
%A Madevu-Matson,Caitlin
%A Davis,Nicole
%A Sharer,Melissa
%+ International Division, JSI, 2733 Crystal Dr, Arlington, VA, 22202, United States, 1 2029573477, jessica_posner@jsi.com
%K person-centered care
%K HIV
%K action plans
%K preliminary
%K person-centered care assessment tool
%K PCC-AT
%K assessment tool
%K Zambia
%K health facility
%K exploratory study
%K HIV treatment
%K inequities
%K framework
%K practitioners
%K health services
%D 2024

%7 23.7.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Person-centered care (PCC) within HIV treatment services has demonstrated potential to overcome inequities in HIV service access while improving treatment outcomes. Despite PCC being widely considered a best practice, no consensus exists on its assessment and measurement. This study in Zambia builds upon previous research that informed development of a framework for PCC and a PCC assessment tool (PCC-AT). Objective: This mixed methods study aims to examine the preliminary effectiveness of the PCC-AT through assessing the association between client HIV service delivery indicators and facility PCC-AT scores. We hypothesize that facilities with higher PCC-AT scores will demonstrate more favorable HIV treatment continuity, viral load (VL) coverage, and viral suppression in comparison to those of facilities with lower PCC-AT scores. Methods: We will implement the PCC-AT at 30 randomly selected health facilities in the Copperbelt and Central provinces of Zambia. For each study facility, data will be gathered from 3 sources: (1) PCC-AT scores, (2) PCC-AT action plans, and (3) facility characteristics, along with service delivery data. Quantitative analysis, using STATA, will include descriptive statistics on the PCC-AT results stratified by facility characteristics. Cross-tabulations and/or regression analysis will be used to determine associations between scores and treatment continuity, VL coverage, and/or viral suppression. Qualitative data will be collected via action planning, with detailed notes collected and recorded into an action plan template. Descriptive coding and emerging themes will be analyzed with NVivo software. Results: As of May 2024, we enrolled 29 facilities in the study and data analysis from the key informant interviews is currently underway. Results are expected to be published by September 2024. Conclusions: Assessment and measurement of PCC within HIV treatment settings is a novel approach that offers HIV treatment practitioners the opportunity to examine their services and identify actions to improve PCC performance. Study results and the PCC-AT will be broadly disseminated for use among all project sites in Zambia as well as other HIV treatment programs, in addition to making the PCC-AT publicly available to global HIV practitioners. International Registered Report Identifier (IRRID): DERR1-10.2196/54129 
%M 39042423
%R 10.2196/54129
%U https://www.researchprotocols.org/2024/1/e54129
%U https://doi.org/10.2196/54129
%U http://www.ncbi.nlm.nih.gov/pubmed/39042423

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e62891
%T Authors’ Reply: The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care
%A Tong,Huong Ly
%A Rakic,Severin
%A Al-Hazzaa,Hazzaa M
%A Alqahtani,Saleh A
%+ The World Bank Group, J5-068, 1818 H Street NW, Washington, DC, 20433, United States, 1 2024585552, srakic@worldbank.org
%K mobile apps
%K fitness trackers
%K SMS
%K SMS text messaging
%K physical activity
%K exercise
%K sedentary behavior
%K Middle East
%K Africa, Northern
%K movement
%K physical inactivity
%K smartphone
%K mobile phone
%K mobile health
%K mHealth
%K digital health
%K behavior change
%K intervention
%D 2024

%7 8.7.2024
%9 Letter to the Editor
%J J Med Internet Res
%G English
                
%X 
%M 38976872
%R 10.2196/62891
%U https://www.jmir.org/2024/1/e62891
%U https://doi.org/10.2196/62891
%U http://www.ncbi.nlm.nih.gov/pubmed/38976872

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e60350
%T The Power of Collaboration in Facilitating Mobile Technology Adoption in Health Care
%A Fan,Weijing
%A Liu,Guobin
%+ Department of Peripheral Vascular Surgery, Institute of Surgery of Traditional Chinese Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Zhangheng road 528, Shanghai, 201203, China, 86 15800885533, 15800885533@163.com
%K social workers
%K government
%K mobile technology
%K mobile apps
%K fitness trackers
%K SMS
%K SMS text messaging
%K physical activity
%K exercise
%K sedentary behavior
%K Middle East
%K Africa
%K movement
%K physical inactivity
%K smartphone
%K mobile phone
%K mobile health
%K mHealth
%K digital health
%K behavior change
%K intervention
%D 2024

%7 8.7.2024
%9 Letter to the Editor
%J J Med Internet Res
%G English
                
%X 
%M 38976864
%R 10.2196/60350
%U https://www.jmir.org/2024/1/e60350
%U https://doi.org/10.2196/60350
%U http://www.ncbi.nlm.nih.gov/pubmed/38976864

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e54669
%T Assessment of Heat Exposure and Health Outcomes in Rural Populations of Western Kenya by Using Wearable Devices: Observational Case Study
%A Matzke,Ina
%A Huhn,Sophie
%A Koch,Mara
%A Maggioni,Martina Anna
%A Munga,Stephen
%A Muma,Julius Okoth
%A Odhiambo,Collins Ochieng
%A Kwaro,Daniel
%A Obor,David
%A Bärnighausen,Till
%A Dambach,Peter
%A Barteit,Sandra
%+ Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg University, Im Neuenheimer Feld 130, Heidelberg, 69120, Germany, 49 62215634030, barteit@uni-heidelberg.de
%K wearables
%K wearable
%K tracker
%K trackers
%K climate
%K Africa
%K environment
%K environmental
%K heat
%K weather
%K exposure
%K temperature
%K rural
%K fitness trackers
%K climate change
%K health
%K heat
%K sub-Saharan Africa
%K Kenya
%K outcome
%K outcomes
%D 2024

%7 4.7.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Climate change increasingly impacts health, particularly of rural populations in sub-Saharan Africa due to their limited resources for adaptation. Understanding these impacts remains a challenge, as continuous monitoring of vital signs in such populations is limited. Wearable devices (wearables) present a viable approach to studying these impacts on human health in real time. Objective: The aim of this study was to assess the feasibility and effectiveness of consumer-grade wearables in measuring the health impacts of weather exposure on physiological responses (including activity, heart rate, body shell temperature, and sleep) of rural populations in western Kenya and to identify the health impacts associated with the weather exposures. Methods: We conducted an observational case study in western Kenya by utilizing wearables over a 3-week period to continuously monitor various health metrics such as step count, sleep patterns, heart rate, and body shell temperature. Additionally, a local weather station provided detailed data on environmental conditions such as rainfall and heat, with measurements taken every 15 minutes. Results: Our cohort comprised 83 participants (42 women and 41 men), with an average age of 33 years. We observed a positive correlation between step count and maximum wet bulb globe temperature (estimate 0.06, SE 0.02; P=.008). Although there was a negative correlation between minimum nighttime temperatures and heat index with sleep duration, these were not statistically significant. No significant correlations were found in other applied models. A cautionary heat index level was recorded on 194 (95.1%) of 204 days. Heavy rainfall (>20 mm/day) occurred on 16 (7.8%) out of 204 days. Despite 10 (21%) out of 47 devices failing, data completeness was high for sleep and step count (mean 82.6%, SD 21.3% and mean 86.1%, SD 18.9%, respectively), but low for heart rate (mean 7%, SD 14%), with adult women showing significantly higher data completeness for heart rate than men (2-sided t test: P=.003; Mann-Whitney U test: P=.001). Body shell temperature data achieved 36.2% (SD 24.5%) completeness. Conclusions: Our study provides a nuanced understanding of the health impacts of weather exposures in rural Kenya. Our study’s application of wearables reveals a significant correlation between physical activity levels and high temperature stress, contrasting with other studies suggesting decreased activity in hotter conditions. This discrepancy invites further investigation into the unique socioenvironmental dynamics at play, particularly in sub-Saharan African contexts. Moreover, the nonsignificant trends observed in sleep disruption due to heat expose the need for localized climate change mitigation strategies, considering the vital role of sleep in health. These findings emphasize the need for context-specific research to inform policy and practice in regions susceptible to the adverse health effects of climate change. 
%M 38963698
%R 10.2196/54669
%U https://mhealth.jmir.org/2024/1/e54669
%U https://doi.org/10.2196/54669
%U http://www.ncbi.nlm.nih.gov/pubmed/38963698

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e49127
%T Factors Influencing Data Quality in Electronic Health Record Systems in 50 Health Facilities in Rwanda and the Role of Clinical Alerts: Cross-Sectional Observational Study
%A Fraser,Hamish S F
%A Mugisha,Michael
%A Bacher,Ian
%A Ngenzi,Joseph Lune
%A Seebregts,Christopher
%A Umubyeyi,Aline
%A Condo,Jeanine
%+ Brown Center for Biomedical Informatics, Brown University, 233 Richmond Street, Providence, RI, 02903, United States, 1 4018631815, hamish_fraser@brown.edu
%K data quality
%K electronic health record
%K EHR
%K electronic medical record
%K EMR
%K HIV
%K Rwanda
%D 2024

%7 3.7.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Electronic health records (EHRs) play an increasingly important role in delivering HIV care in low- and middle-income countries. The data collected are used for direct clinical care, quality improvement, program monitoring, public health interventions, and research. Despite widespread EHR use for HIV care in African countries, challenges remain, especially in collecting high-quality data. Objective: We aimed to assess data completeness, accuracy, and timeliness compared to paper-based records, and factors influencing data quality in a large-scale EHR deployment in Rwanda. Methods: We randomly selected 50 health facilities (HFs) using OpenMRS, an EHR system that supports HIV care in Rwanda, and performed a data quality evaluation. All HFs were part of a larger randomized controlled trial, with 25 HFs receiving an enhanced EHR with clinical decision support systems. Trained data collectors visited the 50 HFs to collect 28 variables from the paper charts and the EHR system using the Open Data Kit app. We measured data completeness, timeliness, and the degree of matching of the data in paper and EHR records, and calculated concordance scores. Factors potentially affecting data quality were drawn from a previous survey of users in the 50 HFs. Results: We randomly selected 3467 patient records, reviewing both paper and EHR copies (194,152 total data items). Data completeness was >85% threshold for all data elements except viral load (VL) results, second-line, and third-line drug regimens. Matching scores for data values were close to or >85% threshold, except for dates, particularly for drug pickups and VL. The mean data concordance was 10.2 (SD 1.28) for 15 (68%) variables. HF and user factors (eg, years of EHR use, technology experience, EHR availability and uptime, and intervention status) were tested for correlation with data quality measures. EHR system availability and uptime was positively correlated with concordance, whereas users’ experience with technology was negatively correlated with concordance. The alerts for missing VL results implemented at 11 intervention HFs showed clear evidence of improving timeliness and completeness of initially low matching of VL results in the EHRs and paper records (11.9%-26.7%; P<.001). Similar effects were seen on the completeness of the recording of medication pickups (18.7%-32.6%; P<.001). Conclusions: The EHR records in the 50 HFs generally had high levels of completeness except for VL results. Matching results were close to or >85% threshold for nondate variables. Higher EHR stability and uptime, and alerts for entering VL both strongly improved data quality. Most data were considered fit for purpose, but more regular data quality assessments, training, and technical improvements in EHR forms, data reports, and alerts are recommended. The application of quality improvement techniques described in this study should benefit a wide range of HFs and data uses for clinical care, public health, and disease surveillance. 
%M 38959048
%R 10.2196/49127
%U https://publichealth.jmir.org/2024/1/e49127
%U https://doi.org/10.2196/49127
%U http://www.ncbi.nlm.nih.gov/pubmed/38959048

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 7
%N 
%P e51743
%T Chest X-Ray–Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study
%A Gómez-Valverde,Juan J
%A Sánchez-Jacob,Ramón
%A Ribó,José Luis
%A Schaaf,H Simon
%A García Delgado,Lara
%A Hernanz-Lobo,Alicia
%A Capellán-Martín,Daniel
%A Lancharro,Ángel
%A Augusto,Orvalho
%A García-Basteiro,Alberto L
%A Santiago-García,Begoña
%A López-Varela,Elisa
%A Ledesma-Carbayo,María J
%+ Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid, 28040, Spain, 34 910672210, juanjo.gomez@upm.es
%K telemedicine
%K telehealth
%K pediatric tuberculosis
%K tuberculosis
%K screening
%K chest radiograph
%K usability
%K low-resource settings
%D 2024

%7 1.7.2024
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform’s usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3%-28.2%) but high specificity (91.1%-98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification (χ21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification (κ=0.54-0.67) and pleural effusion (κ=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. 
%M 38949860
%R 10.2196/51743
%U https://pediatrics.jmir.org/2024/1/e51743
%U https://doi.org/10.2196/51743
%U http://www.ncbi.nlm.nih.gov/pubmed/38949860

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e57863
%T The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial
%A Buis,Lorraine R
%A Kim,Junhan
%A Sen,Ananda
%A Chen,Dongru
%A Dawood,Katee
%A Kadri,Reema
%A Muladore,Rachelle
%A Plegue,Melissa
%A Richardson,Caroline R
%A Djuric,Zora
%A McNaughton,Candace
%A Hutton,David
%A Robert,Lionel P
%A Park,Sun Young
%A Levy,Phillip
%+ Department of Family Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI, 48104, United States, 1 734 998 7120, buisl@umich.edu
%K blood pressure
%K hypertension
%K mobile health
%K mHealth
%K mobile phone
%K smartphone
%D 2024

%7 28.6.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease–related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. Objective: We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. Methods: We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). Results: We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). Conclusions: Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. Trial Registration: ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537 International Registered Report Identifier (IRRID): RR2-10.2196/12601 
%R 10.2196/57863
%U https://mhealth.jmir.org/2024/1/e57863
%U https://doi.org/10.2196/57863

%0 Journal Article
        
%@ 1947-2579
%I JMIR Publications
%V 16
%N 
%P e51662
%T Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study
%A Mtenga,Alan Elias
%A Maro,Rehema Anenmose
%A Dillip,Angel
%A Msoka,Perry
%A Emmanuel,Naomi
%A Ngowi,Kennedy
%A Sumari-de Boer,Marion
%+ mHealth Department, Kilimanjaro Clinical Research Institute, KCMC/Kitandu, Longuo st, 2236, Moshi, Moshi, 25116, United Republic of Tanzania, 255 763285424, a.mtenga@kcri.ac.tz
%K acceptability
%K digital adherence tool
%K medication reminder monitors
%K patients with tuberculosis
%K TB
%K adherence
%K TB care provider
%D 2024

%7 26.6.2024
%9 Original Paper
%J Online J Public Health Inform
%G English
                
%X Background: The World Health Organization has recommended digital adherence tools (DATs) as a promising intervention to improve antituberculosis drug adherence. However, the acceptability of DATs in resource-limited settings is not adequately studied. Objective: We investigated the acceptability of a DAT among patients with tuberculosis (TB) and TB care providers in Kilimanjaro, Tanzania. Methods: We conducted a convergent parallel mixed methods study among patients with TB and TB care providers participating in our 2-arm cluster randomized trial (REMIND-TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among patients with TB in Kilimanjaro, Tanzania. We conducted exit and in-depth interviews among patients as well as in-depth interviews among TB care providers in the intervention arm. We conducted a descriptive analysis of the quantitative data from exit interviews. Translated transcripts and memos were organized using NVivo software. We employed inductive and deductive thematic framework analysis, guided by Sekhon’s theoretical framework of acceptability. Results: Out of the 245 patients who completed treatment, 100 (40.8%) were interviewed during exit interviews, and 18 patients and 15 TB care providers were interviewed in-depth. Our findings showed that the DAT was highly accepted: 83% (83/100) expressed satisfaction, 98% (98/100) reported positive experiences with DAT use, 78% (78/100) understood how the intervention works, and 92% (92/100) successfully used the pillbox. Good perceived effectiveness was reported by 84% (84/100) of the participants who noticed improved adherence, and many preferred continuing receiving reminders through SMS text messages, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85 (85%) participants did not worry about remote monitoring. However, some participants felt burdened using DATs; 9 (9%) faced difficulties keeping the device at home, 12 (12%) were not pleased with receiving daily reminder SMS text messages, and 30 (30%) reported challenges related to mobile network connectivity issues. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling, and they demonstrated high level of intervention coherence. Conclusions: DATs are highly acceptable in Tanzania. However, some barriers such as TB-related stigma and mobile network connectivity issues may limit acceptance. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3483-4 
%M 38922643
%R 10.2196/51662
%U https://ojphi.jmir.org/2024/1/e51662
%U https://doi.org/10.2196/51662
%U http://www.ncbi.nlm.nih.gov/pubmed/38922643

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 9
%N 
%P e55201
%T Inequalities in the Ability for People With Type 2 Diabetes and Prediabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the COVID-19 Pandemic and Beyond: Qualitative Study
%A Turnbull,Sophie
%A Cabral,Christie
%+ Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue Bristol, Bristol, BS8 1UD, United Kingdom, 44 117 455 8613, sophie.turnbull@bristol.ac.uk
%K diabetes
%K diabetic
%K DM
%K diabetes mellitus
%K type 2 diabetes
%K type 1 diabetes
%K prediabetes
%K prediabetic
%K COVID-19 pandemic
%K COVID-19
%K SARS-CoV-2
%K coronavirus
%K severe acute respiratory syndrome
%K coronavirus infections
%K novel coronavirus
%K motivation
%K health inequalities
%K self-care
%K mHealth
%K mobile health
%K app
%K apps
%K application
%K applications
%K digital health
%K digital intervention
%K digital interventions
%K telemedicine
%K telehealth
%K virtual care
%K virtual health
%K virtual medicine
%K remote consultation
%K telephone consultation
%K video consultation
%K remote consultations
%K telephone consultations
%K video consultations
%D 2024

%7 25.6.2024
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes. Objective: This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond. Methods: A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach. Results: A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools. Conclusions: Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs. 
%M 38917452
%R 10.2196/55201
%U https://diabetes.jmir.org/2024/1/e55201
%U https://doi.org/10.2196/55201
%U http://www.ncbi.nlm.nih.gov/pubmed/38917452

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e55443
%T Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study
%A Weichelt,Bryan P
%A Burke,Rick
%A Kieke,Burney
%A Pilz,Matt
%A Shimpi,Neel
%+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@marshfieldresearch.org
%K mHealth
%K clinician
%K physician
%K rural
%K patient
%K mobile
%K health care
%K adoption
%K attitude
%K attitudes
%K opinion
%K perception
%K perceptions
%K perspective
%K perspectives
%K acceptance
%K mobile health
%K app
%K apps
%K provider
%K providers
%K physicians
%K survey
%K surveys
%K barrier
%K barriers
%K digital health
%D 2024

%7 24.6.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients’ internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system’s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions: These findings echo similar studies in other health systems, surrounding providers’ lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients’ internet access to fully use mHealth in their delivery of care. 
%M 38913992
%R 10.2196/55443
%U https://humanfactors.jmir.org/2024/1/e55443
%U https://doi.org/10.2196/55443
%U http://www.ncbi.nlm.nih.gov/pubmed/38913992

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e54250
%T Development of a Consolidated Health Facility Masterlist Using Data From Polio Electronic Surveillance in the World Health Organization African Region
%A Babona Nshuti,Marie Aimee
%A Touray,Kebba
%A Muluh,Ticha Johnson
%A Ubong,Godwin Akpan
%A Ngofa,Reuben Opara
%A Mohammed,Bello Isa
%A Roselyne,Ishimwe
%A Oviaesu,David
%A Bakata,Evans Mawa Oliver
%A Lau,Fiona
%A Kipterer,John
%A Green,Hugh Henry W
%A Seaman,Vincent
%A Ahmed,Jamal A
%A Ndoutabe,Modjirom
%+ World Health Organization Regional Office for Africa, Cite du Djoué, Bacongo, PO Box 06, Brazzaville, Congo, 242 069248040, shutaime03@gmail.com
%K African region
%K electronic surveillance
%K geographic information systems
%K Global Polio Eradication Initiative
%K integrated supportive supervision
%K polio
%D 2024

%7 21.6.2024
%9 Viewpoint
%J JMIR Public Health Surveill
%G English
                
%X Geospatial data reporting from surveillance and immunization efforts is a key aspect of the World Health Organization (WHO) Global Polio Eradication Initiative in Africa. These activities are coordinated through the WHO Regional Office for Africa Geographic Information Systems Centre. To ensure the accuracy of field-collected data, the WHO Regional Office for Africa Geographic Information Systems Centre has developed mobile phone apps such as electronic surveillance (eSURV) and integrated supportive supervision (ISS) geospatial data collection programs. While eSURV and ISS have played a vital role in efforts to eradicate polio and control other communicable diseases in Africa, disease surveillance efforts have been hampered by incomplete and inaccurate listings of health care sites throughout the continent. To address this shortcoming, data compiled from eSURV and ISS are being used to develop, update, and validate a Health Facility master list for the WHO African region that contains comprehensive listings of the names, locations, and types of health facilities in each member state. The WHO and Ministry of Health field officers are responsible for documenting and transmitting the relevant geospatial location information regarding health facilities and traditional medicine sites using the eSURV and ISS form; this information is then used to update the Health Facility master list and is also made available to national ministries of health to update their respective health facility lists. This consolidation of health facility information into a single registry is expected to improve disease surveillance and facilitate epidemiologic research for the Global Polio Eradication Initiative, as well as aid public health efforts directed at other diseases across the African continent. This review examines active surveillance using eSURV at the district, country, and regional levels, highlighting its role in supporting polio surveillance and immunization efforts, as well as its potential to serve as a fundamental basis for broader public health initiatives and research throughout Africa.
%M 38904997
%R 10.2196/54250
%U https://publichealth.jmir.org/2024/1/e54250
%U https://doi.org/10.2196/54250
%U http://www.ncbi.nlm.nih.gov/pubmed/38904997

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e50248
%T Effectiveness of a Multifaceted Mobile Health Intervention (Multi-Aid-Package) in Medication Adherence and Treatment Outcomes Among Patients With Hypertension in a Low- to Middle-Income Country: Randomized Controlled Trial
%A Arshed,Muhammad
%A Mahmud,Aidalina
%A Minhat,Halimatus Sakdiah
%A Lim,Poh Ying
%A Zakar,Rubeena
%+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 397692416, aidalina@upm.edu.my
%K mobile health
%K mHealth
%K intervention
%K medication adherence
%K hypertension
%K low- to middle-income country
%K effectiveness
%K randomized controlled trial
%K Pakistan
%K drug adherence
%K tool
%K mHealth module
%K self-efficacy
%K systolic blood pressure
%K feedback
%D 2024

%7 19.6.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The high prevalence of uncontrolled hypertension in Pakistan is predominantly attributed to poor medication adherence. As more than 137 million people in Pakistan use cell phones, a suitable mobile health (mHealth) intervention can be an effective tool to overcome poor medication adherence. Objective: We sought to determine whether a novel mHealth intervention is useful in enhancing antihypertensive therapy adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Methods: A 6-month parallel, single-blinded, superiority randomized controlled trial recruited 439 patients with hypertension with poor adherence to antihypertensive therapy and access to smartphones. An innovative, multifaceted mHealth intervention (Multi-Aid-Package), based on the Health Belief Model and containing reminders (written, audio, visual), infographics, video clips, educational content, and 24/7 individual support, was developed for the intervention group; the control group received standard care. The primary outcome was self-reported medication adherence measured using the Self-Efficacy for Appropriate Medication Adherence Scale (SEAMS) and pill counting; the secondary outcome was systolic blood pressure (SBP) change. Both outcomes were evaluated at baseline and 6 months. Technology acceptance feedback was also assessed at the end of the study. A generalized estimating equation was used to control the covariates associated with the probability of affecting adherence to antihypertensive medication. Results: Of 439 participants, 423 (96.4%) completed the study. At 6 months post intervention, the median SEAMS score was statistically significantly higher in the intervention group compared to the controls (median 32, IQR 11 vs median 21, IQR 6; U=10,490, P<.001). Within the intervention group, there was an increase in the median SEAMS score by 12.5 points between baseline and 6 months (median 19.5, IQR 5 vs median 32, IQR 11; P<.001). Results of the pill-counting method showed an increase in adherent patients in the intervention group compared to the controls (83/220, 37.2% vs 2/219, 0.9%; P<.001), as well as within the intervention group (difference of n=83, 37.2% of patients, baseline vs 6 months; P<.001). There was a statistically significant difference in the SBP of 7 mmHg between the intervention and control groups (P<.001) at 6 months, a 4 mmHg reduction (P<.001) within the intervention group, and a 3 mmHg increase (P=.314) within the controls. Overall, the number of patients with uncontrolled hypertension decreased by 46 in the intervention group (baseline vs 6 months), but the control group remained unchanged. The variables groups (adjusted odds ratio [AOR] 1.714, 95% CI 2.387-3.825), time (AOR 1.837, 95% CI 1.625-2.754), and age (AOR 1.618, 95% CI 0.225-1.699) significantly contributed (P<.001) to medication adherence. Multi-Aid-Package received a 94.8% acceptability score. Conclusions: The novel Multi-Aid-Package is an effective mHealth intervention for enhancing medication adherence and treatment outcomes among patients with hypertension in a low- to middle-income country. Trial Registration: ClinicalTrials.gov NCT04577157; https://clinicaltrials.gov/study/NCT04577157 
%M 38896837
%R 10.2196/50248
%U https://mhealth.jmir.org/2024/1/e50248
%U https://doi.org/10.2196/50248
%U http://www.ncbi.nlm.nih.gov/pubmed/38896837

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e55548
%T Remote Inclusion of Vulnerable Users in mHealth Intervention Design: Retrospective Case Analysis
%A Straand,Ingjerd J
%A Baxter,Kimberley A
%A Følstad,Asbjørn
%+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no
%K user testing
%K user participation in research
%K COVID-19
%K remote testing
%K intervention design
%K mobile phone
%D 2024

%7 14.6.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods. Objective: In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations. Methods: Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions. Results: Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people’s lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants. Conclusions: Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants’ environment via webcams and screen share and how technology mediates participants’ action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants’ privacy. 
%M 38875700
%R 10.2196/55548
%U https://mhealth.jmir.org/2024/1/e55548
%U https://doi.org/10.2196/55548
%U http://www.ncbi.nlm.nih.gov/pubmed/38875700

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e55000
%T Health Information System Strengthening During Antenatal Care in Haiti: Continuous Quality Improvement Study
%A Casella Jean-Baptiste,Meredith
%A Vital Julmiste,Thamar Monide
%A Ball,Ellen
%+ Hôpital Universitaire de Mirebalais, Sante Fanm, Rue Chatulee, Mirebalais, HT 5210, Haiti, 509 4892 3626, mjeanbaptiste@pih.org
%K maternal health
%K health informatics
%K quality improvement
%K Plan-Do-Study-Act
%K PDSA
%K maternal
%K neonatal
%K data collection
%K prenatal
%K outpatient
%K electronic data
%K nursing
%K nursing staff
%K nursing leadership
%D 2024

%7 14.6.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project. Objective: This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system. Methods: A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change. Results: At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month. Conclusions: The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems. 
%M 38875702
%R 10.2196/55000
%U https://formative.jmir.org/2024/1/e55000
%U https://doi.org/10.2196/55000
%U http://www.ncbi.nlm.nih.gov/pubmed/38875702

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e52281
%T Combating Fraudulent Participation in Urban American Indian and Alaska Native Virtual Health Research: Protocol for Increasing Data Integrity in Online Research (PRIOR)
%A Reed,Nicole D
%A Bull,Sheana
%A Shrestha,Umit
%A Sarche,Michelle
%A Kaufman,Carol E
%+ Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, 13055 East 17th Ave, Aurora, CO, 80045, United States, 1 3037240177, nicole.d.reed@cuanschutz.edu
%K fraudulent survey participation
%K online survey research
%K American Indian and Alaska Native
%K data integrity
%K health research
%K research trust
%K online survey
%K case study
%K randomized control trial
%K RCT
%K social media
%K recruitment
%K young women
%K women
%K American Indian
%K Native Americans
%K Native American
%K fraudulent
%K data privacy
%D 2024

%7 13.6.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: While the advantages of using the internet and social media for research recruitment are well documented, the evolving online environment also enhances motivations for misrepresentation to receive incentives or to “troll” research studies. Such fraudulent assaults can compromise data integrity, with substantial losses in project time; money; and especially for vulnerable populations, research trust. With the rapid advent of new technology and ever-evolving social media platforms, it has become easier for misrepresentation to occur within online data collection. This perpetuation can occur by bots or individuals with malintent, but careful planning can help aid in filtering out fraudulent data. Objective: Using an example with urban American Indian and Alaska Native young women, this paper aims to describe PRIOR (Protocol for Increasing Data Integrity in Online Research), which is a 2-step integration protocol for combating fraudulent participation in online survey research. Methods: From February 2019 to August 2020, we recruited participants for formative research preparatory to an online randomized control trial of a preconceptual health program. First, we described our initial protocol for preventing fraudulent participation, which proved to be unsuccessful. Then, we described modifications we made in May 2020 to improve the protocol performance and the creation of PRIOR. Changes included transferring data collection platforms, collecting embedded geospatial variables, enabling timing features within the screening survey, creating URL links for each method or platform of data collection, and manually confirming potentially eligible participants’ identifying information. Results: Before the implementation of PRIOR, the project experienced substantial fraudulent attempts at study enrollment, with less than 1% (n=6) of 1300 screened participants being identified as truly eligible. With the modified protocol, of the 461 individuals who completed a screening survey, 381 did not meet the eligibility criteria assessed on the survey. Of the 80 that did, 25 (31%) were identified as ineligible via PRIOR. A total of 55 (69%) were identified as eligible and verified in the protocol and were enrolled in the formative study. Conclusions: Fraudulent surveys compromise study integrity, validity of the data, and trust among participant populations. They also deplete scarce research resources including respondent compensation and personnel time. Our approach of PRIOR to prevent online misrepresentation in data was successful. This paper reviews key elements regarding fraudulent data participation in online research and demonstrates why enhanced protocols to prevent fraudulent data collection are crucial for building trust with vulnerable populations. Trial Registration: ClinicalTrials.gov NCT04376346; https://www.clinicaltrials.gov/study/NCT04376346 International Registered Report Identifier (IRRID): DERR1-10.2196/52281 
%M 38869930
%R 10.2196/52281
%U https://www.researchprotocols.org/2024/1/e52281
%U https://doi.org/10.2196/52281
%U http://www.ncbi.nlm.nih.gov/pubmed/38869930

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53049
%T Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study
%A Dickerson,Suzanne S
%A George,Saliyah J
%A Ventuneac,Ana
%A Dharia,Arpan
%A Talal,Andrew H
%+ Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, UB-CTRC, Suite 6090, 875 Ellicot Street, Buffalo, NY, 14203, United States, 1 716 829 5354, ahtalal@buffalo.edu
%K hepatitis C virus
%K integrated treatment
%K facilitated telemedicine
%K substance users
%K people with opioid use disorder
%K opioid
%K opioids
%K telemedicine
%K telehealth
%K eHealth
%K e-health
%K ICT
%K substance use
%K substance abuse
%K HCV
%K hepatitis
%K liver
%K interview
%K interviews
%K qualitative
%K hermeneutic
%K phenomenological
%K implementation
%K integration
%K experience
%K experiences
%K attitude
%K attitudes
%K opinion
%K perception
%K perceptions
%K perspective
%K perspectives
%K addict
%K addiction
%K addictions
%K addicts
%K hepatic
%D 2024

%7 12.6.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings. Objective: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. Methods: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences. Results: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a “win” for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have “eyes on” patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities. Conclusions: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. Trial Registration: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970 
%M 38865703
%R 10.2196/53049
%U https://www.jmir.org/2024/1/e53049
%U https://doi.org/10.2196/53049
%U http://www.ncbi.nlm.nih.gov/pubmed/38865703

%0 Journal Article
        
%@ 2561-7605
%I JMIR Publications
%V 7
%N 
%P e55557
%T Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation
%A Fisher,Emily
%A Venkatesan,Shreenila
%A Benevides,Pedro
%A Bertrand,Elodie
%A Brum,Paula Schimidt
%A El Baou,Céline
%A Ferri,Cleusa P
%A Fossey,Jane
%A Jelen,Maria
%A Laks,Jerson
%A Liu,Lisa
%A Mograbi,Daniel C
%A Natarajan,Nirupama
%A Naylor,Renata
%A Pantouli,Despina
%A Ramanujam,Vaishnavi
%A Rangaswamy,Thara
%A Santos de Carvalho,Raquel L
%A Stoner,Charlotte
%A Vaitheswaran,Sridhar
%A Spector,Aimee
%+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 5770, emily.fisher@ucl.ac.uk
%K psychosocial
%K intervention
%K technology
%K COVID-19
%K LMIC
%K low and middle income countries
%D 2024

%7 11.6.2024
%9 Original Paper
%J JMIR Aging
%G English
                
%X Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. 
%M 38861708
%R 10.2196/55557
%U https://aging.jmir.org/2024/1/e55557
%U https://doi.org/10.2196/55557
%U http://www.ncbi.nlm.nih.gov/pubmed/38861708

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e54207
%T Leveraging Ecological Momentary Assessment Data to Characterize Individual Mobility: Exploratory Pilot Study in Rural Uganda
%A Khalifa,Aleya
%A Beres,Laura K
%A Anok,Aggrey
%A Mbabali,Ismail
%A Katabalwa,Charles
%A Mulamba,Jeremiah
%A Thomas,Alvin G
%A Bugos,Eva
%A Nakigozi,Gertrude
%A Chang,Larry W
%A Grabowski,M Kate
%+ Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, United States, 1 212 305 2862, ak4598@cumc.columbia.edu
%K ecological momentary assessment
%K spatial analysis
%K geographic mobility
%K global positioning system
%K health behaviors
%K Uganda
%K mobility
%K pilot study
%K smartphone
%K alcohol
%K cigarette
%K smoking
%K promoting
%K promotion
%K alcohol use
%K cigarette smoking
%K mobile phone
%D 2024

%7 10.6.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The geographical environments within which individuals conduct their daily activities may influence health behaviors, yet little is known about individual-level geographic mobility and specific, linked behaviors in rural low- and middle-income settings. Objective: Nested in a 3-month ecological momentary assessment intervention pilot trial, this study aims to leverage mobile health app user GPS data to examine activity space through individual spatial mobility and locations of reported health behaviors in relation to their homes. Methods: Pilot trial participants were recruited from the Rakai Community Cohort Study—an ongoing population-based cohort study in rural south-central Uganda. Participants used a smartphone app that logged their GPS coordinates every 1-2 hours for approximately 90 days. They also reported specific health behaviors (alcohol use, cigarette smoking, and having condomless sex with a non–long-term partner) via the app that were both location and time stamped. In this substudy, we characterized participant mobility using 3 measures: average distance (kilometers) traveled per week, number of unique locations visited (deduplicated points within 25 m of one another), and the percentage of GPS points recorded away from home. The latter measure was calculated using home buffer regions of 100 m, 400 m, and 800 m. We also evaluated the number of unique locations visited for each specific health behavior, and whether those locations were within or outside the home buffer regions. Sociodemographic information, mobility measures, and locations of health behaviors were summarized across the sample using descriptive statistics. Results: Of the 46 participants with complete GPS data, 24 (52%) participants were men, 30 (65%) participants were younger than 35 years, and 33 (72%) participants were in the top 2 socioeconomic status quartiles. On median, participants traveled 303 (IQR 152-585) km per week. Over the study period, participants on median recorded 1292 (IQR 963-2137) GPS points—76% (IQR 58%-86%) of which were outside their 400-m home buffer regions. Of the participants reporting drinking alcohol, cigarette smoking, and engaging in condomless sex, respectively, 19 (83%), 8 (89%), and 12 (86%) reported that behavior at least once outside their 400-m home neighborhood and across a median of 3.0 (IQR 1.5-5.5), 3.0 (IQR 1.0-3.0), and 3.5 (IQR 1.0-7.0) unique locations, respectively. Conclusions: Among residents in rural Uganda, an ecological momentary assessment app successfully captured high mobility and health-related behaviors across multiple locations. Our findings suggest that future mobile health interventions in similar settings can benefit from integrating spatial data collection using the GPS technology in mobile phones. Leveraging such individual-level GPS data can inform place-based strategies within these interventions for promoting healthy behavior change. 
%M 38857493
%R 10.2196/54207
%U https://formative.jmir.org/2024/1/e54207
%U https://doi.org/10.2196/54207
%U http://www.ncbi.nlm.nih.gov/pubmed/38857493

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e55194
%T From the Public Health Perspective: a Scalable Model for Improving Epidemiological Testing Efficacy in Low- and Middle-Income Areas
%A Huang,Xuefeng
%A Kong,Qian-Yi
%A Wan,Xiaowen
%A Huang,Yating
%A Wang,Rongrong
%A Wang,Xiaoxue
%A Li,Yingying
%A Wu,Yuqing
%A Guan,Chongyuan
%A Wang,Junyang
%A Zhang,Yuanyuan
%+ School of Public Health, Dalian Medical University, No 9, West Section of Lvshun South Road, Dalian, 116041, China, 86 18641106272, zhangyuan@dmu.edu.cn
%K low- and middle-income country
%K LMIC
%K pandemic
%K epidemiological surveillance
%K universal public health
%K nonpharmacological interventions
%K public health
%K callable model
%K efficacy
%K COVID-19
%K public safety threats
%K effectiveness
%K China
%K detection
%K epidemic
%D 2024

%7 10.6.2024
%9 Viewpoint
%J JMIR Public Health Surveill
%G English
                
%X The globe is an organically linked whole, and in the pandemic era, COVID-19 has brought heavy public safety threats and economic costs to humanity as almost all countries began to pay more attention to taking steps to minimize the risk of harm to society from sudden-onset diseases. It is worth noting that in some low- and middle-income areas, where the environment for epidemic detection is complex, the causative and comorbid factors are numerous, and where public health resources are scarce. It is often more difficult than in other areas to obtain timely and effective detection and control in the event of widespread virus transmission, which, in turn, is a constant threat to local and global public health security. Pandemics are preventable through effective disease surveillance systems, with nonpharmacological interventions (NPIs) as the mainstay of the control system, effectively controlling the spread of epidemics and preventing larger outbreaks. However, current state-of-the-art NPIs are not applicable in low- and middle-income areas and tend to be decentralized and costly. Based on a 3-year case study of SARS-CoV-2 preventive detection in low-income areas in south-central China, we explored a strategic model for enhancing disease detection efficacy in low- and middle-income areas. For the first time, we propose an integrated and comprehensive approach that covers structural, social, and personal strategies to optimize the epidemic surveillance system in low- and middle-income areas. This model can improve the local epidemic detection efficiency, ensure the health care needs of more people, reduce the public health costs in low- and middle-income areas in a coordinated manner, and ensure and strengthen local public health security sustainably.
%M 38857063
%R 10.2196/55194
%U https://publichealth.jmir.org/2024/1/e55194
%U https://doi.org/10.2196/55194
%U http://www.ncbi.nlm.nih.gov/pubmed/38857063

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 11
%N 
%P e53976
%T Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach
%A Kabukye,Johnblack K
%A Namagembe,Rosemary
%A Nakku,Juliet
%A Kiberu,Vincent
%A Sjölinder,Marie
%A Nilsson,Susanne
%A Wamala-Larsson,Caroline
%+ SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12 (NOD Building), PO Box 7003 Kista, Stockholm, SE-164 07, Sweden, 46 8162000, kabukye@dsv.su.se
%K mHealth
%K mobile health
%K digital health
%K digital solution
%K digital solutions
%K digital intervention
%K digital interventions
%K mental health
%K awareness
%K Uganda
%K Africa
%K African
%K user centred
%K user centered
%K design
%K qualitative
%K focus group
%K focus groups
%K call centre
%K call centres
%K call center
%K call centers
%K mental
%K experience
%K experiences
%K attitude
%K attitudes
%K opinion
%K perception
%K perceptions
%K perspective
%K perspectives
%K cocreated
%K cocreation
%K service
%K services
%K mobile phone
%D 2024

%7 6.6.2024
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants’ experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants’ enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. 
%M 38843515
%R 10.2196/53976
%U https://humanfactors.jmir.org/2024/1/e53976
%U https://doi.org/10.2196/53976
%U http://www.ncbi.nlm.nih.gov/pubmed/38843515

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e52221
%T Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis
%A Luo,Yizhe
%A Zhang,Longyao
%A Xu,Yameng
%A Kuai,Qiyuan
%A Li,Wenhao
%A Wu,Yifan
%A Liu,Licheng
%A Ren,Jiarong
%A Zhang,Lingling
%A Shi,Qiufang
%A Liu,Xiaobo
%A Tan,Weilong
%+ Department of Epidemiology, School of Public Health, Nanjing Medical University, Meiyuan Xincun Street, Nanjing, 210002, China, 86 17384408593, njcdc@163.com
%K China
%K hemorrhagic fever with renal syndrome
%K HFRS
%K climate change
%K meteorological factors
%K distributed lag nonlinear model
%D 2024

%7 5.6.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicates that HFRS is climate sensitive and influenced by meteorological factors. However, past studies either focused on too-narrow geographical regions or investigated time periods that were too early. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones. Objective: In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China. Methods: The reported HFRS cases and meteorological data were collected from 151 cities in China during the period from 2015 to 2021. We conducted a 3-stage analysis, adopting a distributed lag nonlinear model and a generalized additive model to estimate the interactions and marginal effects of meteorological factors on HFRS. Results: This study included a total of 63,180 cases of HFRS; the epidemic trends showed seasonal fluctuations, with patterns varying across different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being at 1 month (–19 ºC; relative risk [RR] 1.64, 95% CI 1.24-2.15) in the midtemperate zone, 0 months (28 ºC; RR 3.15, 95% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 ºC; RR 1.72, 95% CI 1.31-2.25) in the subtropical zone. Interactions were discovered between the average temperature, relative humidity, and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors did not end after an epidemic season, but gradually weakened in the following 1 or 2 seasons. Conclusions: Weather variability, especially low temperature, plays an important role in epidemics of HFRS in China. A long hysteresis effect indicates the necessity of continuous intervention following an HFRS epidemic. This finding can help public health departments guide the prevention and control of HFRS and develop strategies to cope with the impacts of climate change in specific regions. 
%M 38837197
%R 10.2196/52221
%U https://publichealth.jmir.org/2024/1/e52221
%U https://doi.org/10.2196/52221
%U http://www.ncbi.nlm.nih.gov/pubmed/38837197

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e53411
%T Tuberculosis Treatment Compliance Under Smartphone-Based Video-Observed Therapy Versus Community-Based Directly Observed Therapy: Cluster Randomized Controlled Trial
%A Kumwichar,Ponlagrit
%A Prappre,Tagoon
%A Chongsuvivatwong,Virasakdi
%+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Kho Hong, Hat Yai, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th
%K video-enhanced therapy
%K tuberculosis
%K health care system
%K observed therapy
%K treatment compliance
%K lung disease
%K randomized trial
%K digital health
%K telehealth
%K telemedicine
%K mobile phone
%D 2024

%7 3.6.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There are no recent studies comparing the compliance rates of both patients and observers in tuberculosis treatment between the video-observed therapy (VOT) and directly observed therapy (DOT) programs. Objective: This study aims to compare the average number of days that patients with pulmonary tuberculosis and their observers were compliant under VOT and DOT. In addition, this study aims to compare the sputum conversion rate of patients under VOT with that of patients under DOT. Methods: Patient and observer compliance with tuberculosis treatment between the VOT and DOT programs were compared based on the average number of VOT and DOT compliance days and sputum conversion rates in a 60-day cluster randomized controlled trial with patients with pulmonary tuberculosis (VOT: n=63 and DOT: n=65) with positive sputum acid-fast bacilli smears and 38 observers equally randomized into the VOT and DOT groups (19 observers per group and n=1-5 patients per observer). The VOT group submitted videos to observers via smartphones; the DOT group followed standard procedures. An intention-to-treat analysis assessed the compliance of both the patients and the observers. Results: The VOT group had higher average compliance than the DOT group (patients: mean difference 15.2 days, 95% CI 4.8-25.6; P=.005 and observers: mean difference 21.2 days, 95% CI 13.5-28.9; P<.001). The sputum conversion rates in the VOT and DOT groups were 73% and 61.5%, respectively (P=.17). Conclusions: Smartphone-based VOT significantly outperformed community-based DOT in ensuring compliance with tuberculosis treatment among observers. However, the study was underpowered to confirm improved compliance among patients with pulmonary tuberculosis and to detect differences in sputum conversion rates. Trial Registration: Thai Clinical Trials Registry (TCTR) TCTR20210624002; https://tinyurl.com/3bc2ycrh International Registered Report Identifier (IRRID): RR2-10.2196/38796 
%M 38830205
%R 10.2196/53411
%U https://mhealth.jmir.org/2024/1/e53411
%U https://doi.org/10.2196/53411
%U http://www.ncbi.nlm.nih.gov/pubmed/38830205

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e52243
%T The Durban University of Technology Faculty of Health Sciences Decentralized Clinical Training Project: Protocol for an Implementation Study in KwaZulu-Natal, South Africa
%A Nxumalo,Celenkosini Thembelenkosini
%A Pillay,Pavitra
%A Mchunu,Gugu Gladness
%+ Academic Development Unit, Faculty of Health Sciences, Durban University of Technology, 7 Ritson Road, Berea, Durban, 4001, South Africa, 27 313736620 ext 6620, cnxumalo@uwc.ac.za
%K decentralized clinical training programs
%K curriculum
%K clinical education
%K health science education
%K university of technology
%K pedagogy
%K transformative education
%K teaching
%K higher education
%K South Africa
%D 2024

%7 3.6.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. Objective: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. Methods: Participatory action research comprising various designs—namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design—will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs—namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue—will be part of the project’s pilot phase. Findings from the project’s pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university’s strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. Results: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. Conclusions: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. International Registered Report Identifier (IRRID): PRR1-10.2196/52243 
%M 38829695
%R 10.2196/52243
%U https://www.researchprotocols.org/2024/1/e52243
%U https://doi.org/10.2196/52243
%U http://www.ncbi.nlm.nih.gov/pubmed/38829695

%0 Journal Article
        
%I 
%V 
%N 
%P 
%T 
%D 

%7 ..
%9 
%J 
%G English
                
%X 
%U 

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e50622
%T Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis
%A Meng,Yingying
%A Yu,Ran
%A Bai,Huixin
%A Han,Junqiang
%+ School of Public Management, South-Central Minzu University, 182 Minzu Avenue, Hongshan District, Wuhan, 430074, China, 86 35 5409 4333, Junqianghan@scuec.edu.cn
%K medical insurance system integration
%K Urban and Rural Resident Basic Medical Insurance
%K URRBMI
%K urban and rural residents
%K health equity
%K China
%K difference-in-differences
%K DID
%K staggered DID
%D 2024

%7 30.5.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objective: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. Results: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. Conclusions: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration. 
%M 38815256
%R 10.2196/50622
%U https://publichealth.jmir.org/2024/1/e50622
%U https://doi.org/10.2196/50622
%U http://www.ncbi.nlm.nih.gov/pubmed/38815256

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 11
%N 
%P e55544
%T Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial
%A Abi Hana,Racha
%A Abi Ramia,Jinane
%A Burchert,Sebastian
%A Carswell,Kenneth
%A Cuijpers,Pim
%A Heim,Eva
%A Knaevelsrud,Christine
%A Noun,Philip
%A Sijbrandij,Marit
%A van Ommeren,Mark
%A van’t Hof,Edith
%A Wijnen,Ben
%A Zoghbi,Edwina
%A El Chammay,Rabih
%A Smit,Filip
%+ Clinical, Neuro- and Developmental Psychology Department, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1105 1081 HV, Netherlands, 31 3978968, rasha_abihana@hotmail.com
%K depression
%K internet-based intervention
%K economic evaluation
%K Lebanese
%K Syrian
%K digital mental health
%K digital health
%K mental health
%K usual care
%K Lebanon
%K anxiety
%K stress-related disorders
%K treatment
%K symptoms
%K large randomized controlled trial
%K effectiveness
%D 2024

%7 29.5.2024
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: There is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs are highest. Step-by-Step (SbS), a digital mental health intervention for depression, anxiety, and stress-related disorders, proved to be effective for Lebanese citizens and war-affected Syrians residing in Lebanon. Assessing the cost-effectiveness of SbS is crucial because Lebanon’s overstretched health care system must prioritize cost-effective treatment options in the face of continuing humanitarian and economic crises. Objective: This study aims to assess the cost-effectiveness of SbS in a randomized comparison with enhanced usual care (EUC). Methods: The cost-effectiveness analysis was conducted alongside a pragmatic randomized controlled trial in 2 parallel groups comparing SbS (n=614) with EUC (n=635). The primary outcome was cost (in US $ for the reference year 2019) per treatment response of depressive symptoms, defined as >50% reduction of depressive symptoms measured using the Patient Health Questionnaire (PHQ). The secondary outcome was cost per remission of depressive symptoms, defined as a PHQ score <5 at last follow-up (5 months post baseline). The evaluation was conducted first from the health care perspective then from the societal perspective. Results: Taking the health care perspective, SbS had an 80% probability to be regarded as cost-effective compared with EUC when there is a willingness to pay US $220 per additional treatment response or US $840 per additional remission. Taking the wider societal perspective, SbS had a >75% probability to be cost-saving while gaining response or remission. Conclusions: To our knowledge, this study is the first cost-effectiveness analysis based on a large randomized controlled trial (n=1249) of a guided digital mental health intervention in an LMIC. From the principal findings, 2 implications flowed, from the (1) health care perspective and (2) wider societal perspective. First, our findings suggest that SbS is associated with greater health benefits, albeit for higher costs than EUC. It is up to decision makers in health care to decide if they find the balance between additional health gains and additional health care costs acceptable. Second, as seen from the wider societal perspective, there is a substantial likelihood that SbS is not costing more than EUC but is associated with cost-savings as SBS participants become more productive, thus offsetting their health care costs. This finding may suggest to policy makers that it is in the interest of both population health and the wider Lebanese economy to implement SbS on a wide scale. In brief, SbS may offer a scalable, potentially cost-saving response to humanitarian emergencies in an LMIC. Trial Registration: ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID): RR2-10.2196/21585 
%M 38810255
%R 10.2196/55544
%U https://mental.jmir.org/2024/1/e55544
%U https://doi.org/10.2196/55544
%U http://www.ncbi.nlm.nih.gov/pubmed/38810255

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54933
%T Patients and Stakeholders’ Perspectives Regarding the Privacy, Security, and Confidentiality of Data Collected via Mobile Health Apps in Saudi Arabia: Protocol for a Mixed Method Study
%A Alhammad,Nasser
%A Alajlani,Mohannad
%A Abd-alrazaq,Alaa
%A Arvanitis,Theodoros
%A Epiphaniou,Gregory
%+ Institute of Digital Healthcare, WMG, University of Warwick, Millburn House, Coventry, CV4 7AL, United Kingdom, 44 558885007, N.alhammad@seu.edu.sa
%K awareness
%K data privacy
%K confidentiality
%K security
%K health care
%K patients
%K Saudi Arabia
%K mHealth
%K mobile apps
%D 2024

%7 22.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There is data paucity regarding users’ awareness of privacy concerns and the resulting impact on the acceptance of mobile health (mHealth) apps, especially in the Saudi context. Such information is pertinent in addressing users’ needs in the Kingdom of Saudi Arabia (KSA). Objective: This article presents a study protocol for a mixed method study to assess the perspectives of patients and stakeholders regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA and the factors affecting the adoption of mHealth apps. Methods: A mixed method study design will be used. In the quantitative phase, patients and end users of mHealth apps will be randomly recruited from various provinces in Saudi Arabia with a high population of mHealth users. The research instrument will be developed based on the emerging themes and findings from the interview conducted among stakeholders, app developers, health care professionals, and users of mHealth apps (n=25). The survey will focus on (1) how to improve patients’ awareness of data security, privacy, and confidentiality; (2) feedback on the current mHealth apps in terms of data security, privacy, and confidentiality; and (3) the features that might improve data security, privacy, and confidentiality of mHealth apps. Meanwhile, specific sections of the questionnaire will focus on patients’ awareness, privacy concerns, confidentiality concerns, security concerns, perceived usefulness, perceived ease of use, and behavioral intention. Qualitative data will be analyzed thematically using NVivo version 12. Descriptive statistics, regression analysis, and structural equation modeling will be performed using SPSS and partial least squares structural equation modeling. Results: The ethical approval for this research has been obtained from the Biomedical and Scientific Research Ethics Committee, University of Warwick, and the Medical Research and Ethics Committee Ministry of Health in the KSA. The qualitative phase is ongoing and 15 participants have been interviewed. The interviews for the remaining 10 participants will be completed by November 25, 2023. Preliminary thematic analysis is still ongoing. Meanwhile, the quantitative phase will commence by December 10, 2023, with 150 participants providing signed and informed consent to participate in the study. Conclusions: The mixed methods study will elucidate the antecedents of patients’ awareness and concerns regarding the privacy, security, and confidentiality of data collected via mHealth apps in the KSA. Furthermore, pertinent findings on the perspectives of stakeholders and health care professionals toward the aforementioned issues will be gleaned. The results will assist policy makers in developing strategies to improve Saudi users’/patients’ adoption of mHealth apps and addressing the concerns raised to benefit significantly from these advanced health care modalities. International Registered Report Identifier (IRRID): DERR1-10.2196/54933 
%M 38776540
%R 10.2196/54933
%U https://www.researchprotocols.org/2024/1/e54933
%U https://doi.org/10.2196/54933
%U http://www.ncbi.nlm.nih.gov/pubmed/38776540

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e49168
%T Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers’ Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study
%A Morales-Cahuancama,Bladimir
%A Verdezoto,Nervo
%A Gonzales-Achuy,Elena
%A Quispe-Gala,Cinthia
%A Bautista-Olortegui,William
%A Hinojosa-Mamani,Paul
%A Aparco,Juan Pablo
%+ Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Av Ricardo Tizón y Bueno 276, Jesús María, Lima, 15072, Peru, 51 7480000 ext 6626, bmorales@ins.gob.pe
%K child
%K children
%K schoolchildren
%K youth
%K student
%K students
%K adolescent
%K schoolchildren
%K formative research
%K digital media
%K digital games
%K serious game
%K serious games
%K nutrition
%K obesity
%K obese
%K overweight
%K mHealth
%K caregivers’ perspectives
%K perspective
%K perspectives
%K diet
%K healthy eating
%D 2024

%7 14.5.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren’s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren’s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren’s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children’s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers’ perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren’s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. 
%M 38743472
%R 10.2196/49168
%U https://formative.jmir.org/2024/1/e49168
%U https://doi.org/10.2196/49168
%U http://www.ncbi.nlm.nih.gov/pubmed/38743472

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e55238
%T Evaluating and Enhancing an Educational Intervention to Reduce Smallholder Farmers’ Exposure to Pesticides in Uganda Through a Digital, Systematic Approach to Behavior Change: Protocol for a Cluster-Randomized Controlled Trial
%A Ssekkadde,Peter
%A Tomberge,Vica Marie Jelena
%A Brugger,Curdin
%A Atuhaire,Aggrey
%A Dalvie,Mohamed Aqiel
%A Rother,Hanna-Andrea
%A Röösli,Martin
%A Inauen,Jennifer
%A Fuhrimann,Samuel
%+ Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland, 41 762010833, samuel.fuhrimann@swisstph.ch
%K smallholder farmers
%K knowledge
%K attitude
%K practice
%K behavior change
%K psychosocial determinants of behavior
%K health
%K education
%K pesticide exposure
%K SMS text messages
%D 2024

%7 8.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Smallholder farmers receive educational interventions on safe pesticide handling by governmental agencies, industries, or nongovernmental organizations to reduce exposure risks. However, existing educational interventions have limited effects on changing behaviors. Targeting psychosocial determinants of behavior change in educational interventions through theory- and evidence-based approaches may enhance their effectiveness. Objective: We aim at describing the intervention development and study design of a 3-arm cluster-randomized controlled trial to assess the effects in improving safe pesticide handling and reducing pesticide exposure of (1) an existing educational intervention and (2) a newly developed SMS text messaging intervention based on the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) behavior change approach. Methods: We enrolled 539 Ugandan smallholder farmers in 12 clusters (subcounties). The clusters, each with 45 farmers, were randomly allocated to one of the three arms: (1) educational intervention, (2) educational intervention+RANAS-based SMS text messages, or (3) control group. The educational intervention comprised a 2-day workshop that targeted multiple aspects of safe pesticide handling, whereas the SMS text messages targeted the use of personal protective equipment (PPE) and were based on the RANAS approach. For intervention development in this study, this approach includes identifying psychosocial determinants of PPE use at baseline and selecting behavior change techniques to target them in SMS text messages. The primary outcomes of the study are (1) pesticide knowledge, attitude, and practice scores indicating performance throughout the educational intervention; and (2) frequency of PPE use. Secondary outcomes are the RANAS-based behavioral determinants of PPE use, the frequency of glove use, algorithm-based pesticide exposure intensity scores, and signs and symptoms of pesticide poisoning. The outcomes were assessed in structured interviews before the intervention (baseline) and at the 12-month follow-up. The effect of the interventions among the arms will be analyzed using the intervention arms and baseline measures as predictors and the follow-up measures as outcomes in linear multivariable mixed models including the clusters as random effects. The mediating psychosocial determinants of the interventions will be assessed in multiple mediation models. Results: The study was conducted from 2020 to 2021—baseline interviews were conducted in October 2020, and the educational intervention was delivered in November 2020. The RANAS-based SMS text messages were developed based on the baseline data for relevant behavioral determinants of PPE use and sent between February 2021 and September 2021. Follow-up interviews were conducted in October 2021. Overall, 539 farmers were enrolled in the study at baseline; 8.3% (45/539) were lost to follow-up by the end of the study. Conclusions: This study will contribute to a better understanding of the effectiveness and behavior change mechanisms of educational interventions by using an experimental, cluster-randomized study design to improve pesticide handling among smallholder farmers. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 18237656; https://doi.org/10.1186/ISRCTN18237656 International Registered Report Identifier (IRRID): DERR1-10.2196/55238 
%M 38718387
%R 10.2196/55238
%U https://www.researchprotocols.org/2024/1/e55238
%U https://doi.org/10.2196/55238
%U http://www.ncbi.nlm.nih.gov/pubmed/38718387

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e50826
%T Perceptions of Wearable Health Tools Post the COVID-19 Emergency in Low-Income Latin Communities: Qualitative Study
%A Cruz,Stefany
%A Lu,Claire
%A Ulloa,Mara
%A Redding,Alexander
%A Hester,Josiah
%A Jacobs,Maia
%+ Department of Electrical and Computer Engineering, McCormick School of Engineering, Northwestern University, 633 Clark Street, Evanston, IL, 60208, United States, 1 8474913741, stefanycruz2024@u.northwestern.edu
%K mHealth
%K mobile health
%K wearable
%K wearables
%K Health wearables
%K COVID-19
%K digital divide
%K low-socioeconomic status
%K socioeconomic
%K adoption
%K underserved
%K poverty
%K low income
%K low resource
%K marginalized
%K equity
%K attitude
%K attitudes
%K opinion
%K opinions
%K perception
%K perceptions
%K perspective
%K perspectives
%K acceptance
%K Spanish
%K Hispanic
%K Latinx
%K Hispanics
%K interview
%K interviews
%D 2024

%7 8.5.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) wearable devices are increasingly being adopted by individuals to help manage and monitor physiological signals. However, the current state of wearables does not consider the needs of racially minoritized low–socioeconomic status (SES) communities regarding usability, accessibility, and price. This is a critical issue that necessitates immediate attention and resolution. Objective: This study’s aims were 3-fold, to (1) understand how members of minoritized low-SES communities perceive current mHealth wearable devices, (2) identify the barriers and facilitators toward adoption, and (3) articulate design requirements for future wearable devices to enable equitable access for these communities. Methods: We performed semistructured interviews with low-SES Hispanic or Latine adults (N=19) from 2 metropolitan cities in the Midwest and West Coast of the United States. Participants were asked questions about how they perceive wearables, what are the current benefits and barriers toward use, and what features they would like to see in future wearable devices. Common themes were identified and analyzed through an exploratory qualitative approach. Results: Through qualitative analysis, we identified 4 main themes. Participants’ perceptions of wearable devices were strongly influenced by their COVID-19 experiences. Hence, the first theme was related to the impact of COVID-19 on the community, and how this resulted in a significant increase in interest in wearables. The second theme highlights the challenges faced in obtaining adequate health resources and how this further motivated participants’ interest in health wearables. The third theme focuses on a general distrust in health care infrastructure and systems and how these challenges are motivating a need for wearables. Lastly, participants emphasized the pressing need for community-driven design of wearable technologies. Conclusions: The findings from this study reveal that participants from underserved communities are showing emerging interest in using health wearables due to the COVID-19 pandemic and health care access issues. Yet, the needs of these individuals have been excluded from the design and development of current devices. 
%M 38717816
%R 10.2196/50826
%U https://mhealth.jmir.org/2024/1/e50826
%U https://doi.org/10.2196/50826
%U http://www.ncbi.nlm.nih.gov/pubmed/38717816

%0 Journal Article
        
%@ 2819-2044
%I JMIR Publications
%V 2
%N 
%P e50588
%T Establishing Antimicrobial Resistance Surveillance in the Water and Environment Sector in a Resource-Limited Setting: Methodical Qualitative and Quantitative Description of Uganda’s Experience From 2021 to 2023
%A Katumba,Godfrey
%A Mwanja,Herman
%A Mayito,Jonathan
%A Mbolanyi,Betty
%A Isaasi,Fred
%A Kibombo,Daniel
%A Namumbya,Judith
%A Musoke,David
%A Kabazzi,Jonathan
%A Sekamatte,Musa
%A Idrakua,Lillian
%A Walwema,Richard
%A Lamorde,Mohammed
%A Kakooza,Francis
%A Etimu,Simon
%+ Infectious Diseases Institute, Makerere University, Makerere University Main Campus, Kampala, P.O. Box 22418, Uganda, 256 0770781589, hmwanja@idi.co.ug
%K antimicrobial resistance
%K surveillance system
%K water and environment sector
%D 2024

%7 7.5.2024
%9 Original Paper
%J JMIRx Bio
%G English
                
%X Background: Antimicrobial irrational use and poor disposal in the human and animal sectors promote antimicrobial resistance (AMR) in the environment as these antimicrobials and their active ingredients, coupled with resistant microbes, are released into the environment. While AMR containment programs in the human and animal sectors are well established in Uganda, those in the water and environment sector still need to be established and strengthened. Therefore, the Ministry of Water and Environment set out to establish an AMR surveillance program to bolster the One Health efforts for the containment of AMR under the National Action Plan 2018-2023. Objective: This study aims to describe Uganda’s experience in establishing AMR surveillance in the water and environment sector. Methods: A methodical qualitative and quantitative description of the steps undertaken between August 2021 and March 2023 to establish an AMR surveillance system in the water and environment sector is provided. The Uganda Ministry of Water and Environment used a stepwise approach. Governance structures were streamlined, and sector-specific AMR surveillance guiding documents were developed, pretested, and rolled out. The National Water Quality Reference Laboratory infrastructure and microbiology capacity were enhanced to aid AMR detection and surveillance using conventional culture-based methods. A passive and targeted active surveillance hybrid was used to generate AMR data. Passive surveillance used remnants of water samples collected routinely for water quality monitoring while targeted active surveys were done at selected sites around the Kampala and Wakiso districts. Excel and Stata 15 statistical software were used for data analysis. Results: A sector-specific technical working group of 10 members and focal persons is in place, providing strategic direction and linkage to the national AMR surveillance program. The National Water Quality Reference Laboratory is now at biosafety level 2 and conducting microbiology testing using conventional culture-based techniques. Up to 460 water samples were processed and 602 bacterial isolates were recovered, of which 399 (66.3%) and 203 (33.7%) were priority pathogens and nonpriority pathogens, respectively. Of the 399 priority pathogens, 156 (39.1%), 140 (35.1%), 96 (24.1%), and 7 (1.8%) were Escherichia coli, Klebsiella species, Enterococcus species, and Salmonella species, respectively. E coli showed resistance to ampicillin (79%), ciprofloxacin (29%), and ceftriaxone (29%). Similarly, Klebsiella species showed resistance to ampicillin (100%), ciprofloxacin (17%), and ceftriaxone (18%). Enterococcus species showed resistance to ciprofloxacin (52%), vancomycin (45%), and erythromycin (56%). Up to 254 (63.7%) of the priority pathogens recovered exhibited multiple and extensive resistance to the different antibiotics set. Conclusions: Initial efforts to establish and implement AMR surveillance in the water and environment sector have succeeded in streamlining governance and laboratory systems to generate AMR data using conventional culture-based methods. 
%R 10.2196/50588
%U https://bio.jmirx.org/2024/1/e50588
%U https://doi.org/10.2196/50588

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e55559
%T Development and Pilot-Testing of an Optimized Conversational Agent or “Chatbot” for Peruvian Adolescents Living With HIV to Facilitate Mental Health Screening, Education, Self-Help, and Linkage to Care: Protocol for a Mixed Methods, Community-Engaged Study
%A Galea,Jerome T
%A Vasquez,Diego H
%A Rupani,Neil
%A Gordon,Moya B
%A Tapia,Milagros
%A Greene,Karah Y
%A Kolevic,Lenka
%A Franke,Molly F
%A Contreras,Carmen
%+ School of Social Work, College of Behavioral and Community Sciences, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 1400, Tampa, FL, 33612-3807, United States, 1 813 974 2310, jeromegalea@usf.edu
%K chatbot
%K digital assistant
%K depression
%K HIV
%K adolescents
%D 2024

%7 7.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Adolescents living with HIV are disproportionally affected by depression, which worsens antiretroviral therapy adherence, increases viral load, and doubles the risk of mortality. Because most adolescents living with HIV live in low- and middle-income countries, few receive depression treatment due to a lack of mental health services and specialists in low-resource settings. Chatbot technology, used increasingly in health service delivery, is a promising approach for delivering low-intensity depression care to adolescents living with HIV in resource-constrained settings. Objective: The goal of this study is to develop and pilot-test for the feasibility and acceptability of a prototype, optimized conversational agent (chatbot) to provide mental health education, self-help skills, and care linkage for adolescents living with HIV. Methods: Chatbot development comprises 3 phases conducted over 2 years. In the first phase (year 1), formative research will be conducted to understand the views, opinions, and preferences of up to 48 youths aged 10-19 years (6 focus groups of up to 8 adolescents living with HIV per group), their caregivers (5 in-depth interviews), and HIV program personnel (5 in-depth interviews) regarding depression among adolescents living with HIV. We will also investigate the perceived acceptability of a mental health chatbot, including barriers and facilitators to accessing and using a chatbot for depression care by adolescents living with HIV. In the second phase (year 1), we will iteratively program a chatbot using the SmartBot360 software with successive versions (0.1, 0.2, and 0.3), meeting regularly with a Youth Advisory Board comprised of adolescents living with HIV who will guide and inform the chatbot development and content to arrive at a prototype version (version 1.0) for pilot-testing. In the third phase (year 2), we will pilot-test the prototype chatbot among 50 adolescents living with HIV naïve to its development. Participants will interact with the chatbot for up to 2 weeks, and data will be collected on the acceptability of the chatbot-delivered depression education and self-help strategies, depression knowledge changes, and intention to seek care linkage. Results: The study was awarded in April 2022, received institutional review board approval in November 2022, received funding in December 2022, and commenced recruitment in March 2023. By the completion of study phases 1 and 2, we expect our chatbot to incorporate key needs and preferences gathered from focus groups and interviews to develop the chatbot. By the completion of study phase 3, we will have assessed the feasibility and acceptability of the prototype chatbot. Study phase 3 began in April 2024. Final results are expected by January 2025 and published thereafter. Conclusions: The study will produce a prototype mental health chatbot developed with and for adolescents living with HIV that will be ready for efficacy testing in a subsequent, larger study. International Registered Report Identifier (IRRID): DERR1-10.2196/55559 
%M 38713501
%R 10.2196/55559
%U https://www.researchprotocols.org/2024/1/e55559
%U https://doi.org/10.2196/55559
%U http://www.ncbi.nlm.nih.gov/pubmed/38713501

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e52853
%T An mHealth Intervention for Gay and Bisexual Men’s Mental, Behavioral, and Sexual Health in a High-Stigma, Low-Resource Context (Project Comunică): Protocol for a Randomized Controlled Trial
%A Leluțiu-Weinberger,Corina
%A Filimon,Mircea L
%A Hoover,Donald
%A Lixandru,Mihai
%A Hanu,Lucian
%A Dogaru,Bogdan
%A Kovacs,Tudor
%A Fierbințeanu,Cristina
%A Ionescu,Florentina
%A Manu,Monica
%A Mariș,Alexandra
%A Pană,Elena
%A Dorobănțescu,Cristian
%A Streinu-Cercel,Adrian
%A Pachankis,John E
%+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 646 217 9205, cl4265@cumc.columbia.edu
%K gay and bisexual men
%K HIV prevention
%K heavy alcohol use
%K stigma
%K mental health
%K behavioral intervention
%K mobile phone
%D 2024

%7 6.5.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The World Health Organization reported that 80% of new HIV diagnoses in Europe in 2014 occurred in Central and Eastern Europe. Romania has a particularly high HIV incidence, AIDS prevalence, and number of related deaths. HIV incidence in Romania is largely attributed to sexual contact among gay and bisexual men. However, homophobic stigma in Romania serves as a risk factor for HIV infection for gay and bisexual men. The Comunică intervention aims to provide a much-needed HIV risk reduction strategy, and it entails the delivery of motivational interviewing and cognitive behavioral therapy skills across 8 live text-based counseling sessions on a mobile platform to gay and bisexual men at risk of HIV. The intervention is based on the information-motivation-behavior and minority stress models. There is preliminary evidence suggesting that Comunică holds promise for reducing gay and bisexual men’s co-occurring sexual (eg, HIV transmission risk behavior), behavioral (eg, heavy alcohol use), and mental (eg, depression) health risks in Romania. Objective: This paper describes the protocol for a randomized controlled trial designed to test the efficacy of Comunică in a national trial. Methods: To test Comunică’s efficacy, 305 gay and bisexual men were randomized to receive Comunică or a content-matched education attention control condition. The control condition consisted of 8 time-matched educational modules that present information regarding gay and bisexual men’s identity development, information about HIV transmission and prevention, the importance of HIV and sexually transmitted infection testing and treatment, heavy alcohol use and its associations with HIV transmission risk behavior, sexual health communication, finding social support, and creating sexual health goals. Participants undergo rapid HIV and syphilis testing and 3-site chlamydia and gonorrhea testing at baseline and the 12-month follow-up. Outcomes are measured before the intervention (baseline) and at the 4-, 8-, and 12-month follow-ups. Results: The study was funded in September 2018, and data collection began in May 2019. The last participant follow-up was in January 2024. Currently, the data analyst is cleaning data sets in preparation for data analyses, which are scheduled to begin in April 2024. Data analysis meetings are scheduled regularly to establish timelines and examine the results as analyses are gradually being conducted. Upon completion, a list of manuscripts will be reviewed and prioritized, and the team will begin preparing them for publication. Conclusions: This study is the first to test the efficacy of an intervention with the potential to simultaneously support the sexual, behavioral, and mental health of gay and bisexual men in Central and Eastern Europe using motivational interviewing support and sensitivity to the high-stigma context of the region. If efficacious, Comunică presents a scalable platform to provide support to gay and bisexual men living in Romania and similar high-stigma, low-resource countries. Trial Registration: ClinicalTrials.gov NCT03912753; https://clinicaltrials.gov/study/NCT03912753 International Registered Report Identifier (IRRID): DERR1-10.2196/52853 
%M 38709550
%R 10.2196/52853
%U https://www.researchprotocols.org/2024/1/e52853
%U https://doi.org/10.2196/52853
%U http://www.ncbi.nlm.nih.gov/pubmed/38709550

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e50385
%T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups
%A Donkin,Liesje
%A Bidois-Putt,Marie-Claire
%A Wilson,Holly
%A Hayward,Penelope
%A Chan,Amy Hai Yan
%+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz
%K Indigenous people
%K Māori
%K eHealth
%K mental health
%K web-based intervention
%K digital intervention
%D 2024

%7 2.5.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. 
%M 38696236
%R 10.2196/50385
%U https://formative.jmir.org/2024/1/e50385
%U https://doi.org/10.2196/50385
%U http://www.ncbi.nlm.nih.gov/pubmed/38696236

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e51628
%T Evaluating the World Health Organization’s SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study
%A Cano,Mireia
%A Ruiz-Postigo,José A
%A Macharia,Paul
%A Ampem Amoako,Yaw
%A Odame Phillips,Richard
%A Kinyeru,Esther
%A Carrion,Carme
%+ eHealth Lab Research Group, eHealth Center, School of Health Sciences, Universitat de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 630983328, mcarrionr@uoc.edu
%K SkinNTDs app
%K mHealth
%K mobile health
%K neglected tropical diseases
%K NTDs
%K skin neglected tropical diseases
%K low- and middle-income countries
%K tropical disease
%K app
%K training tool
%K digital health
%K intervention
%K decision support tool
%K mobile phone
%D 2024

%7 30.4.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. Objective: This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. Methods: A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Results: Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. Conclusions: The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. International Registered Report Identifier (IRRID): RR2-10.2196/39393 
%M 38687587
%R 10.2196/51628
%U https://www.jmir.org/2024/1/e51628
%U https://doi.org/10.2196/51628
%U http://www.ncbi.nlm.nih.gov/pubmed/38687587

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e52191
%T The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria
%A Mitchell,Ellen MH
%A Adejumo,Olusola Adedeji
%A Abdur-Razzaq,Hussein
%A Ogbudebe,Chidubem
%A Gidado,Mustapha
%+ Mycobacterial Diseases and Neglected Tropical Diseases Unit, Department of Public Health, Institute for Tropical Medicine, 155 Nationaalestraat, Roche, Antwerp, 2000, Belgium, 31 634790509, emitchell@itg.be
%K surveillance
%K trust
%K Integrated Disease Surveillance and Response
%K IDSR
%K tuberculosis
%K notification
%K public-private mix
%K infectious disease
%K disease surveillance
%K surveillance behavior
%K health care worker
%K health professional
%K public health
%K Nigeria
%K survey
%K behavior
%K self-reported
%D 2024

%7 25.4.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers’ intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers’ attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the “software” of surveillance. Objective: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. Methods: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Results: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed “always” notifying via IDSR monthly reported higher median trust in the state’s public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Conclusions: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers’ public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the “software” of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance. 
%M 38506095
%R 10.2196/52191
%U https://publichealth.jmir.org/2024/1/e52191
%U https://doi.org/10.2196/52191
%U http://www.ncbi.nlm.nih.gov/pubmed/38506095

%0 Journal Article
        
%@ 2369-2529
%I JMIR Publications
%V 11
%N 
%P e56348
%T Introducing JMIR Rehabilitation and Assistive Technologies: A Venue for Publishing Interdisciplinary Research on the Development, Implementation, and Evaluation of Health Innovations and Emerging Technologies in the Field of Rehabilitation
%A Munce,Sarah EP
%+ KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, 345 Rumsey Road, Toronto, ON, M4G 1R7, Canada, 1 416 597 3422, Sarah.Munce@uhn.ca
%K rehabilitation
%K assistive technologies
%K JMIR Rehabilitation and Assistive Technologies
%K digital
%K online
%D 2024

%7 22.4.2024
%9 Editorial
%J JMIR Rehabil Assist Technol
%G English
                
%X Rehabilitation supports the affected individual and their caregivers in managing the health condition and its associated symptoms, altering the environment to accommodate needs, adapting tasks for safe and independent performance, facilitating self-management, and using assistive devices and technologies. JMIR Rehabilitation and Assistive Technologies focuses on pragmatic yet rigorous and impactful science that reports on the development, implementation, and evaluation of health innovations and interventions as well as emerging technologies in the field of rehabilitation.
%M 38648632
%R 10.2196/56348
%U https://rehab.jmir.org/2024/1/e56348
%U https://doi.org/10.2196/56348
%U http://www.ncbi.nlm.nih.gov/pubmed/38648632

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e49163
%T Regulatory Standards and Guidance for the Use of Health Apps for Self-Management in Sub-Saharan Africa: Scoping Review
%A Bene,Benard Ayaka
%A Ibeneme,Sunny
%A Fadahunsi,Kayode Philip
%A Harri,Bala Isa
%A Ukor,Nkiruka
%A Mastellos,Nikolaos
%A Majeed,Azeem
%A Car,Josip
%+ Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 7598439185, b.bene15@imperial.ac.uk
%K regulation
%K standard
%K framework
%K guidance
%K guideline
%K health app
%K self-management
%K World Health Organization
%K WHO African Region
%K sub-Saharan Africa
%D 2024

%7 11.4.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Health apps are increasingly recognized as crucial tools for enhancing health care delivery. Many countries, particularly those in sub-Saharan Africa, can substantially benefit from using health apps to support self-management and thus help to achieve universal health coverage and the third sustainable development goal. However, most health apps published in app stores are of unknown or poor quality, which poses a risk to patient safety. Regulatory standards and guidance can help address this risk and promote patient safety. Objective: This review aims to assess the regulatory standards and guidance for health apps supporting evidence-based best practices in sub-Saharan Africa with a focus on self-management. Methods: A methodological framework for scoping reviews was applied. A search strategy was built and applied across the following databases, gray literature sources, and institutional websites: PubMed, Scopus, World Health Organization (WHO) African Index Medicus, OpenGrey, WHO Regional Office for Africa Library, ICTworks, WHO Directory of eHealth policies, HIS Strengthening Resource Center, International Telecommunication Union, Ministry of Health websites, and Google. The search covered the period between January 2005 and January 2024. The findings were analyzed using a deductive descriptive content analysis. The policy analysis framework was adapted and used to organize the findings. The Reporting Items for Stakeholder Analysis tool guided the identification and mapping of key stakeholders based on their roles in regulating health apps for self-management. Results: The study included 49 documents from 31 sub-Saharan African countries. While all the documents were relevant for stakeholder identification and mapping, only 3 regulatory standards and guidance contained relevant information on regulation of health apps. These standards and guidance primarily aimed to build mutual trust; promote integration, inclusion, and equitable access to services; and address implementation issues and poor coordination. They provided guidance on systems quality, software acquisition and maintenance, security measures, data exchange, interoperability and integration, involvement of relevant stakeholders, and equitable access to services. To enhance implementation, the standards highlight that legal authority, coordination of activities, building capacity, and monitoring and evaluation are required. A number of stakeholders, including governments, regulatory bodies, funders, intergovernmental and nongovernmental organizations, academia, and the health care community, were identified to play key roles in regulating health apps. Conclusions: Health apps have huge potential to support self-management in sub-Saharan Africa, but the lack of regulatory standards and guidance constitutes a major barrier. Hence, for these apps to be safely and effectively integrated into health care, more attention should be given to regulation. Learning from countries with effective regulations can help sub-Saharan Africa build a more robust and responsive regulatory system, ensuring the safe and beneficial use of health apps across the region. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025714 
%M 38602718
%R 10.2196/49163
%U https://www.jmir.org/2024/1/e49163
%U https://doi.org/10.2196/49163
%U http://www.ncbi.nlm.nih.gov/pubmed/38602718

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e55509
%T Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study
%A Lozada-Tequeanes,Ana Lilia
%A Théodore,Florence L
%A Kim-Herrera,Edith
%A García-Guerra,Armando
%A Quezada-Sánchez,Amado D
%A Alvarado-Casas,Rocio
%A Bonvecchio,Anabelle
%+ National Institute of Public Health, Instituto Nacional de Salud Pública de México, Avenida Universidad 655, Cuernavaca, 62100, Mexico, 52 +527773293000, ftheodore@insp.mx
%K effectiveness
%K feasibility
%K mHealth
%K SMS text message
%K mixed methods
%K infant obesity
%K physical activity
%K healthy feeding
%K children
%K COVID-19
%K Mexico
%D 2024

%7 9.4.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 
%M 38592753
%R 10.2196/55509
%U https://mhealth.jmir.org/2024/1/e55509
%U https://doi.org/10.2196/55509
%U http://www.ncbi.nlm.nih.gov/pubmed/38592753

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e48060
%T Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study
%A Rieckmann,Andreas
%A Nielsen,Sebastian
%A Dworzynski,Piotr
%A Amini,Heresh
%A Mogensen,Søren Wengel
%A Silva,Isaquel Bartolomeu
%A Chang,Angela Y
%A Arah,Onyebuchi A
%A Samek,Wojciech
%A Rod,Naja Hulvej
%A Ekstrøm,Claus Thorn
%A Benn,Christine Stabell
%A Aaby,Peter
%A Fisker,Ane Bærent
%+ Section of Epidemiology, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1353, Denmark, 45 35326765, aric@sund.ku.dk
%K child mortality
%K causal discovery
%K Guinea-Bissau
%K inductive-deductive
%K machine learning
%K targeted preventive and risk-mitigating interventions
%D 2024

%7 9.4.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. Objective: This study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. Methods: We used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. Results: We analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. Conclusions: The study’s results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups. 
%M 38592761
%R 10.2196/48060
%U https://publichealth.jmir.org/2024/1/e48060
%U https://doi.org/10.2196/48060
%U http://www.ncbi.nlm.nih.gov/pubmed/38592761

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e48144
%T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study
%A Mabetha,Khuthala
%A Soepnel,Larske M
%A Mabena,Gugulethu
%A Motlhatlhedi,Molebogeng
%A Nyati,Lukhanyo
%A Norris,Shane A
%A Draper,Catherine E
%+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za
%K mobile technologies
%K health promotion
%K mixed methods
%K clinical practice
%K mobile phone
%D 2024

%7 8.4.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. 
%M 38588527
%R 10.2196/48144
%U https://formative.jmir.org/2024/1/e48144
%U https://doi.org/10.2196/48144
%U http://www.ncbi.nlm.nih.gov/pubmed/38588527

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e48963
%T Leveraging Routinely Collected Program Data to Inform Extrapolated Size Estimates for Key Populations in Namibia: Small Area Estimation Study
%A Loeb,Talia
%A Willis,Kalai
%A Velishavo,Frans
%A Lee,Daniel
%A Rao,Amrita
%A Baral,Stefan
%A Rucinski,Katherine
%+ Data for Implementation (Data.FI), Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3227, tloeb2@jh.edu
%K female sex workers
%K HIV
%K key populations
%K men who have sex with men
%K Namibia
%K population size estimation
%K small area estimation
%D 2024

%7 4.4.2024
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Estimating the size of key populations, including female sex workers (FSW) and men who have sex with men (MSM), can inform planning and resource allocation for HIV programs at local and national levels. In geographic areas where direct population size estimates (PSEs) for key populations have not been collected, small area estimation (SAE) can help fill in gaps using supplemental data sources known as auxiliary data. However, routinely collected program data have not historically been used as auxiliary data to generate subnational estimates for key populations, including in Namibia. Objective: To systematically generate regional size estimates for FSW and MSM in Namibia, we used a consensus-informed estimation approach with local stakeholders that included the integration of routinely collected HIV program data provided by key populations’ HIV service providers. Methods: We used quarterly program data reported by key population implementing partners, including counts of the number of individuals accessing HIV services over time, to weight existing PSEs collected through bio-behavioral surveys using a Bayesian triangulation approach. SAEs were generated through simple imputation, stratified imputation, and multivariable Poisson regression models. We selected final estimates using an iterative qualitative ranking process with local key population implementing partners. Results: Extrapolated national estimates for FSW ranged from 4777 to 13,148 across Namibia, comprising 1.5% to 3.6% of female individuals aged between 15 and 49 years. For MSM, estimates ranged from 4611 to 10,171, comprising 0.7% to 1.5% of male individuals aged between 15 and 49 years. After the inclusion of program data as priors, the estimated proportion of FSW derived from simple imputation increased from 1.9% to 2.8%, and the proportion of MSM decreased from 1.5% to 0.75%. When stratified imputation was implemented using HIV prevalence to inform strata, the inclusion of program data increased the proportion of FSW from 2.6% to 4.0% in regions with high prevalence and decreased the proportion from 1.4% to 1.2% in regions with low prevalence. When population density was used to inform strata, the inclusion of program data also increased the proportion of FSW in high-density regions (from 1.1% to 3.4%) and decreased the proportion of MSM in all regions. Conclusions: Using SAE approaches, we combined epidemiologic and program data to generate subnational size estimates for key populations in Namibia. Overall, estimates were highly sensitive to the inclusion of program data. Program data represent a supplemental source of information that can be used to align PSEs with real-world HIV programs, particularly in regions where population-based data collection methods are challenging to implement. Future work is needed to determine how best to include and validate program data in target settings and in key population size estimation studies, ultimately bridging research with practice to support a more comprehensive HIV response. 
%M 38573760
%R 10.2196/48963
%U https://publichealth.jmir.org/2024/1/e48963
%U https://doi.org/10.2196/48963
%U http://www.ncbi.nlm.nih.gov/pubmed/38573760

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e55270
%T Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study
%A Wang,Zheng
%A Kempen,John
%A Luo,Gang
%+ Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, 20 Staniford Street, Boston, MA, 02114, United States, 1 6179122529, gang_luo@meei.harvard.edu
%K vision screening
%K refractive error
%K strabismus
%K smartphone
%K visual acuity
%K vision
%K visual
%K eye
%K eyes
%K screening
%K mHealth
%K mobile health
%K app
%K apps
%K application
%K applications
%K feasibility
%K optometry
%K ophthalmology
%D 2024

%7 4.4.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. Objective: We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. Methods: A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. Results: A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72–prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). Conclusions: The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas. 
%M 38573757
%R 10.2196/55270
%U https://formative.jmir.org/2024/1/e55270
%U https://doi.org/10.2196/55270
%U http://www.ncbi.nlm.nih.gov/pubmed/38573757

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e50337
%T Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study
%A Aboye,Genet Tadese
%A Simegn,Gizeaddis Lamesgin
%A Aerts,Jean-Marie
%+ M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, kasteelpark Arenberg 30, Leuven, 3001, Belgium, 32 489304866, genettadese.aboye@kuleuven.be
%K barriers
%K chronic disease
%K digital health
%K eHealth
%K enablers
%K health care
%K mHealth
%K mobile health
%K perspectives
%K Sub-Saharan Africa
%D 2024

%7 27.3.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital technologies are increasingly being used to deliver health care services and promote public health. Mobile wireless technologies or mobile health (mHealth) technologies are particularly relevant owing to their ease of use, broad reach, and wide acceptance. Unlike developed countries, Sub-Saharan Africa experiences more challenges and obstacles when it comes to deploying, using, and expanding mHealth systems. In addition to barriers, there are enabling factors that could be exploited for the design, implementation, and scaling up of mHealth systems. Sub-Saharan Africa may require tailored solutions that address the specific challenges facing the region. Objective: The overall aim of this study was to identify the barriers and enablers for using mHealth systems in Sub-Saharan Africa from the perspectives of patients, physicians, and health care executives. Methods: Multi-level and multi-actor in-depth semistructured interviews were employed to qualitatively explore the barriers and enablers of the use of mHealth systems. Data were collected from patients, physicians, and health care executives. The interviews were audio recorded, transcribed verbatim, translated, and coded. Thematic analysis methodology was adopted, and NVivo software was used for the data analysis. Results: Through this rigorous study, a total of 137 determinants were identified. Of these determinants, 68 were identified as barriers and 69 were identified as enablers. Perceived barriers in patients included lack of awareness about mHealth systems and language barriers. Perceived enablers in patients included need for automated tools for health monitoring and an increasing literacy level of the society. According to physicians, barriers included lack of available digital health systems in the local context and concern about patients’ mHealth capabilities, while enablers included the perceived usefulness in reducing workload and improving health care service quality, as well as the availability of mobile devices and the internet. As perceived by health care executives, barriers included competing priorities alongside digitalization in the health sector and lack of interoperability and complete digitalization of implemented digital health systems, while enablers included the perceived usefulness of digitalization for the survival of the highly overloaded health care system and the abundance of educated manpower specializing in technology. Conclusions: mHealth systems in Sub-Saharan Africa are hindered and facilitated by various factors. Common barriers and enablers were identified by patients, physicians, and health care executives. To promote uptake, all relevant stakeholders must actively mitigate the barriers. This study identified a promising outlook for mHealth in Sub-Saharan Africa, despite the present barriers. Opportunities exist for successful integration into health care systems, and a user-centered design is crucial for maximum uptake. 
%M 38536231
%R 10.2196/50337
%U https://www.jmir.org/2024/1/e50337
%U https://doi.org/10.2196/50337
%U http://www.ncbi.nlm.nih.gov/pubmed/38536231

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 12
%N 
%P e49501
%T Views of Service Users, Their Family or Carers, and Health Care Professionals on Telerehabilitation for People With Neurological Conditions in Ghana: Qualitative Study
%A Paul,Lorna
%A Thomson,Katie
%A Asibey,Shadrack Osei
%A Brady,Marian
%A van Wijck,Frederike
%A Antwi,Derrick
%A Opoku,Eric Nkansah
%A Sarfo,Fred Stephen
%+ School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 01413318108, Lorna.Paul@gcu.ac.uk
%K telerehabilitation
%K low- to middle-income country
%K LMIC
%K service user
%K health care professional
%K qualitative study
%K caregiver
%K neurorehabilitation
%K barriers
%K facilitators
%K eHealth
%K focus group
%K thematic analysis
%D 2024

%7 27.3.2024
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Up to 50% of people in low- and middle-income countries do not receive the rehabilitation they require. Telerehabilitation has the potential to improve access to neurorehabilitation services especially in low- and middle-income countries. Although there are reports of the barriers and facilitators to telerehabilitation in such settings, almost all are anecdotal. Furthermore, family or carers have a significant influence on the adoption and success of telerehabilitation, but their views have not been reported. Objective: This study aimed to investigate the views of service users, their family or carers, and health care professionals (HCPs) on telerehabilitation for people with neurological conditions in Ghana. Methods: Two focus groups were held at Komfo Anokye Hospital in Kumasi, Ghana: one in person for service users (n=11) and their family or carers (n=9), conducted in the Ghanaian language of Twi, and one hybrid for HCPs (n=18) conducted in English. The mean (SD) age of the service users was 59.8 (8.6) years; 5 users had a stroke and 6 had Parkinson disease. The HCP group consisted of 7 speech and language therapists, 3 physiotherapists, 3 occupational therapists, 3 medical staff, 1 nurse, and 1 industry representative. Focus groups were semi-structured and explored previous experiences of telerehabilitation, perceived benefits and challenges, and solutions to overcome these challenges. Focus groups were audio transcribed, and the service user transcript was translated into English. The resulting transcripts were analyzed using thematic analysis. Results: Overall, participants were positive about the role of telerehabilitation but recommended hybrid delivery, with in-person rehabilitation in the early stages and telerehabilitation in the later stages. In relation to telerehabilitation in Ghana, there were 3 main themes: benefits, challenges or barriers, and implementation. Benefits included the convenience and lower cost for service users, the higher dose of therapy possible, and increased access for people in remote areas. However, challenges included lack of a stable internet connection, cost of phones and data packages, and low levels of literacy. Implementation issues included cultural relevance, information governance, and the platform used to deliver telerehabilitation, with most participants being familiar with WhatsApp. Conclusions: Telerehabilitation has the potential to be a useful method of delivering rehabilitation to people with neurological conditions in Ghana, especially in a hybrid rehabilitation model with telerehabilitation augmenting in-person sessions. However, many people were unaware of telerehabilitation, and challenges such as a reliable internet connection, cultural relevance, and costs need to be addressed. Clinical trials of low-cost telerehabilitation interventions contextualized to the specific user group are required. 
%M 38536218
%R 10.2196/49501
%U https://mhealth.jmir.org/2024/1/e49501
%U https://doi.org/10.2196/49501
%U http://www.ncbi.nlm.nih.gov/pubmed/38536218

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53651
%T The Use of Mobile Technologies to Promote Physical Activity and Reduce Sedentary Behaviors in the Middle East and North Africa Region: Systematic Review and Meta-Analysis
%A Tong,Huong Ly
%A Alnasser,Aroub
%A Alshahrani,Najim Z
%A Bawaked,Rowaedh A
%A AlAhmed,Reem
%A Alsukait,Reem F
%A Rakic,Severin
%A Cetinkaya,Volkan
%A Al-Hazzaa,Hazzaa M
%A Alqahtani,Saleh A
%+ Cultural and Indigenous Research Centre Australia, 16 Eveleight St, Redfern, 2016, Australia, 61 28585 ext 1311, lytong.2208@gmail.com
%K mobile apps
%K fitness trackers
%K SMS
%K SMS text messaging
%K physical activity
%K exercise
%K sedentary behavior
%K Middle East
%K Africa, Northern
%K movement
%K physical inactivity
%K smartphone
%K mobile phone
%K mobile health
%K mHealth
%K digital health
%K behavior change
%K intervention
%D 2024

%7 19.3.2024
%9 Review
%J J Med Internet Res
%G English
                
%X Background: The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region. Objective: This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users’ perspectives on these interventions as well as any other outcomes that might influence users’ adoption and use of mobile technologies (eg, appropriateness and cultural fit). Methods: A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools. Results: In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users’ perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users’ perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes. Conclusions: The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region. Trial Registration: PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699 
%M 38502160
%R 10.2196/53651
%U https://www.jmir.org/2024/1/e53651
%U https://doi.org/10.2196/53651
%U http://www.ncbi.nlm.nih.gov/pubmed/38502160

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e45070
%T Outcomes and Costs of the Transition From a Paper-Based Immunization System to a Digital Immunization System in Vietnam: Mixed Methods Study
%A Dang,Thi Thanh Huyen
%A Carnahan,Emily
%A Nguyen,Linh
%A Mvundura,Mercy
%A Dao,Sang
%A Duong,Thi Hong
%A Nguyen,Trung
%A Nguyen,Doan
%A Nguyen,Tu
%A Werner,Laurie
%A Ryman,Tove K
%A Nguyen,Nga
%+ PATH, 1101, 11th floor, Hanoi Towers, 49 Hai Ba Trung Street, Hanoi, 100000, Vietnam, 84 243936221 ext 130, ntnguyen@path.org
%K eHealth
%K digital health
%K immunization information system
%K electronic immunization registry
%K immunization
%K data quality
%K data use
%K costing
%D 2024

%7 18.3.2024
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The electronic National Immunization Information System (NIIS) was introduced nationwide in Vietnam in 2017. Health workers were expected to use the NIIS alongside the legacy paper-based system. Starting in 2018, Hanoi and Son La provinces transitioned to paperless reporting. Interventions to support this transition included data guidelines and training, internet-based data review meetings, and additional supportive supervision visits. Objective: This study aims to assess (1) changes in NIIS data quality and use, (2) changes in immunization program outcomes, and (3) the economic costs of using the NIIS versus the traditional paper system. Methods: This mixed methods study took place in Hanoi and Son La provinces. It aimed to analyses pre- and postintervention data from various sources including the NIIS; household and health facility surveys; and interviews to measure NIIS data quality, data use, and immunization program outcomes. Financial data were collected at the national, provincial, district, and health facility levels through record review and interviews. An activity-based costing approach was conducted from a health system perspective. Results: NIIS data timeliness significantly improved from pre- to postintervention in both provinces. For example, the mean number of days from birth date to NIIS registration before and after intervention dropped from 18.6 (SD 65.5) to 5.7 (SD 31.4) days in Hanoi (P<.001) and from 36.1 (SD 94.2) to 11.7 (40.1) days in Son La (P<.001). Data from Son La showed that the completeness and accuracy improved, while Hanoi exhibited mixed results, possibly influenced by the COVID-19 pandemic. Data use improved; at postintervention, 100% (667/667) of facilities in both provinces used NIIS data for activities beyond monthly reporting compared with 34.8% (202/580) in Hanoi and 29.4% (55/187) in Son La at preintervention. Across nearly all antigens, the percentage of children who received the vaccine on time was higher in the postintervention cohort compared with the preintervention cohort. Up-front costs associated with developing and deploying the NIIS were estimated at US $0.48 per child in the study provinces. The commune health center level showed cost savings from changing from the paper system to the NIIS, mainly driven by human resource time savings. At the administrative level, incremental costs resulted from changing from the paper system to the NIIS, as some costs increased, such as labor costs for supportive supervision and additional capital costs for equipment associated with the NIIS. Conclusions: The Hanoi and Son La provinces successfully transitioned to paperless reporting while maintaining or improving NIIS data quality and data use. However, improvements in data quality were not associated with improvements in the immunization program outcomes in both provinces. The COVID-19 pandemic likely had a negative influence on immunization program outcomes, particularly in Hanoi. These improvements entail up-front financial costs. 
%M 38498020
%R 10.2196/45070
%U https://www.jmir.org/2024/1/e45070
%U https://doi.org/10.2196/45070
%U http://www.ncbi.nlm.nih.gov/pubmed/38498020

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 13
%N 
%P e54635
%T An mHealth Intervention to Address Depression and Improve Antiretroviral Therapy Adherence Among Youths Living With HIV in Uganda: Protocol for a Pilot Randomized Controlled Trial
%A Nabunya,Proscovia
%A Cavazos-Rehg,Patricia
%A Mugisha,James
%A Kasson,Erin
%A Namuyaba,Olive Imelda
%A Najjuuko,Claire
%A Nsubuga,Edward
%A Filiatreau,Lindsey M
%A Mwebembezi,Abel
%A Ssewamala,Fred M
%+ International Center for Child Health and Development, Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, United States, 1 3149359087, nabunyap@wustl.edu
%K depression
%K adherence
%K mHealth
%K cognitive behavioral therapy
%K antiretroviral therapy
%K youth living with HIV
%K Uganda
%D 2024

%7 8.3.2024
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: People living with HIV often struggle with mental health comorbidities that lower their antiretroviral therapy (ART) adherence. There is growing evidence that depression treatment may improve ART adherence and result in improved HIV outcomes. Given that mental health services are severely underequipped in low-resource settings, including in Uganda, new solutions to increase access to mental health care and close the treatment gap are urgently needed. This protocol paper presents the Suubi-Mhealth study, which proposed to develop a mobile health (mHealth) intervention for use among Ugandan youths (14-17 years) with comorbid HIV and depression, taking into account their unique contextual, cultural, and developmental needs. Objective: The proposed study is guided by the following objectives: (1) to develop and iteratively refine an intervention protocol for Suubi-Mhealth based on formative work to understand the needs of youths living with HIV; (2) to explore the feasibility and acceptability of Suubi-Mhealth on a small scale to inform subsequent refinement; (3) to test the preliminary impact of Suubi-Mhealth versus a waitlist control group on youths’ outcomes, including depression and treatment adherence; and (4) to examine barriers and facilitators for integrating Suubi-Mhealth into health care settings. Methods: Youths will be eligible to participate in the study if they are (1) 14-17 years of age, (2) HIV-positive and aware of their status, (3) receiving care and ART from one of the participating clinics, and (4) living within a family. The study will be conducted in 2 phases. In phase 1, we will conduct focus group discussions with youths and health care providers, for feedback on the proposed intervention content and methods, and explore the feasibility and acceptability of the intervention. In phase II, we will pilot-test the preliminary impact of the intervention on reducing depression and improving ART adherence. Assessments will be conducted at baseline, 1-, 2-, and 6-months post intervention completion. Results: Participant recruitment for phase 1 is completed. Youths and health care providers participated in focus group discussions to share their feedback on the proposed Suubi-Mhealth intervention content, methods, design, and format. Transcription and translation of focus group discussions have been completed. The team is currently developing Suubi-Mhealth content based on participants’ feedback. Conclusions: This study will lay important groundwork for several initiatives at the intersection of digital therapeutics, HIV treatment, and mental health, especially among sub-Saharan African youths, as they transition through adolescence and into adult HIV care settings. Trial Registration: ClinicalTrials.gov NCT05965245; https://clinicaltrials.gov/study/NCT05965245 International Registered Report Identifier (IRRID): DERR1-10.2196/54635 
%M 38457202
%R 10.2196/54635
%U https://www.researchprotocols.org/2024/1/e54635
%U https://doi.org/10.2196/54635
%U http://www.ncbi.nlm.nih.gov/pubmed/38457202

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 8
%N 
%P e44111
%T Evaluating the Intensity of Exposure to MTV Shuga, an Edutainment Program for HIV Prevention: Cross-Sectional Study in Eastern Cape, South Africa
%A Mulwa,Sarah
%A Baker,Venetia
%A Cawood,Cherie
%A Khanyile,David
%A O'Donnell,Dominique
%A Sarrassat,Sophie
%A Cousens,Simon
%A Birdthistle,Isolde
%+ Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 863, sarah.mulwa@lshtm.ac.uk
%K young people
%K media
%K evaluation
%K dose-response
%K edutainment
%K HIV prevention
%K mobile phone
%D 2024

%7 13.2.2024
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: MTV Shuga is an edutainment campaign designed to equip young people with knowledge, motivation, and informed choices to protect themselves from HIV infection. From 2019 to 2020, a total of 10 episodes of a new dramatic series, MTV Shuga “Down South 2” (DS2), were broadcast via television and the internet, alongside complementary media activities. Objective: This study aims to investigate whether the intensity of DS2 exposure was linked with positive HIV prevention outcomes in a setting with high HIV prevalence and relatively low levels of HIV testing. Methods: We analyzed data from a web-based survey of participants aged 15 to 24 years in South Africa in 2020. The survey was promoted via social media platforms of schools, universities, and communities in Eastern Cape, South Africa. The primary exposure of interest was the intensity of exposure to DS2, measured by the number of episodes of DS2 watched on the television or the internet or listened to on the radio (out of 10 episodes). Individuals who had not watched or listened to any DS2 episode were classified according to other MTV Shuga content that they had accessed. We estimated associations between the intensity of DS2 exposure and HIV-related outcomes, including knowledge of HIV status, awareness of HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP), uptake of HIVST, and demand for HIVST and PrEP, adjusting for potential confounders using multivariable logistic regression. Results: Among the 3431 survey participants, 827 (24.1%) were exposed to DS2. Specifically, 18.1% (622/3431) watched or listened to only 1 DS2 episode, and 2.4% (82/3431), 1.7% (58/3431), and 1.8% (62/3431) watched or listened to 2 to 4, 5 to 7, and 8 to 10 DS2 episodes, respectively. Increasing the exposure to DS2 was associated with improvements in most outcomes. Exposure to multiple episodes (eg, 2-4, 5-7, and 8-10) was associated with successively higher odds of knowing one’s HIV status, awareness of PrEP and HIVST, and uptake of HIVST compared with no MTV Shuga exposure, albeit with statistical uncertainty around some estimates. The interest in using HIVST or PrEP was high overall (>80%), with no measurable differences by DS2 intensity. Conclusions: We found evidence consistent with a dose-response relationship between MTV Shuga DS2 exposure and outcomes, including knowledge of HIV status, awareness and uptake of HIVST, and awareness of PrEP among young people in Eastern Cape. This indicates that greater engagement with a youth-focused edutainment campaign can improve HIV testing and prevention options in a setting and population with high need. However, only a few participants accessed multiple DS2 episodes despite its availability on multiple media platforms. We conclude that there is potential to benefit more young people by increasing access to and interest in the show. 
%M 38349729
%R 10.2196/44111
%U https://formative.jmir.org/2024/1/e44111
%U https://doi.org/10.2196/44111
%U http://www.ncbi.nlm.nih.gov/pubmed/38349729

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e55930
%T Authors' Reply: Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers
%A Adam,Maya
%A Nguyễn,Vān Kính
%+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu
%K maternal child health
%K mHealth
%K mobile health
%K randomized controlled trial
%K short animated storytelling
%K South Africa
%K video health messaging
%D 2024

%7 12.2.2024
%9 Letter to the Editor
%J J Med Internet Res
%G English
                
%X 
%M 38345840
%R 10.2196/55930
%U https://www.jmir.org/2024/1/e55930
%U https://doi.org/10.2196/55930
%U http://www.ncbi.nlm.nih.gov/pubmed/38345840

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e53861
%T Concerns About the Generalizability Associated With a South African Randomized Controlled Trial on Prenatal Mothers
%A Lin,Yongjian
%+ Department of Gastrointestinal and Gland Surgery, The First Affiliated Hospital of Guangxi Medical University, No. 22, Shuangyou Road, Qingxiu District, Nanning, 530021, China, 86 13878870525, linyongjian@stu.gxmu.edu.cn
%K letter
%K maternal child health
%K mHealth
%K mobile health
%K randomized controlled trial
%K short animated storytelling
%K South Africa
%K video health messaging
%D 2024

%7 12.2.2024
%9 Letter to the Editor
%J J Med Internet Res
%G English
                
%X 
%M 38345847
%R 10.2196/53861
%U https://www.jmir.org/2024/1/e53861
%U https://doi.org/10.2196/53861
%U http://www.ncbi.nlm.nih.gov/pubmed/38345847

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 10
%N 
%P e47703
%T Designing Electronic Data Capture Systems for Sustainability in Low-Resource Settings: Viewpoint With Lessons Learned From Ethiopia and Myanmar
%A Benda,Natalie
%A Dougherty,Kylie
%A Gebremariam Gobezayehu,Abebe
%A Cranmer,John N
%A Zawtha,Sakie
%A Andreadis,Katerina
%A Biza,Heran
%A Masterson Creber,Ruth
%+ School of Nursing, Columbia University, 560 W 168th St, New York, NY, 10032, United States, 1 212 305 5756, nb3115@cumc.columbia.edu
%K low and middle income countries
%K LMIC
%K electronic data capture
%K population health surveillance, sociotechnical system
%K data infrastructure
%K electronic data system
%K health care system
%K technology
%K information system
%K health program development
%K intervention
%D 2024

%7 12.2.2024
%9 Viewpoint
%J JMIR Public Health Surveill
%G English
                
%X Electronic data capture (EDC) is a crucial component in the design, evaluation, and sustainment of population health interventions. Low-resource settings, however, present unique challenges for developing a robust EDC system due to limited financial capital, differences in technological infrastructure, and insufficient involvement of those who understand the local context. Current literature focuses on the evaluation of health interventions using EDC but does not provide an in-depth description of the systems used or how they are developed. In this viewpoint, we present case descriptions from 2 low- and middle-income countries: Ethiopia and Myanmar. We address a gap in evidence by describing each EDC system in detail and discussing the pros and cons of different approaches. We then present common lessons learned from the 2 case descriptions as recommendations for considerations in developing and implementing EDC in low-resource settings, using a sociotechnical framework for studying health information technology in complex adaptive health care systems. Our recommendations highlight the importance of selecting hardware compatible with local infrastructure, using flexible software systems that facilitate communication across different languages and levels of literacy, and conducting iterative, participatory design with individuals with deep knowledge of local clinical and cultural norms.
%M 38345833
%R 10.2196/47703
%U https://publichealth.jmir.org/2024/1/e47703
%U https://doi.org/10.2196/47703
%U http://www.ncbi.nlm.nih.gov/pubmed/38345833

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 10
%N 
%P e43120
%T Democratizing the Development of Chatbots to Improve Public Health: Feasibility Study of COVID-19 Misinformation
%A Powell,Leigh
%A Nour,Radwa
%A Sleibi,Randa
%A Al Suwaidi,Hanan
%A Zary,Nabil
%+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, nabil.zary@mbru.ac.ae
%K COVID-19
%K vaccine hesitancy
%K infodemic
%K chatbot
%K motivational interviewing
%K social media
%K conversational agent
%K misinformation
%K online health information
%K usability study
%K vaccine misinformation
%D 2023

%7 28.12.2023
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Chatbots enable users to have humanlike conversations on various topics and can vary widely in complexity and functionality. An area of research priority in chatbots is democratizing chatbots to all, removing barriers to entry, such as financial ones, to help make chatbots a possibility for the wider global population to improve access to information, help reduce the digital divide between nations, and improve areas of public good (eg, health communication). Chatbots in this space may help create the potential for improved health outcomes, potentially alleviating some of the burdens on health care providers and systems to be the sole voices of outreach to public health. Objective: This study explored the feasibility of developing a chatbot using approaches that are accessible in low- and middle-resource settings, such as using technology that is low cost, can be developed by nonprogrammers, and can be deployed over social media platforms to reach the broadest-possible audience without the need for a specialized technical team. Methods: This study is presented in 2 parts. First, we detailed the design and development of a chatbot, VWise, including the resources used and development considerations for the conversational model. Next, we conducted a case study of 33 participants who engaged in a pilot with our chatbot. We explored the following 3 research questions: (1) Is it feasible to develop and implement a chatbot addressing a public health issue with only minimal resources? (2) What is the participants’ experience with using the chatbot? (3) What kinds of measures of engagement are observed from using the chatbot? Results: A high level of engagement with the chatbot was demonstrated by the large number of participants who stayed with the conversation to its natural end (n=17, 52%), requested to see the free online resource, selected to view all information about a given concern, and returned to have a dialogue about a second concern (n=12, 36%). Conclusions: This study explored the feasibility of and the design and development considerations for a chatbot, VWise. Our early findings from this initial pilot suggest that developing a functioning and low-cost chatbot is feasible, even in low-resource environments. Our results show that low-resource environments can enter the health communication chatbot space using readily available human and technical resources. However, despite these early indicators, many limitations exist in this study and further work with a larger sample size and greater diversity of participants is needed. This study represents early work on a chatbot in its virtual infancy. We hope this study will help provide those who feel chatbot access may be out of reach with a useful guide to enter this space, enabling more democratized access to chatbots for all. 
%M 37290040
%R 10.2196/43120
%U https://humanfactors.jmir.org/2023/1/e43120
%U https://doi.org/10.2196/43120
%U http://www.ncbi.nlm.nih.gov/pubmed/37290040

%0 Journal Article
        
%@ 2291-5222
%I 
%V 11
%N 
%P e50467
%T Development and Pilot Implementation of Neotree, a Digital Quality Improvement Tool Designed to Improve Newborn Care and Survival in 3 Hospitals in Malawi and Zimbabwe: Cost Analysis Study
%A Haghparast-Bidgoli,Hassan
%A Hull-Bailey,Tim
%A Nkhoma,Deliwe
%A Chiyaka,Tarisai
%A Wilson,Emma
%A Fitzgerald,Felicity
%A Chimhini,Gwendoline
%A Khan,Nushrat
%A Gannon,Hannah
%A Batura,Rekha
%A Cortina-Borja,Mario
%A Larsson,Leyla
%A Chiume,Msandeni
%A Sassoon,Yali
%A Chimhuya,Simbarashe
%A Heys,Michelle
%K mHealth
%K clinical decision support
%K quality improvement tool
%K costs
%K cost
%K economic
%K economics
%K decision support
%K costing
%K expenditure
%K child
%K children
%K pediatric
%K pediatrics
%K paediatric
%K paediatrics
%K preterm
%K premature
%K baby
%K babies
%K newborn
%K newborns
%K maternal
%K neonatal
%K mobile health
%D 2023

%7 22.12.2023
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Two-thirds of the 2.4 million newborn deaths that occurred in 2020 within the first 28 days of life might have been avoided by implementing existing low-cost evidence-based interventions for all sick and small newborns. An open-source digital quality improvement tool (Neotree) combining data capture with education and clinical decision support is a promising solution for this implementation gap. Objective: We present results from a cost analysis of a pilot implementation of Neotree in 3 hospitals in Malawi and Zimbabwe. Methods: We combined activity-based costing and expenditure approaches to estimate the development and implementation cost of a Neotree pilot in 1 hospital in Malawi, Kamuzu Central Hospital (KCH), and 2 hospitals in Zimbabwe, Sally Mugabe Central Hospital (SMCH) and Chinhoyi Provincial Hospital (CPH). We estimated the costs from a provider perspective over 12 months. Data were collected through expenditure reports, monthly staff time-use surveys, and project staff interviews. Sensitivity and scenario analyses were conducted to assess the impact of uncertainties on the results or estimate potential costs at scale. A pilot time-motion survey was conducted at KCH and a comparable hospital where Neotree was not implemented. Results: Total cost of pilot implementation of Neotree at KCH, SMCH, and CPH was US $37,748, US $52,331, and US $41,764, respectively. Average monthly cost per admitted child was US $15, US $15, and US $58, respectively. Staff costs were the main cost component (average 73% of total costs, ranging from 63% to 79%). The results from the sensitivity analysis showed that uncertainty around the number of admissions had a significant impact on the costs in all hospitals. In Malawi, replacing monthly web hosting with a server also had a significant impact on the costs. Under routine (nonresearch) conditions and at scale, total costs are estimated to fall substantially, up to 76%, reducing cost per admitted child to as low as US $5 in KCH, US $4 in SMCH, and US $14 in CPH. Median time to admit a baby was 27 (IQR 20-40) minutes using Neotree (n=250) compared to 26 (IQR 21-30) minutes using paper-based systems (n=34), and the median time to discharge a baby was 9 (IQR 7-13) minutes for Neotree (n=246) compared to 3 (IQR 2-4) minutes for paper-based systems (n=50). Conclusion: Neotree is a time- and cost-efficient tool, comparable with the results from limited similar mHealth decision-support tools in low- and middle-income countries. Implementation costs of Neotree varied substantially between the hospitals, mainly due to hospital size. The implementation costs could be substantially reduced at scale due to economies of scale because of integration to the health systems and reductions in cost items such as staff and overhead. More studies assessing the impact and cost-effectiveness of large-scale mHealth decision-support tools are needed. 
%R 10.2196/50467
%U https://mhealth.jmir.org/2023/1/e50467
%U https://doi.org/10.2196/50467

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e51427
%T A Relationship-Based Resilience Program for Promotores: Protocol for a Randomized Controlled Waitlist Trial
%A Arcos,Daniela
%A Russo,Lyric N
%A Kazmierski,Kelly F M
%A Zhou,Elayne
%A Montiel,Gloria Itzel
%A Bracho,America
%A Mejia,Nancy
%A Borelli,Jessica L
%+ Department of Psychological Science, University of California Irvine, 401 E Peltason Drive, Irvine, CA, 92617, United States, 1 203 887 8857, jessica.borelli@uci.edu
%K psychosocial intervention
%K relational savoring
%K cardiometabolic health
%K community service providers
%K Hispanic or Latinx
%K CSP
%D 2023

%7 19.12.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Community service providers (CSPs) play an integral role in the health care of low-income Hispanic or Latinx (HL) communities. CSPs have high-stress frontline jobs and share the high-risk demographics of their communities. Relational savoring (RS) has been associated with lower cardiovascular reactivity and psychosocial benefits, with particular promise among HL participants. In this study, we aim to identify RS’s potential in promoting CSPs’ cardiometabolic health and, in so doing, having broader impacts on the community they serve. Objective: This randomized controlled waitlist study aims to examine the effect of an RS intervention on (1) CSPs’ cardiometabolic health (cardiometabolic risk factors and outcomes) and (2) CSPs’ threats to leaving the workforce. Methods: We will recruit a sample of 80 CSPs from community health agencies serving low-income HL populations. Participating CSPs will be randomized into an experimental or a waitlist control. Participants will complete 1 or 2 baseline assessment batteries (before the intervention), depending on the assigned group, and then complete 2 more assessment batteries following the 4-week RS intervention (after the intervention and at a 3-mo follow-up). The RS intervention consists of guided reflections on positive moments of connection with others. Electrocardiogram data will be obtained from a wearable device (Polar Verity Sense or Movisens) to measure heart rate variability. The primary outcome is cardiometabolic health, consisting of cardiometabolic risk (obtained from heart rate variability) and cardiometabolic health behaviors. The secondary outcomes include CSPs’ threats to leaving the workforce (assessed via psychological well-being), intervention acceptability, and CSPs’ delivery of cardiometabolic health programming to the community (exploratory). Analyses of covariance will be used to examine the effects of RS on cardiometabolic health and on CSPs’ threats to leaving the workforce, comparing outcomes at baseline, postintervention, and at follow-up across participants in the experimental versus waitlist group. Results: The study has been approved by the University of California, Irvine, Institutional Review Board and is currently in the data collection phase. By May 2023, 37 HL CSPs have been recruited: 34 have completed the baseline assessment, 28 have completed the 4 intervention sessions, 27 have completed the posttreatment assessment, and 10 have completed all assessments (including the 3-mo follow-up). Conclusions: This study will provide valuable information on the potential of RS to support cardiometabolic health in HL CSPs and, indirectly, in the communities they serve. Trial Registration: ClinicalTrials.gov NCT05560893; https://clinicaltrials.gov/study/NCT05560893 International Registered Report Identifier (IRRID): DERR1-10.2196/51427 
%M 38113093
%R 10.2196/51427
%U https://www.researchprotocols.org/2023/1/e51427
%U https://doi.org/10.2196/51427
%U http://www.ncbi.nlm.nih.gov/pubmed/38113093

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e49352
%T Mobile Phone Technology for Preventing HIV and Related Youth Health Problems, Sexual Health, Mental Health, and Substance Use Problems in Southwest Uganda (Youth Health SMS): Protocol for a Pilot Randomized Controlled Trial
%A Kreniske,Philip
%A Namuyaba,Olive Imelda
%A Kasumba,Robert
%A Namatovu,Phionah
%A Ssewamala,Fred
%A Wingood,Gina
%A Wei,Ying
%A Ybarra,Michele L
%A Oloya,Charlotte
%A Tindyebwa,Costella
%A Ntulo,Christina
%A Mujune,Vincent
%A Chang,Larry W
%A Mellins,Claude A
%A Santelli,John S
%+ Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th Street, New York, NY, 10027, United States, 1 (646) 364 9600, philip.kreniske@sph.cuny.edu
%K adolescence
%K PrEP
%K pre-exposure prophylaxis
%K HIV
%K mental health
%K substance use
%K sexual health
%K mobile phones
%K randomized controlled trial
%K adaptation
%K Uganda
%D 2023

%7 19.12.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: East and Southern Africa have the highest HIV incidence and prevalence in the world, with adolescents and young adults being at the greatest risk. Despite effective combination prevention tools, including the recently available pre-exposure prophylaxis (PrEP), HIV incidence among adolescents and young adults in Uganda remains high, and PrEP use remains low. Mental health and substance use (behavioral health) play a role in sexual behavior and decision-making, contributing to an increase in the risk for acquiring HIV. Interventions that target multiple HIV risk factors, including sexual and mental health and problematic substance use, are crucial to ending the HIV epidemic. Yet few interventions addressing HIV related health disparities and comorbidities among adolescents and young adults in East and Southern Africa currently exist. Objective: This study aims to evaluate the acceptability and feasibility of Kirabo, an SMS text message intervention informed by the information, motivation, and behavior model and to be disseminated through secondary schools. The study will gather preliminary estimates of Kirabo’s effectiveness in increasing HIV testing and linking users to mental health counselors. Methods: We identified Mobile 4 Reproductive Health for adaptation using the assessment, decision, administration, production, topical experts, integration, training, testing (ADAPT-ITT) framework. Mobile 4 Reproductive Health is an evidence-based automated 2-way SMS text messaging and interactive voice response platform that offers sexual and reproductive health information and links users to HIV clinics in East Africa. Through ADAPT-ITT we refined our approach and created Kirabo, an SMS text message–based intervention for linking adolescents and young adults to health services, including HIV testing and mental health counseling. We will conduct a 2-arm randomized controlled trial in Masaka, Uganda. Adolescents (N=200) will be recruited from local schools. Baseline sociodemographic characteristics, HIV test history, and behavioral health symptoms will be assessed. We will evaluate acceptability and feasibility using surveys, interviews, and mobile phone data. The preliminary efficacy of Kirabo in increasing HIV testing and linking users to mental health counselors will be evaluated immediately after the intervention and at the 3-month follow-up. We will also assess the intervention’s impact on self-efficacy in testing for HIV, adopting PrEP, and contacting a mental health counselor. Results: Intervention adaptation began in 2019. A pretest was conducted in 2021. The randomized controlled trial, including usability and feasibility assessments and effectiveness measurements, commenced in August 2023. Conclusions: Kirabo is a tool that assists in the efforts to end the HIV epidemic by targeting the health disparities and comorbidities among adolescents in Uganda. The intervention includes local HIV clinic information, PrEP information, and behavioral health screening, with referrals as needed. Increasing access to prevention strategies and mitigating factors that make adolescents and young adults susceptible to HIV acquisition can contribute to global efforts to end the HIV epidemic. Trial Registration: ClinicalTrials.gov NCT05130151; https://clinicaltrials.gov/study/NCT05130151 International Registered Report Identifier (IRRID): DERR1-10.2196/49352 
%M 38113102
%R 10.2196/49352
%U https://www.researchprotocols.org/2023/1/e49352
%U https://doi.org/10.2196/49352
%U http://www.ncbi.nlm.nih.gov/pubmed/38113102

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e48271
%T Designing Mobile Phone Text Messages Using the Behavior Change Wheel Framework to Influence Food Literacy in Adults With Type 2 Diabetes in Kenya: Protocol for a Systematic Development Study
%A Mokaya,Moses
%A Kyallo,Florence
%A Yiga,Peter
%A Koole,Janna Lena
%A Boedt,Tessy
%A Vangoitsenhoven,Roman
%A Matthys,Christophe
%+ Experimental and Clinical Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, Leuven, 3000, Belgium, 32 16 347000, christophe.matthys@uzleuven.be
%K behavior change techniques
%K Behavior Change Wheel
%K type 2 diabetes
%K low-income populations
%K mHealth
%K mobile health
%K glycemic control
%K adults
%K diabetes
%K Africa
%K mobile phone
%K support care
%K care
%K support
%K behavior
%K diabetes
%D 2023

%7 4.12.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The worldwide prevalence of type 2 diabetes (T2D) has increased in the past decade, and it is projected to increase by 126% by 2045 in Africa. At the same time, mobile phone use has increased in Africa, providing a potential for innovative mobile health interventions to support diabetes care. Objective: This study aimed to apply the Behavior Change Wheel (BCW) framework to develop text messages to influence food literacy in adults with T2D in urban Kenya. Methods: The 8 steps of the BCW framework guided the development of text messages: (1) Define the problem in behavioral terms; (2) select target behaviors; (3) specify the target behaviors based on who needs to perform the behaviors, what needs to change, and when, where, how often, and with whom; (4) identify what needs to change; (5) identify intervention functions; (6) select policy categories; (7) select behavior change techniques (BCTs); and (8) select the mode of delivery. Recent exploratory studies in Kenya and other low- and middle-income countries provided information that was used to contextualize the intervention. Results: In step 1, the behavioral problem was defined as unhealthy dietary patterns among adults with T2D. In step 2, based on a qualitative study in the target population, the target behavior was selected to be evaluation of reliable sources of information, and selection and preparation of healthy food. In step 3, unhealthy dietary patterns were selected. In step 4, 10 domains of the Theoretical Domains Framework were identified, and in step 5, 5 intervention functions were linked to the domains and unhealthy dietary patterns were specified. In step 6, communication and regulations were identified as policy categories, while in step 7, 9 BCTs were selected from the Behavior Change Technique Taxonomy version 1. In step 8, the most suitable mode of delivery was determined to be mobile text messages. A total of 36 mobile text messages were developed based on the 9 BCTs. Conclusions: This study shows the step-by-step application of the BCW framework to develop mobile text messages to influence food literacy in adults with T2D. International Registered Report Identifier (IRRID): RR1-10.2196/48271 
%M 38048150
%R 10.2196/48271
%U https://www.researchprotocols.org/2023/1/e48271
%U https://doi.org/10.2196/48271
%U http://www.ncbi.nlm.nih.gov/pubmed/38048150

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44705
%T Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study
%A Shea,Amanda A
%A Thornburg,Jonathan
%A Vitzthum,Virginia J
%+ Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology/Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 250 984 3033, dr.vj.vitzthum@gmail.com
%K mobile health
%K mHealth
%K femtech
%K reproductive health
%K menstrual health
%K sexual health
%K survey modalities
%K menstrual tracking app
%K India
%K South Africa
%K United States
%K mobile phone
%D 2023

%7 1.12.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors—notably, high costs, considerable effort, and the sensitivity of these topics—impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods. Objective: The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA. Methods: In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India). Results: Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples’ consistency across countries regarding users’ demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app’s users. Conclusions: MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research. 
%M 38039064
%R 10.2196/44705
%U https://formative.jmir.org/2023/1/e44705
%U https://doi.org/10.2196/44705
%U http://www.ncbi.nlm.nih.gov/pubmed/38039064

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e46614
%T Design Research to Embed mHealth into a Community-Led Blood Pressure Management System in Uganda: Protocol for a Mixed Methods Study
%A Schwab,Josephine
%A Wachinger,Jonas
%A Munana,Richard
%A Nabiryo,Maxencia
%A Sekitoleko,Isaac
%A Cazier,Juliette
%A Ingenhoff,Rebecca
%A Favaretti,Caterina
%A Subramonia Pillai,Vasanthi
%A Weswa,Ivan
%A Wafula,John
%A Emmrich,Julius Valentin
%A Bärnighausen,Till
%A Knauf,Felix
%A Knauss,Samuel
%A Nalwadda,Christine K
%A Sudharsanan,Nikkil
%A Kalyesubula,Robert
%A McMahon,Shannon A
%+ Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 06221 ext 565344, J.Schwab@stud.uni-heidelberg.de
%K Uganda
%K hypertension
%K mobile health
%K mHealth
%K mobile money
%K pooled financing
%K medication availability
%K human-centered design
%K mixed methods
%K mobile phone
%D 2023

%7 30.11.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Uncontrolled hypertension is a leading risk factor for cardiovascular diseases. In Uganda, such diseases account for approximately 10% of all deaths, with 1 in 5 adults having hypertension (>90% of the hypertensive cases are uncontrolled). Although basic health care in the country is available free of cost at government facilities, regularly accessing medication to control hypertension is difficult because supply chain challenges impede availability. Clients therefore frequently suspend treatment or buy medication individually at private facilities or pharmacies (incurring significant costs). In recent years, mobile health (mHealth) interventions have shown increasing potential in addressing health system challenges in sub-Saharan Africa, but the acceptability, feasibility, and uptake conditions of mobile money approaches to chronic disease management remain understudied. Objective: This study aims to design and pilot-test a mobile money–based intervention to increase the availability of antihypertensive medication and lower clients’ out-of-pocket payments. We will build on existing local approaches and assess the acceptability, feasibility, and uptake of the designed intervention. Furthermore, rather than entering the study setting with a ready-made intervention, this research will place emphasis on gathering applied ethnographic insights early, which can then inform the parameters of the intervention prototype and concurrent trial. Methods: We will conduct a mixed methods study following a human-centered design approach. We will begin by conducting extensive qualitative research with a range of stakeholders (clients; health care providers; religious, cultural, and community leaders; academics; and policy makers at district and national levels) on their perceptions of hypertension management, money-saving systems, and mobile money in the context of health care. Our results will inform the design, iterative adaptation, and implementation of an mHealth-facilitated pooled financing intervention prototype. At study conclusion, the finalized prototype will be evaluated quantitatively via a randomized controlled trial. Results: As of August 2023, qualitative data collection, which started in November 2022, is ongoing, with data analysis of the first qualitative interviews underway to inform platform and implementation design. Recruitment for the quantitative part of this study began in August 2023. Conclusions: Our results aim to inform the ongoing discourse on novel and sustainable pathways to facilitate access to medication for the management of hypertension in resource-constrained settings. Trial Registration: German registry of clinical trials DRKS00030922; https://drks.de/search/en/trial/DRKS00030922 International Registered Report Identifier (IRRID): DERR1-10.2196/46614 
%M 38032702
%R 10.2196/46614
%U https://www.researchprotocols.org/2023/1/e46614
%U https://doi.org/10.2196/46614
%U http://www.ncbi.nlm.nih.gov/pubmed/38032702

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e46980
%T Assessing the Effect of Extreme Weather on Population Health Using Consumer-Grade Wearables in Rural Burkina Faso: Observational Panel Study
%A Koch,Mara
%A Matzke,Ina
%A Huhn,Sophie
%A Sié,Ali
%A Boudo,Valentin
%A Compaoré,Guillaume
%A Maggioni,Martina Anna
%A Bunker,Aditi
%A Bärnighausen,Till
%A Dambach,Peter
%A Barteit,Sandra
%+ Heidelberg Institute of Global Health, Faculty of Medicine, University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 5634030, barteit@uni-heidelberg.de
%K wearable
%K consumer-grade wearable
%K sleep
%K activity
%K heart rate
%K climate change
%K heat
%K rain
%K weather
%K sub-Saharan Africa
%K global health
%K public health
%K mobile phone
%D 2023

%7 8.11.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Extreme weather, including heat and extreme rainfall, is projected to increase owing to climate change, which can have adverse impacts on human health. In particular, rural populations in sub-Saharan Africa are at risk because of a high burden of climate-sensitive diseases and low adaptive capacities. However, there is a lack of data on the regions that are anticipated to be most exposed to climate change. Improved public health surveillance is essential for better decision-making and health prioritization and to identify risk groups and suitable adaptation measures. Digital technologies such as consumer-grade wearable devices (wearables) may generate objective measurements to guide data-driven decision-making. Objective: The main objective of this observational study was to examine the impact of weather exposure on population health in rural Burkina Faso using wearables. Specifically, this study aimed to assess the relationship between individual daily activity (steps), sleep duration, and heart rate (HR), as estimated by wearables, and exposure to heat and heavy rainfall. Methods: Overall, 143 participants from the Nouna health and demographic surveillance system in Burkina Faso wore the Withings Pulse HR wearable 24/7 for 11 months. We collected continuous weather data using 5 weather stations throughout the study region. The heat index and wet-bulb globe temperature (WBGT) were calculated as measures of heat. We used linear mixed-effects models to quantify the relationship between exposure to heat and rainfall and the wearable parameters. Participants kept activity journals and completed a questionnaire on their perception of and adaptation to heat and other weather exposure. Results: Sleep duration decreased significantly (P<.001) with higher heat exposure, with approximately 15 minutes shorter sleep duration during heat stress nights with a heat index value of ≥25 °C. Many participants (55/137, 40.1%) reported that heat affected them the most at night. During the day, most participants (133/137, 97.1%) engaged in outdoor physical work such as farming, housework, or fetching water. During the rainy season, when WBGT was highest, daily activity was highest and increased when the daily maximum WBGT surpassed 30 °C during the rainiest month. In the hottest month, daily activity decreased per degree increase in WBGT for values >30 °C. Nighttime HR showed no significant correlation with heat exposure. Daytime HR data were insufficient for analysis. We found no negative health impact associated with heavy rainfall. With increasing rainfall, sleep duration increased, average nightly HR decreased, and activity decreased. Conclusions: During the study period, participants were frequently exposed to heat and heavy rainfall. Heat was particularly associated with impaired sleep and daily activity. Essential tasks such as harvesting, fetching water, and caring for livestock expose this population to weather that likely has an adverse impact on their health. Further research is essential to guide interventions safeguarding vulnerable communities. 
%M 37938879
%R 10.2196/46980
%U https://mhealth.jmir.org/2023/1/e46980
%U https://doi.org/10.2196/46980
%U http://www.ncbi.nlm.nih.gov/pubmed/37938879

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42604
%T Tailoring Educational Materials to Cultural Context Matters
%A Zaki,Sasha
%+ Jinnah Sindh Medical University, Rafiqui HJ Shaheed Road, Karachi, 75510, Pakistan, 92 219 920 5185, sashazaki13@gmail.com
%K Bangladesh
%K health education
%K health knowledge
%K quality of life
%K motivation
%K randomized controlled trial
%K RCT
%K campaign
%K chronic kidney disease
%K knowledge
%K mobile health
%K mHealth
%K kidney
%K chronic disease
%K chronic condition
%K patient education
%K patient knowledge
%K low- and middle-income countries
%K LMIC
%D 2023

%7 6.11.2023
%9 Letter to the Editor
%J J Med Internet Res
%G English
                
%X 
%M 37930771
%R 10.2196/42604
%U https://www.jmir.org/2023/1/e42604
%U https://doi.org/10.2196/42604
%U http://www.ncbi.nlm.nih.gov/pubmed/37930771

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e50304
%T Creating an Intercultural User-Centric Design for a Digital Sexual Health Education App for Young Women in Resource-Poor Regions of Kenya: Qualitative Self-Extended Double Diamond Model for Requirements Engineering Analysis
%A Soehnchen,Clarissa
%A Rietz,Annika
%A Weirauch,Vera
%A Meister,Sven
%A Henningsen,Maike
%+ HealthCare Department, Fraunhofer Institute for Software and System Engineering, Speicherstraße 6, Dortmund, 44147, Germany, 49 2302926, clarissa.soehnchen@uni-wh.de
%K sexual health information
%K sexual health education
%K sub-Saharan Africa
%K women
%K semistructured interviews
%K requirements engineering analysis
%K user-centered design
%K youth, slum
%K health education
%K sexual health
%K digital health
%K stigmatization
%K reproductive health services
%D 2023

%7 3.11.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The stigmatization around sexual health due to culture, religious traditions, and norms leads to myths and a lack of available information and resources related to universal access to sexual and reproductive health services. Additional sexual health education not being part of the Kenya school curriculum leads to insufficient access to knowledge about safe contraception, menstruation, and female genital mutilation. A digital app could support and provide education and information for universal equal access, addressing United Nations Sustainable Development Goals 3, 4, and 5. Objective: The study targeted the requirements for establishing a reusable framework to develop a successful accessible web-based sexual health education app and the behavioral intention to use it to obtain sexual health information by mainly young women in Kenya. Methods: The double diamond model, with a problem room including the discover and define phases, enriched with cultural aspects and modeled to a self-expanded intercultural research model was used in a user-centered design thinking approach to develop a framework for requirements engineering analysis. For problem identification, semistructured pilot phase interviews based on Consolidated Criteria for Reporting Qualitative Research guidelines were conducted, followed by expert interviews for qualitative content analysis. A sample size of 12 pilot phase interviews and 5 expert interviews was determined using data saturation. The responses were coded and analyzed according to the affinity mapping method. Results: The requirements engineering analysis showed potential enablers of and barriers to the use of a digital sexual health education app. Through this qualitative study, a conservative cultural background, classic text communication, and the influence of social affiliation within society were identified as barriers, which should be enhanced through visual and auditory channels as well as a fictional character in the app. Conclusions: The developed intercultural research model provides an impetus to providing digital sexual health education, integrating culture-specific aspects in the design process, while focusing on cultural and religious stigmata. The reusable framework enables identifying and overcoming hurdles in providing information about taboo and intimate topics. The overall use of online education tools focusing on intimate topics is correlated with accessibility and understanding specific cultural needs while delivering content on a basic and comprehensive level. It helps the target user from a social conservative background and in resource-poor circumstances to benefit from a digital educational solution. 
%M 37921860
%R 10.2196/50304
%U https://formative.jmir.org/2023/1/e50304
%U https://doi.org/10.2196/50304
%U http://www.ncbi.nlm.nih.gov/pubmed/37921860

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e49407
%T mHealth Self-Monitoring Model for Medicine Adherence of Patients With Diabetes in Resource-Limited Countries: Structural Equation Modeling Approach
%A Kgasi,Mmamolefe
%A Chimbo,Bester
%A Motsi,Lovemore
%+ Faculty of ICT, Tshwane University of Technology, Department of End User Computing, Pretoria, South Africa, 27 715633727, kgasimr@tut.ac.za
%K diabetes
%K mobile health
%K mHealth
%K self-monitoring
%K self-management
%K chronic diseases
%K health care provision
%D 2023

%7 23.10.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The COVID-19 pandemic has led to serious challenges and emphasized the importance of using technology for health care operational transformation. Consequently, the need for technological innovations has increased, thus empowering patients with chronic conditions to tighten their adherence to medical prescriptions. Objective: This study aimed to develop a model for a mobile health (mHealth) self-monitoring system for patients with diabetes in rural communities within resource-limited countries. The developed model could be based on the implementation of a system for the self-monitoring of patients with diabetes to increase medical adherence. Methods: This study followed a quantitative approach, in which data were collected from health care providers using a questionnaire with close-ended questions. Data were collected from district hospitals in 3 South African provinces that were selected based on the prevalence rates of diabetes and the number of patients with diabetes treated. The collected data were analyzed using smart partial least squares to validate the model and test the suggested hypotheses. Results: Using variance-based structural equation modeling that leverages smart partial least squares, the analysis indicated that environmental factors significantly influence all the independent constructs that inform patients’ change of behavior toward the use of mHealth for self-monitoring of medication adherence. Technology characteristics such as effort expectancy, self-efficacy, and performance expectancy were equally significant; hence, their hypotheses were accepted. In contrast, the contributions of culture and social aspects were found to be insignificant, and their hypotheses were rejected. In addition, an analysis was conducted to determine the interaction effects of the moderating variables on the independent constructs. The results indicated that with the exception of cultural and social influences, there were significant interacting effects on other independent constructs influencing mHealth use for self-monitoring. Conclusions: On the basis of the findings of this study, we conclude that behavioral changes are essential for the self-monitoring of chronic diseases. Therefore, it is important to enhance those effects that stimulate the behavior to change toward the use of mHealth for self-monitoring. Motivational aspects were also found to be highly significant as they triggered changes in behavior. The developed model can be used to extend the research on the self-monitoring of patients with chronic conditions. Moreover, the model will be used as a basic architecture for the implementation of fully fledged systems for self-monitoring of patients with diabetes. 
%M 37870902
%R 10.2196/49407
%U https://formative.jmir.org/2023/1/e49407
%U https://doi.org/10.2196/49407
%U http://www.ncbi.nlm.nih.gov/pubmed/37870902

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e45715
%T Facilitators and Barriers in the Implementation of a Digital Surveillance and Outbreak Response System in Ghana Before and During the COVID-19 Pandemic: Qualitative Analysis of Stakeholder Interviews
%A Kaburi,Basil Benduri
%A Wyss,Kaspar
%A Kenu,Ernest
%A Asiedu-Bekoe,Franklin
%A Hauri,Anja M
%A Laryea,Dennis Odai
%A Klett-Tammen,Carolina J
%A Leone,Frédéric
%A Walter,Christin
%A Krause,Gérard
%+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, Braunschweig, 38124, Germany, 49 5316181 ext 3147, BasilBenduri.Kaburi@helmholtz-hzi.de
%K implementation
%K Surveillance Outbreak Response Management and Analysis System
%K SORMAS
%K barriers
%K facilitators
%K digital disease surveillance
%K outbreak response
%K COVID-19
%K pandemic
%K Ghana
%K mobile phone
%D 2023

%7 20.10.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: In the past 2 decades, many countries have recognized the use of electronic systems for disease surveillance and outbreak response as an important strategy for disease control and prevention. In low- and middle-income countries, the adoption of these electronic systems remains a priority and has attracted the support of global health players. However, the successful implementation and institutionalization of electronic systems in low- and middle-income countries have been challenged by the local capacity to absorb technologies, decisiveness and strength of leadership, implementation costs, workforce attitudes toward innovation, and organizational factors. In November 2019, Ghana piloted the Surveillance Outbreak Response Management and Analysis System (SORMAS) for routine surveillance and subsequently used it for the national COVID-19 response. Objective: This study aims to identify the facilitators of and barriers to the sustainable implementation and operation of SORMAS in Ghana. Methods: Between November 2021 and March 2022, we conducted a qualitative study among 22 resource persons representing different stakeholders involved in the implementation of SORMAS in Ghana. We interviewed study participants via telephone using in-depth interview guides developed consistent with the model of diffusion of innovations in health service organizations. We transcribed the interviews verbatim and performed independent validation of transcripts and pseudonymization. We performed deductive coding using 7 a priori categories: innovation, adopting health system, adoption and assimilation, diffusion and dissemination, outer context, institutionalization, and linkages among the aspects of implementation. We used MAXQDA Analytics Pro for transcription, coding, and analysis. Results: The facilitators of SORMAS implementation included its coherent design consistent with the Integrated Disease Surveillance and Response system, adaptability to evolving local needs, relative advantages for task performance (eg, real-time reporting, generation of case-base data, improved data quality, mobile offline capability, and integration of laboratory procedures), intrinsic motivation of users, and a smartphone-savvy workforce. Other facilitators were its alignment with health system goals, dedicated national leadership, political endorsement, availability of in-country IT capacities, and financial and technical support from inventors and international development partners. The main barriers were unstable technical interoperability between SORMAS and existing health information systems, reliance on a private IT company for data hosting, unreliable internet connectivity, unstable national power supply, inadequate numbers and poor quality of data collection devices, and substantial dependence on external funding. Conclusions: The facilitators of and barriers to SORMAS implementation are multiple and interdependent. Important success conditions for implementation include enhanced scope and efficiency of task performance, strong technical and political stewardship, and a self-motivated workforce. Inadequate funding, limited IT infrastructure, and lack of software development expertise are mutually reinforcing barriers to implementation and progress to country ownership. Some barriers are external, relate to the overall national infrastructural development, and are not amenable even to unlimited project funding. 
%M 37862105
%R 10.2196/45715
%U https://formative.jmir.org/2023/1/e45715
%U https://doi.org/10.2196/45715
%U http://www.ncbi.nlm.nih.gov/pubmed/37862105

%0 Journal Article
        
%@ 2291-5222
%I 
%V 11
%N 
%P e46853
%T Retention in an mHealth App Aiming to Promote the Use of HIV Pre-Exposure Prophylaxis Among Female Sex Workers in Dar es Salaam, Tanzania: Prospective Cohort Study
%A Mbotwa,Christopher H
%A Kazaura,Method R
%A Moen,Kåre
%A Leshabari,Melkizedeck T
%A Metta,Emmy
%A Mmbaga,Elia J
%K mobile health
%K retention
%K engagement
%K mHealth
%K sex workers
%K pre-exposure prophylaxis
%K HIV
%K Africa
%K PrEP
%D 2023

%7 17.10.2023
%9 
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Increasing access to smartphones in sub-Saharan Africa offers an opportunity to leverage mobile health (mHealth) technology to improve access to health care in underserved populations. In the domain of HIV prevention, mHealth interventions can potentially contribute to solving the challenges of suboptimal adherence to pre-exposure prophylaxis (PrEP) and low retention in PrEP services among populations most vulnerable to HIV acquisition. However, there is a gap in the knowledge about the use of such interventions in sub-Saharan Africa. Objective: This study aims to evaluate the extent and predictors of retention in an mHealth app (Jichunge) that aims to promote adherence to PrEP and retention in PrEP care among female sex workers in Dar es Salaam, Tanzania. Methods: A prospective cohort of female sex workers residing in Dar es Salaam were recruited, using respondent-driven sampling. All participants were provided with the Jichunge app as they started PrEP. A questionnaire was used to collect data on sociodemographics and other structural factors, while app use data for the 60-day period following the first 150 days of being in the intervention arm were extracted from the app’s back end. A multivariable log-binomial model was used to determine predictors of 6-month retention in the Jichunge app. Results: A total of 470 female sex workers were recruited. Nearly three-quarters of participants (206/284, 72.5%) who came to the 6-month follow-up interview no longer had the Jichunge app on their phones. The majority of these participants (193/206, 93.7%) no longer had access to the app because of issues related to their phones. Data extracted from the back end of the app showed that the use of the app declined over time, and only 13.4% (63/470) of the participants were retained (continued to use the app) after 6 months of intervention. At 6 months, women aged ≥35 years were >2 times more likely to use the app than women aged 18 to 24 years (adjusted risk ratio [aRR] 2.2, 95% CI 1.2-4.1; P=.01). Furthermore, retention in the app was higher among participants who demonstrated high PrEP awareness at baseline (aRR 1.8, 95% CI 1.1-3; P=.01) and among those who had experienced financial difficulties due to health care spending (aRR 1.9, 95% CI 1.2-3.2; P=.01). Conclusions: Most female sex workers (206/284, 72.5%) who were enrolled in PrEP care in Tanzania no longer used the Jichunge app after 6 months. Retention in the app at 6 months was predicted by older age, high PrEP awareness, and financial difficulties due to health care spending. Strategies for the long-term retention of participants in mHealth apps, such as systems for reinstallations of apps, should be considered during the design phase. Trial Registration: Pan African Clinical Trials Registry PACTR202003823226570; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9781 
%R 10.2196/46853
%U https://mhealth.jmir.org/2023/1/e46853
%U https://doi.org/10.2196/46853

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e47266
%T Effect of Short, Animated Video Storytelling on Maternal Knowledge and Satisfaction in the Perinatal Period in South Africa: Randomized Controlled Trial
%A Adam,Maya
%A Kwinda,Zwannda
%A Dronavalli,Mithilesh
%A Leonard,Elizabeth
%A Nguyễn,Vān Kính
%A Tshivhase,Vusani
%A Bärnighausen,Till
%A Pillay,Yogan
%+ Department of Pediatrics, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 6508393600, madam@stanford.edu
%K maternal child health
%K mHealth
%K mobile health
%K randomized controlled trial
%K short animated storytelling
%K South Africa
%K video health messaging
%D 2023

%7 13.10.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Innovative mobile health (mHealth) interventions can improve maternal knowledge, thereby supporting national efforts to reduce preventable maternal and child mortality in South Africa. Studies have documented a potential role for mobile video content to support perinatal health messaging, enhance maternal satisfaction, and overcome literacy barriers. Short, animated storytelling (SAS) is an innovative, emerging approach to mHealth messaging. Objective: We aimed to measure the effect of SAS videos on maternal knowledge and user satisfaction for mothers enrolled in antenatal care programs at 2 public health facilities in the Tshwane District of South Africa. Methods: We used a randomized controlled trial with a nested evaluation of user satisfaction. Participants were randomized 1:1 into Standard-of-Care (SOC) Control, and SAS Intervention groups. The intervention videos were delivered through WhatsApp, and 1 month later, participants responded to telephone surveys assessing their knowledge. The intervention group then participated in a nested evaluation of user satisfaction. Results: We surveyed 204 participants. Of them, 49.5% (101/204) were aged between 25 and 34 years. Almost all participants self-identified as Black, with the majority (190/204, 93.2%) having completed secondary school. The mean overall knowledge score was 21.92/28. We observed a slight increase of 0.28 (95% uncertainty interval [UI] –0.58 to 1.16) in the overall knowledge score in the intervention arm. We found that those with secondary education or above scored higher than those with only primary education by 2.24 (95% UI 0.76-4.01). Participants aged 35 years or older also scored higher than the youngest age group (18-24 years) by 1.83 (95% CI 0.39-3.33). Finally, the nested user satisfaction evaluation revealed high maternal satisfaction (4.71/5) with the SAS video series. Conclusions: While the SAS videos resulted in high user satisfaction, measured knowledge gains were small within a participant population that was already receiving perinatal health messages through antenatal clinics. The higher knowledge scores observed in older participants with higher education levels suggest that boosting maternal knowledge in younger mothers with lower education levels should continue to be a public health priority in South Africa. Given the high maternal satisfaction among the SAS video-users in this study, policy makers should consider integrating similar approaches into existing, broad-reaching perinatal health programs, such as MomConnect, to boost satisfaction and potentially enhance maternal engagement. While previous studies have shown the promise of animated video health education, most of this research has been conducted in high-income countries. More research in underresourced settings is urgently needed, especially as access to mobile technology increases in the Global South. Future studies should explore the effect of SAS videos on maternal knowledge in hard-to-reach populations with limited access to antenatal care, although real-world logistical challenges persist when implementing studies in underresourced South African populations. Trial Registration: Pan African Clinical Trials Registry PACTR202203673222680; https://tinyurl.com/362cpuny 
%M 37831505
%R 10.2196/47266
%U https://www.jmir.org/2023/1/e47266
%U https://doi.org/10.2196/47266
%U http://www.ncbi.nlm.nih.gov/pubmed/37831505

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 10
%N 
%P e47288
%T Immigrant, Refugee, and Indigenous Canadians’ Experiences With Virtual Health Care Services: Rapid Review
%A MacPherson,Megan
%+ Virtual Health, Fraser Health Authority, 13450 - 102nd ave, Surrey, BC, V3T0H1, Canada, 1 6045616605, meganmargaretmacpherson@gmail.com
%K delivery of health care
%K emigrants and immigrants
%K health disparate
%K indigenous Canadians
%K minority and vulnerable populations
%K refugees
%K telemedicine
%D 2023

%7 9.10.2023
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: The remote, dispersed, and multicultural population of Canada presents unique challenges for health care services. Currently, virtual care solutions are being offered as an innovative solution to improve access to care. Objective: Given the inequities in health care access faced by immigrant, refugee, and Indigenous Canadians, this review aimed to summarize information obtained from original research regarding these people’s experiences with virtual care services in Canada. Methods: We conducted a rapid review following published recommendations. MEDLINE and CINAHL were searched for studies relating to virtual care and Canadian immigrants, refugees, or Indigenous peoples. Peer-reviewed articles of any type were included so long as they included information on the experiences of virtual care service delivery in Canada among the abovementioned groups. Results: This review demonstrates an extreme paucity of evidence examining the experiences of immigrant, refugee, and Indigenous groups with virtual care in Canada. Of the 694 publications screened, 8 were included in this review. A total of 2 studies focused on immigrants and refugees in Canada, with the remaining studies focusing on Indigenous communities. Results demonstrate that virtual care is generally accepted within these communities; however, cultural appropriateness or safety and inequitable access to wireless services in certain communities were among the most cited barriers. Conclusions: Little evidence exists outlining immigrants’, refugees’, and Indigenous peoples’ perspectives on the landscape of virtual care in Canada. The development of virtual care programming should take into consideration the barriers, facilitators, and recommendations outlined in this review to improve equitable access. Further, developers should consult with local community members to ensure the appropriateness of services for immigrant, refugee, and Indigenous communities in Canada. 
%M 37812489
%R 10.2196/47288
%U https://humanfactors.jmir.org/2023/1/e47288
%U https://doi.org/10.2196/47288
%U http://www.ncbi.nlm.nih.gov/pubmed/37812489

%0 Journal Article
        
%I 
%V 
%N 
%P 
%T 
%D 

%7 ..
%9 
%J 
%G English
                
%X 
%U 

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e49150
%T Digital Rights and Mobile Health in Low- and Middle-Income Countries: Protocol for a Scoping Review
%A Poulsen,Adam
%A Song,Yun J C
%A Fosch-Villaronga,Eduard
%A LaMonica,Haley M
%A Iannelli,Olivia
%A Alam,Mafruha
%A Hickie,Ian B
%+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 481082211, adam.poulsen@sydney.edu.au
%K human right
%K digital right
%K mobile health
%K mHealth
%K smartphone
%K mobile phone
%K digital health
%K scoping review
%K health equity
%K patient empowerment
%D 2023

%7 3.10.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Digital technology is a means to uphold or violate human rights in various domains, including business, military, and health. Given the pervasiveness of mobile technology in low- and middle-income countries (LMICs), mobile health (mHealth) interventions present an opportunity to reach remote populations and enable them to exercise civil and political rights and economic, social, and cultural rights, such as the right to health and education. Simultaneously, the ubiquity of mobile phones involves processing sensitive data which can threaten rights, including the right to privacy and nondiscrimination. Digital health is often promoted as advancing human rights and health equity; however, digital rights are underexplored in the literature on mHealth in LMICs. As such, creating an understanding of the digital rights topics covered in the 2022 literature is important to avoid exacerbating existing inequities relating to digital health design, use, implementation, and access. Objective: This scoping review aims to identify digital rights topics in the 2022 peer-reviewed literature on mHealth in LMICs. Methods: The Arksey and O’Malley framework for scoping reviews guides this review. Searches were performed across 7 electronic databases (Web of Science, Scopus, Ovid, ACM Digital Library, IEEE Xplore, ProQuest, and PubMed). The screening processes were guided by the research question “What digital rights topics have been explored in the 2022 literature on mHealth in LMICs?” Only papers addressing mHealth in LMICs and digital rights topics were included. Data extraction will include publication title, year, and type; first author’s affiliation country; LMICs implicated; infrastructure challenges; study aims, design, limitations, and future work; health area; mHealth technology, functions, purpose or application, and target end users; human or digital right terms used; explicit rights topics cited; and implied rights topics. The results will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: This scoping review was registered in Open Science Framework (December 22, 2022). Title and abstract screening and full-text paper screening were completed in 2023. This resulted in 56 papers being included in the study. The target date for completing data extraction and publishing a case study of the initial findings is the end of 2023. The full scoping review findings are expected to be disseminated through various pathways benefiting academia, practice, and policy making by the end of 2024. These include journal papers, conference presentations, publicly available toolkits for research and practice, public webinars, and policy briefs with evidence-based policy recommendations emerging from this review. Conclusions: The planned scoping review will identify digital rights topics in the 2022 literature at the intersection of mHealth and LMICs. Furthermore, it will highlight the importance of patient empowerment, data protection, and inclusion in mHealth research and related policies in LMICs. Trial Registration: Open Science Framework osf.io/7mz24; https://osf.io/7mz24 International Registered Report Identifier (IRRID): DERR1-10.2196/49150 
%M 37788054
%R 10.2196/49150
%U https://www.researchprotocols.org/2023/1/e49150
%U https://doi.org/10.2196/49150
%U http://www.ncbi.nlm.nih.gov/pubmed/37788054

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e45132
%T Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders’ Perceptions
%A Kabukye,Johnblack K
%A Namugga,Jane
%A Mpamani,Collins Jackson
%A Katumba,Andrew
%A Nakatumba-Nabende,Joyce
%A Nabuuma,Hanifa
%A Musoke,Stephen Senkomago
%A Nankya,Esther
%A Soomre,Edna
%A Nakisige,Carolyn
%A Orem,Jackson
%+ SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12 (NOD Building), Campus Kista, PO Box 7003 Kista, Stockholm, SE-164 07, Sweden, 46 8 16 20 00, kabukye@dsv.su.se
%K telemedicine
%K cervical cancer
%K screening
%K visual inspection with acetic acid
%K cervicography
%K Uganda
%K digital health
%D 2023

%7 2.10.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. Objective: This study aimed to describe stakeholders’ perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. Methods: We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. Results: In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. Conclusions: This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation. 
%M 37782541
%R 10.2196/45132
%U https://www.jmir.org/2023/1/e45132
%U https://doi.org/10.2196/45132
%U http://www.ncbi.nlm.nih.gov/pubmed/37782541

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e45343
%T Mediating and Moderating Effects of Internet Use on Urban-Rural Disparities in Health Among Older Adults: Nationally Representative Cross-Sectional Survey in China
%A Liu,Jing
%A Peng,Junwei
%A Chen,Minyan
%A Zhang,Tao
%+ Department of Health Policy and Management, School of Public Health, Hangzhou Normal University, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311100, China, 86 18768429445, lucky1230405@163.com
%K internet use
%K cognitive function
%K depressive symptoms
%K functional disability
%K mediation analysis
%K mobile phone
%D 2023

%7 28.9.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The urban-rural disparities in health outcomes in China are remarkable. The internet has shown the potential to reduce the likelihood of contracting a disease by increasing disease knowledge. However, little is known about the effects of internet use in alleviating health inequities between urban and rural areas. Objective: This study aimed to examine the mediation and moderation of health disparities between urban and rural older adults through internet use. Methods: A total of 8223 respondents were selected from the China Health and Retirement Longitudinal Study 2018 data set. Basic activities of daily living, a brief Community Screening Instrument for Dementia, and the Centre for Epidemiologic Studies Depression Scale were used to measure functional disability, cognitive function, and depressive symptoms, respectively. Logistic regressions testing “internet use×urban-rural status” interactions for moderation and Karlson-Holm-Breen decomposition for mediation were performed. Results: Internet use moderated the urban-rural disparities in cognitive function (odds ratio 7.327, 95% CI 3.011-17.832) and depressive symptoms (odds ratio 1.070, 95% CI 1.037-1.787), but the moderating effects were significant only for those using the internet daily. Karlson-Holm-Breen results showed the suppression effects of using the internet daily (β=.012, 95% CI .002-.021) on the association between urban-rural status and cognitive function. The urban-rural inequality in depressive symptoms was partially attributed to the disparity in internet use (β=−.027, 95% CI −.043 to −.009). Conclusions: The urban-rural inequalities in mental health are partially attributable to disparities in the prevalence of internet use between the 2 groups. However, using the internet is more beneficial for the psychological health of rural users, thereby alleviating the urban-rural disparities in health. Providing convenient channels for rural older adults to use the internet, improving the ability of rural users to effectively use the internet, and promoting internet popularity in rural areas are effective approaches to reducing urban-rural health inequalities. 
%M 37768721
%R 10.2196/45343
%U https://www.jmir.org/2023/1/e45343
%U https://doi.org/10.2196/45343
%U http://www.ncbi.nlm.nih.gov/pubmed/37768721

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44402
%T An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility
%A Oladele,David Ayoola
%A Iwelunmor,Juliet
%A Gbajabiamila,Titilola
%A Obiezu-Umeh,Chisom
%A Okwuzu,Jane Ogoamaka
%A Nwaozuru,Ucheoma
%A Musa,Adesola Zaidat
%A Tahlil,Kadija
%A Idigbe,Ifeoma
%A Ong,Jason
%A Tang,Weiming
%A Tucker,Joseph
%A Ezechi,Oliver
%+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 314 7458150, david.oladele@slu.edu
%K adolescent
%K adolescents and young adults
%K Africa
%K AYA
%K development
%K feasibility
%K HIV self-testing
%K HIV
%K HIVST
%K information system
%K Nigeria
%K platform
%K testing
%K think aloud
%K unstructured supplementary service data
%K usability
%K user-centered
%K USSD
%K young adult
%K youth
%D 2023

%7 25.9.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform’s usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. 
%M 37747780
%R 10.2196/44402
%U https://formative.jmir.org/2023/1/e44402
%U https://doi.org/10.2196/44402
%U http://www.ncbi.nlm.nih.gov/pubmed/37747780

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e43654
%T A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Health Behavioral Determinants During Pregnancy Among Adolescent Girls and Young Women in South Africa: Development and Protocol for a Pilot Randomized Controlled Trial
%A Sewpaul,Ronel
%A Resnicow,Ken
%A Crutzen,Rik
%A Dukhi,Natisha
%A Ellahebokus,Afzal
%A Reddy,Priscilla
%+ Public Health, Societies and Belonging, Human Sciences Research Council, 134 Pretorius Street, Pretoria, 0002, South Africa, 27 214667912, rsewpaul@hsrc.ac.za
%K antenatal care
%K adolescent girls and young women
%K AGYW
%K adolescent pregnancy
%K mobile health
%K mHealth
%K tailoring
%K motivational interviewing
%K South Africa
%K mobile phone
%D 2023

%7 13.9.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: South Africa, a middle-income country, has an adolescent fertility rate far higher than that of high-income countries. Adolescent girls and young women have an increased risk of pregnancy-related complications and lower antenatal appointment attendance rates than older adult pregnant women. Mobile health (mHealth) interventions to improve health behaviors among pregnant adolescent girls and young women in low- and middle-income countries are scarce. Objective: This paper describes the development and components of an mHealth intervention to improve antenatal appointment attendance and health behavioral determinants among pregnant adolescent girls and young women in South Africa and details the protocol for a pilot randomized controlled trial that evaluated the intervention’s efficacy and user acceptability. Methods: The intervention, Teen MomConnect, sent tailored motivational behavior change and behavioral reinforcement SMS text messages to participants about antenatal appointment keeping and pregnancy behaviors. The delivery methodology of the intervention was adapted from MomConnect, an mHealth education program for pregnant women in South Africa that has nationwide coverage. In addition, participants received a face-to-face motivational interviewing session delivered by a trained research assistant. Pregnant adolescent girls and young women aged 13 to 20 years were recruited from health facilities and community networks. Participants were randomized into the control group that received the standard MomConnect health SMS text messages or the experimental group that received the Teen MomConnect intervention. Participants completed a baseline questionnaire upon enrollment in the study and a follow-up questionnaire after the end of their pregnancy. The questionnaires assessed demographic characteristics, pregnancy behaviors, and the psychosocial determinants of antenatal appointment attendance (knowledge, attitudes, social support, risk perceptions, self-efficacy, intention, and action planning). Feasibility was assessed using descriptive analyses of acceptability, study implementation processes, and perceived satisfaction with the intervention. The number of appointments attended was obtained from the participants’ clinic records. Appointment attendance was compared between the control and experimental groups, as were awareness of HIV status and the psychosocial determinants of antenatal appointment attendance. Results: Participant recruitment was conducted from May 2018 to December 2018, and the questionnaire-based data collection was completed by December 2019. Overall, 412 participants were enrolled. Conclusions: This paper describes the Teen MomConnect intervention to improve antenatal appointment attendance and pregnancy health behaviors among adolescent girls and young women. The results on the intervention’s preliminary efficacy and user acceptability will inform policy makers and health program officers on how tailored, age-appropriate, and motivational health behavior messages can be delivered via mobile phone to pregnant adolescent girls and young women. Trial Registration: Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565 International Registered Report Identifier (IRRID): DERR1-10.2196/43654 
%M 37703092
%R 10.2196/43654
%U https://www.researchprotocols.org/2023/1/e43654
%U https://doi.org/10.2196/43654
%U http://www.ncbi.nlm.nih.gov/pubmed/37703092

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e45224
%T Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study
%A O'Brien,Niki
%A Li,Edmond
%A Chaibva,Cynthia N
%A Gomez Bravo,Raquel
%A Kovacevic,Lana
%A Kwame Ayisi-Boateng,Nana
%A Lounsbury,Olivia
%A Nwabufo,Ngnedjou Francoise F
%A Senkyire,Ephraim Kumi
%A Serafini,Alice
%A Surafel Abay,Eleleta
%A van de Vijver,Steven
%A Wanjala,Mercy
%A Wangari,Marie-Claire
%A Moosa,Shabir
%A Neves,Ana Luisa
%+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Hospital, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk
%K digital health
%K digital health technology
%K telemedicine
%K remote care
%K primary care
%K primary health carel PHC
%K COVID-19
%K global health
%K sub-Saharan Africa
%K eHealth
%D 2023

%7 7.9.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers’ contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. 
%M 37676721
%R 10.2196/45224
%U https://www.jmir.org/2023/1/e45224
%U https://doi.org/10.2196/45224
%U http://www.ncbi.nlm.nih.gov/pubmed/37676721

%0 Journal Article
        
%@ 1947-2579
%I JMIR Publications
%V 15
%N 
%P e50927
%T The Health Impact of mHealth Interventions in India: Systematic Review and Meta-Analysis
%A Joshi,Vibha
%A Joshi,Nitin Kumar
%A Bhardwaj,Pankaj
%A Singh,Kuldeep
%A Ojha,Deepika
%A Jain,Yogesh Kumar
%+ Resource Centre Health Technology Assessment, All India Institute of Medical Sciences Jodhpur, B110 Krishna Nagar, Basni-I, Jodhpur, 342005, India, 91 8290163030, drvibhajoshi@gmail.com
%K mobile applications
%K mobile apps
%K cost-benefit analysis
%K telemedicine
%K technology
%K India
%K patient satisfaction
%K pregnancy
%D 2023

%7 4.9.2023
%9 Review
%J Online J Public Health Inform
%G English
                
%X Background: Considerable use of mobile health (mHealth) interventions has been seen, and these interventions have beneficial effects on health and health service delivery processes, especially in resource-limited settings. Various functionalities of mobile phones offer a range of opportunities for mHealth interventions. Objective: This review aims to assess the health impact of mHealth interventions in India. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies conducted in India, and published between April 1, 2011, and March 31, 2021, were considered. A literature search was conducted using a combination of MeSH (Medical Subject Headings) terms in different databases to identify peer-reviewed publications. Thirteen out of 1350 articles were included for the final review. Risk of bias was assessed using the Risk of Bias 2 tool for RCTs and Risk Of Bias In Non-randomised Studies - of Interventions tool (for nonrandomized trials), and a meta-analysis was performed using RevMan for 3 comparable studies on maternal, neonatal, and child health. Results: The meta-analysis showed improved usage of maternal and child health services including iron–folic acid supplementation (odds ratio [OR] 14.30, 95% CI 6.65-30.75), administration of both doses of the tetanus toxoid (OR 2.47, 95% CI 0.22-27.37), and attending 4 or more antenatal check-ups (OR 1.82, 95% CI 0.65-5.09). Meta-analysis for studies concerning economic evaluation and chronic diseases could not be performed due to heterogeneity. However, a positive economic impact was observed from a societal perspective (ReMiND [reducing maternal and newborn deaths] and ImTeCHO [Innovative Mobile Technology for Community Health Operation] interventions), and chronic disease interventions showed a positive impact on clinical outcomes, patient and provider satisfaction, app usage, and improvement in health behaviors. Conclusions: This review provides a comprehensive overview of mHealth technology in all health sectors in India, analyzing both health and health care usage indicators for interventions focused on maternal and child health and chronic diseases. Trial Registration: PROSPERO 2021 CRD42021235315; https://tinyurl.com/yh4tp2j7 
%M 38046564
%R 10.2196/50927
%U https://ojphi.jmir.org/2023/1/e50927
%U https://doi.org/10.2196/50927
%U http://www.ncbi.nlm.nih.gov/pubmed/38046564

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e45262
%T Using HIV Risk Self-Assessment Tools to Increase HIV Testing in Men Who Have Sex With Men in Beijing, China: App-Based Randomized Controlled Trial
%A Luo,Qianqian
%A Wu,Zunyou
%A Mi,Guodong
%A Xu,Jie
%A Scott,Sarah Robbins
%+ School of Nursing, Binzhou Medical University, 346 Guanhai Road, Laishan District, Yantai, 264003, China, 86 535 6913180, luoqq@bzmc.edu.cn
%K app
%K China
%K HIV testing
%K men who have sex with men
%K risk assessment
%D 2023

%7 1.9.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Men who have sex with men (MSM) in China hold a low-risk perception of acquiring HIV. This has resulted in an inadequate HIV testing rate. Objective: This study aims to investigate whether administering HIV risk self-assessments with tailored feedback on a gay geosocial networking (GSN) app could improve HIV testing rates and reduce sexual risk behaviors in Chinese MSM. Methods: We recruited MSM from Beijing, China, who used the GSN platform Blued in October 2017 in this 12-month double-blinded randomized controlled trial. From October 2017 to September 2018, eligible participants were randomly assigned to use a self-reported HIV risk assessment tool that provided tailored feedback according to transmission risk (group 1), access to the same HIV risk assessment without feedback (group 2), or government-recommended HIV education materials (control). All interventions were remotely delivered through the mobile phone–based app Blued, and participants were followed up at 1, 3, 6, and 12 months from baseline. The number of HIV tests over the 12-month study was the primary outcome and was assessed using an intention-to-treat analysis with an incident rate ratio (IRR). Unprotected anal intercourse (UAI) over 6 months was assessed by a modified intention-to-treat analysis and was the secondary outcome. All statistical analyses were conducted in SAS 9.3 (SAS Institute, Inc.), and a P value <.05 was considered statistically significant. Results: In total, 9280 MSM were recruited from baseline and were randomly assigned to group 1 (n=3028), group 2 (n=3065), or controls (n=3187). After follow-up, 1034 (34.1%), 993 (32.4%), and 1103 (34.6%) remained in each group, respectively. Over 12 months, group 1 took 391 tests (mean of 2.51 tests per person), group 2 took 352 tests (mean of 2.01 tests per person), and controls took 295 tests (mean of 1.72 tests per person). Group 1 had significantly more HIV testing than the control group (IRR 1.32, 95% CI 1.09-4.58; P=.01), while group 2 did not differ significantly from the controls (IRR 1.06, 95% CI 0.86-1.30; P=.60). The proportion of UAI was not statistically different among different groups, but all 3 groups had UAI, which declined from baseline. Conclusions: Repeated HIV risk assessments coupled with tailored feedback through GSN apps improved HIV testing. Such interventions should be considered a simple way of improving HIV testing among MSM in China and increasing awareness of HIV status. Trial Registration: ClinicalTrials.gov NCT03320239; https://clinicaltrials.gov/study/NCT03320239 
%M 37656500
%R 10.2196/45262
%U https://www.jmir.org/2023/1/e45262
%U https://doi.org/10.2196/45262
%U http://www.ncbi.nlm.nih.gov/pubmed/37656500

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e46043
%T Mobile Health Hearing Aid Acclimatization and Support Program in Low-Income Communities: Feasibility Study
%A Frisby,Caitlin
%A Eikelboom,Robert H
%A Mahomed-Asmail,Faheema
%A Kuper,Hannah
%A Moore,David R
%A de Kock,Tersia
%A Manchaiah,Vinaya
%A Swanepoel,De Wet
%+ Department of Speech-Language Pathology and Audiology, University of Pretoria, cnr Lynnwood Road and Roper Street, Pretoria, 0028, South Africa, 27 012 420 2357, dewet.swanepoel@up.ac.za
%K community-based rehabilitation
%K community health care worker
%K text message
%K messaging
%K motivational
%K reminder
%K acclimatization
%K technology use
%K hearing aid acclimatization
%K hearing aid
%K hearing loss
%K low- and middle-income countries
%K LMIC
%K low income
%K developing country
%K low resource
%K hearing
%K audiology
%K mobile health
%K mHealth
%K health care workers
%K usability
%D 2023

%7 23.8.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The most common management option for hearing loss is hearing aids. In addition to devices, patients require information and support, including maintenance and troubleshooting. Mobile health (mHealth) technologies can support hearing aid management, acclimatization, and use. This study developed an mHealth acclimatization and support program for first-time hearing aid users and subsequently implemented and pilot-tested the feasibility of the program. The program was facilitated by community health workers (CHWs) in low-income communities in South Africa. Objective: This study aimed to evaluate the feasibility of an mHealth acclimatization and support program supported by CHWs in low-income communities. Methods: An application-based acclimatization and support was adapted and translated for use in low- and middle-income countries. This program was delivered in the form of 20 different voice notes accompanied by graphical illustrations via WhatsApp or 20 different SMS text messages. The program was provided to first-time hearing aid users immediately after a community-based hearing aid fitting in March 2021 in 2 low-income communities in the Western Cape, South Africa. The 20 messages were sent over a period of 45 days. Participants were contacted telephonically on days 8, 20, and 43 of the program and via open-ended paper-based questionnaires translated to isiXhosa 45 days and 6 months after the program started to obtain information on their experiences, perceptions, and accessibility of the program. Their responses were analyzed using inductive thematic analysis. Results: A total of 19 participants fitted with hearing aids received the mHealth acclimatization and support program. Most participants (15/19, 79%) received the program via WhatsApp, with 21% (4/19) of them receiving it via SMS text message. Participants described the program as helpful, supportive, informative, sufficient, and clear at both follow-ups. A total of 14 participants reported that they were still using their hearing aids at the 6-month follow-up. Three participants indicated that not all their questions about hearing aids were answered, and 5 others had minor hearing aid issues. This included feedback (n=1), battery performance (n=1), physical fit (n=2), and issues with hearing aid accessories (n=1). However, CHWs successfully addressed all these issues. There were no notable differences in responses between the participants who received the program via WhatsApp compared with those who received it through SMS text message. Most participants receiving WhatsApp messages reported that the voice notes were easier to understand, but the graphical illustrations supplemented the voice notes well. Conclusions: An mHealth acclimatization and support program is feasible and potentially assists hearing aid acclimatization and use for first-time users in low-income communities. Scalable mHealth support options can facilitate increased access and improve outcomes of hearing care. 
%M 37610802
%R 10.2196/46043
%U https://formative.jmir.org/2023/1/e46043
%U https://doi.org/10.2196/46043
%U http://www.ncbi.nlm.nih.gov/pubmed/37610802

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44267
%T Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children’s Socioemotional and Cognitive Development in Afghanistan: Co-Design Study
%A LaMonica,Haley M
%A Crouse,Jacob J
%A Song,Yun J C
%A Alam,Mafruha
%A Wilson,Chloe E
%A Hindmarsh,Gabrielle
%A Yoon,Adam
%A Boulton,Kelsie A
%A Ekambareshwar,Mahalakshmi
%A Loblay,Victoria
%A Troy,Jakelin
%A Torwali,Mujahid
%A Guastella,Adam J
%A Banati,Richard B
%A Hickie,Ian B
%+ Youth Mental Health and Technology Team, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au
%K child development
%K digital technology
%K global health
%K co-design
%K participatory research
%K stakeholder participation
%K mobile app
%K smartphone
%K mobile phone
%K Afghanistan
%D 2023

%7 23.8.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. Objective: This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. Methods: The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed; detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. Results: The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents; however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children’s screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. Conclusions: Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children’s lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children’s developmental potential despite the security concerns and situational stressors. 
%M 37610805
%R 10.2196/44267
%U https://formative.jmir.org/2023/1/e44267
%U https://doi.org/10.2196/44267
%U http://www.ncbi.nlm.nih.gov/pubmed/37610805

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e28848
%T A Fast and Minimal System to Identify Depression Using Smartphones: Explainable Machine Learning–Based Approach
%A Ahmed,Md Sabbir
%A Ahmed,Nova
%+ Design Inclusion and Access Lab, North South University, Plot #15, Block #B, Bashundhara, Dhaka, 1229, Bangladesh, 880 1781920068, msg2sabbir@gmail.com
%K smartphone
%K depression
%K explainable machine learning
%K low-resource settings
%K real-time system
%K students
%D 2023

%7 10.8.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Existing robust, pervasive device-based systems developed in recent years to detect depression require data collected over a long period and may not be effective in cases where early detection is crucial. Additionally, due to the requirement of running systems in the background for prolonged periods, existing systems can be resource inefficient. As a result, these systems can be infeasible in low-resource settings. Objective: Our main objective was to develop a minimalistic system to identify depression using data retrieved in the fastest possible time. Another objective was to explain the machine learning (ML) models that were best for identifying depression. Methods: We developed a fast tool that retrieves the past 7 days’ app usage data in 1 second (mean 0.31, SD 1.10 seconds). A total of 100 students from Bangladesh participated in our study, and our tool collected their app usage data and responses to the Patient Health Questionnaire-9. To identify depressed and nondepressed students, we developed a diverse set of ML models: linear, tree-based, and neural network–based models. We selected important features using the stable approach, along with 3 main types of feature selection (FS) approaches: filter, wrapper, and embedded methods. We developed and validated the models using the nested cross-validation method. Additionally, we explained the best ML models through the Shapley additive explanations (SHAP) method. Results: Leveraging only the app usage data retrieved in 1 second, our light gradient boosting machine model used the important features selected by the stable FS approach and correctly identified 82.4% (n=42) of depressed students (precision=75%, F1-score=78.5%). Moreover, after comprehensive exploration, we presented a parsimonious stacking model where around 5 features selected by the all-relevant FS approach Boruta were used in each iteration of validation and showed a maximum precision of 77.4% (balanced accuracy=77.9%). Feature importance analysis suggested app usage behavioral markers containing diurnal usage patterns as being more important than aggregated data-based markers. In addition, a SHAP analysis of our best models presented behavioral markers that were related to depression. For instance, students who were not depressed spent more time on education apps on weekdays, whereas those who were depressed used a higher number of photo and video apps and also had a higher deviation in using photo and video apps over the morning, afternoon, evening, and night time periods of the weekend. Conclusions: Due to our system’s fast and minimalistic nature, it may make a worthwhile contribution to identifying depression in underdeveloped and developing regions. In addition, our detailed discussion about the implication of our findings can facilitate the development of less resource-intensive systems to better understand students who are depressed and take steps for intervention. 
%M 37561568
%R 10.2196/28848
%U https://formative.jmir.org/2023/1/e28848
%U https://doi.org/10.2196/28848
%U http://www.ncbi.nlm.nih.gov/pubmed/37561568

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e47018
%T Testing the Impact of Phone Texting Reminders for Children's Immunization Appointments in Rural Cameroon: Protocol for a Nonrandomized Controlled Trial
%A Ngah,Yayah Emerencia
%A Raoufi,Ghazal
%A Amirkhani,Maral
%A Esmaeili,Ashkan
%A Nikooifard,Rasa
%A Ghaemi Mood,Shidrokh
%A Rahmanian,Ava
%A Boltena,Minyahil Tadesse
%A Aga,Eresso
%A Neogi,Ujjwal
%A Ikomey Mondinde,George
%A El-Khatib,Ziad
%+ Department of Global Public Health, Karolinska Institutet, Norrbackagatan 4, Stockholm, 171 76, Sweden, 43 6643461861, ziad.khatib@gmail.com
%K immunization
%K children
%K Cameroon
%K digital health
%K global health
%K nonrandomized controlled trial
%K child vaccination
%D 2023

%7 9.8.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Globally, over 20 million children are unvaccinated and over 25 million missed their follow-up doses during the COVID-19 pandemic; thus, they face vaccine-preventable diseases and unnecessary deaths. This is especially the case for those with HIV or living in vulnerable settings. Using cell phones to send reminders to parents has been shown to improve vaccination rates. Objective: We aim to determine whether implementation of an automated SMS reminder will improve child vaccination rates in a turbulent, semiurban/semirural setting in a low-income country. Methods: This will be a nonrandomized controlled trial that will be conducted at Azire Integrated Health Centre, Bamenda, Cameroon. Results: A total of 200 parents per study group (aged over 18 years) who are registered at the clinic at least one month prior to the study will be recruited. The intervention group will receive 2 reminders: 1 week and 2 days prior to the scheduled vaccination. For those who miss their appointments, a reminder will be sent 1 week after their missed appointment. The control group will receive the regular care provided at the clinic. Baseline information, clinical visit data, and vaccination records will be collected for both groups. Descriptive statistics will be used to summarize baseline characteristics between and within clusters and groups. The Fisher exact test will be used to compare parent-child units who return for follow-up visits (as a percentage) and children vaccinated as scheduled (as a percentage) between the study groups. Finally, we will compare how many members of both study groups return for 1 follow-up visit using Kaplan-Meier survival analysis. Conclusions: Due to limited effective child vaccination interventions in unstable settings, this study will be of high importance for suggesting a holistic approach to improve child vaccination and public health. International Registered Report Identifier (IRRID): DERR1-10.2196/47018 
%M 37556178
%R 10.2196/47018
%U https://www.researchprotocols.org/2023/1/e47018
%U https://doi.org/10.2196/47018
%U http://www.ncbi.nlm.nih.gov/pubmed/37556178

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e37136
%T Effects of the Pregnancy and Newborn Diagnostic Assessment (PANDA) App on Antenatal Care Quality in Burkina Faso: Protocol for a Cluster Randomized Controlled Trial
%A Coulibaly,Abou
%A Kouanda,Séni
%+ Département Biomédical et Santé Publique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Ouagadougou, BP 7047, Burkina Faso, 226 71407789, samsoncoul@gmail.com
%K telemedicine
%K PANDA
%K pregnancy and newborn diagnostic assessment
%K quality
%K antenatal care
%K Burkina Faso
%K trial
%K pregnancy
%K pregnant
%K newborn
%K diagnostic
%K mobile app
%K prenatal care
%K randomized trial
%K first trimester
%K postpartum
%K qualitative research
%K maternity
%K prenatal
%K antenatal
%K mobile phone
%D 2023

%7 9.8.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a digital clinical decision support tool that can facilitate diagnosis and decision-making by health care personnel in antenatal care (ANC). Studies conducted in Madagascar and Burkina Faso showed that PANDA is a feasible system acceptable to various stakeholders. Objective: This study primarily aims to evaluate the effects of the PANDA system on ANC quality at rural health facilities in Burkina Faso. The secondary objectives of this study are to test the effects of the PANDA system on women’s satisfaction, women’s knowledge on birth preparedness and complication readiness, maternal and child health service use, men’s involvement in maternal health service utilization, and women’s contraception use at 6 weeks postpartum. Further, we will identify the factors that hinder or promote such an app and contribute to cost-effectiveness analysis. Methods: This is a randomized controlled trial implementing the PANDA system in 2 groups of health facilities (intervention and comparison groups) randomized using a matched-pair method. We included pregnant women who were <20 weeks pregnant during their first antenatal consultation in health facilities, and we followed up with them until their sixth week postpartum. Thirteen health centers were included, and 423 and 272 women were enrolled in the intervention and comparison groups, respectively. The primary outcome is a binary variable derived from the quality score, coded 1 (yes) for women with at least 75% of the total score and 0 if not. Data were collected electronically using tablets by directly interviewing the women and by extracting data from ANC registers, delivery registers, ANC cards, and health care records. The study procedures were standardized across all sites. We will compare unadjusted and adjusted primary outcome results (ANC quality scores) between the 2 study arms. We added a qualitative evaluation of the implementation of the PANDA system to identify barriers and catalysts. We also included an economic evaluation to determine whether the PANDA strategy is more cost-effective than the usual ANC strategy. Results: The enrollment ran from July 2020 to January 2021 due to the COVID-19 pandemic. Data collection ended in September 2022. Data analyses started in January 2023, ended in June 2023, and the results are expected to be published in February 2024. Conclusions: The PANDA system is one of the most comprehensive apps for ANC because it has many features. However, the use of computerized systems for ANC is limited. Therefore, our trial will be beneficial for evaluating the intrinsic capacity of the PANDA system to improve the quality of care. By including qualitative research and economic evaluation, our findings will be significant because electronic consultation registries are expected to be used for maternal health care in the future in Burkina Faso. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR202009861550402; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=12374 International Registered Report Identifier (IRRID): DERR1-10.2196/37136 
%M 37556195
%R 10.2196/37136
%U https://www.researchprotocols.org/2023/1/e37136
%U https://doi.org/10.2196/37136
%U http://www.ncbi.nlm.nih.gov/pubmed/37556195

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e48799
%T An mHealth Intervention to Improve Guardians’ Adherence to Children’s Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study
%A Chiwanga,Faraja S
%A Woodford,Joanne
%A Masika,Golden M
%A Richards,David A
%A Savi,Victor
%A von Essen,Louise
%+ Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden, 46 070 425 07 14, louise-von.essen@kbh.uu.se
%K childhood cancer
%K eHealth
%K feasibility
%K guardians
%K intervention development
%K low- and middle-income countries
%K Tanzania
%K mHealth
%K mobile health
%K public contribution
%K public involvement
%K mHealth intervention
%K leukemia
%K psychological distress
%D 2023

%7 2.8.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children’s guardians, insufficient cancer knowledge, and psychological distress. Objective: Our aim is to respond to Tanzanian guardians’ poor adherence to children’s follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians’ adherence to children’s medications and follow-up visits and to decrease their psychological distress. Methods: Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians’ needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). Results: Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. Conclusions: By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians’ adherence to children’s follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children’s health and chances to survive, and reducing distress for guardians. International Registered Report Identifier (IRRID): PRR1-10.2196/48799 
%M 37403706
%R 10.2196/48799
%U https://www.researchprotocols.org/2023/1/e48799
%U https://doi.org/10.2196/48799
%U http://www.ncbi.nlm.nih.gov/pubmed/37403706

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44362
%T A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial
%A Nagraj,Shobhana
%A Kennedy,Stephen
%A Jha,Vivekananda
%A Norton,Robyn
%A Hinton,Lisa
%A Billot,Laurent
%A Rajan,Eldho
%A Mohammed Abdul,Ameer
%A Phalswal,Anita
%A Arora,Varun
%A Praveen,Devarsetty
%A Hirst,Jane
%+ Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, The Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, OX1 3SY, United Kingdom, 44 1865 281231, shobhana.nagraj@ndm.ox.ac.uk
%K decision support systems
%K clinical
%K telemedicine
%K community health workers
%K pregnancy
%K high risk
%K diabetes
%K gestational
%K cardiovascular diseases
%D 2023

%7 20.7.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). Objective: The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. Methods: In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. Results: SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. Conclusions: SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. Trial Registration: ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952 International Registered Report Identifier (IRRID): RR2-10.3389/fgwh.2021.620759 
%M 37471135
%R 10.2196/44362
%U https://formative.jmir.org/2023/1/e44362
%U https://doi.org/10.2196/44362
%U http://www.ncbi.nlm.nih.gov/pubmed/37471135

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e48923
%T Ending Tobacco Use Through Interactive Tailored Messaging for Cambodian People With HIV (Project EndIT): Protocol for a Randomized Controlled Trial
%A Bui,Thanh Cong
%A Hoogland,Charles E
%A Chhea,Chhorvann
%A Sopheab,Heng
%A Ouk,Vichea
%A Samreth,Sovannarith
%A Hor,Bunleng
%A Vidrine,Jennifer I
%A Businelle,Michael S
%A Shih,Ya Chen Tina
%A Sutton,Steven K
%A Jones,Sarah R
%A Shorey Fennell,Bethany
%A Cottrell-Daniels,Cherell
%A Frank-Pearce,Summer G
%A Ngor,Chamnab
%A Kulkarni,Shweta
%A Vidrine,Damon J
%+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50559, thanh-c-bui@ouhsc.edu
%K smoking cessation
%K HIV/AIDS
%K cost-effectiveness
%K low- and middle-income countries
%K Cambodia
%K Phase-Based Model
%K RCT
%K randomized controlled trial
%K mHealth
%D 2023

%7 29.6.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The prevalence of smoking remains high in many low- and middle-income countries (LMICs), including the Southeast Asian nation of Cambodia. Smoking is especially hazardous for people with HIV. In Cambodia, approximately 43%-65% of men with HIV and 3%-5% of women with HIV smoke cigarettes. Thus, there is a critical need for cost-effective smoking cessation interventions for Cambodian people with HIV. This paper describes the design, methods, and data analysis plans for a randomized controlled trial assessing the efficacy of a theory-based mobile health smoking cessation intervention in Cambodian people with HIV. Objective: This 2-group randomized controlled trial compares the efficacy of a mobile health–based automated messaging (AM) intervention versus standard care (SC) in facilitating smoking cessation among Cambodian people with HIV. Methods: Cambodian people with HIV who currently smoke and are receiving antiretroviral treatment (target, N=800) will be randomized to (1) SC or (2) the AM intervention. SC participants will receive brief advice to quit smoking, written self-help materials, nicotine patches, and will complete weekly app-delivered dietary assessments for 26 weeks. AM participants will receive all SC components (but will complete smoking-related weekly assessments instead of dietary assessments), in addition to a fully automated tailored messaging program driven by the weekly assessments to facilitate smoking cessation. In the Phase-Based Model of smoking cessation, the cessation process is partitioned into 4 phases: motivation, preparation (precessation), cessation (quit date to 2 weeks post quit), and maintenance (up to 6 months post quit). Our AM program targets processes within these phases, including increasing motivation to quit, enhancing self-efficacy, obtaining social support, skills to cope with nicotine withdrawal symptoms and stress, and skills to maintain abstinence. All participants will complete baseline and 3-, 6-, and 12-month in-person follow-up assessments. The primary outcome is biochemically confirmed abstinence at 12 months, with 3- and 6-month abstinence as secondary outcomes. Potential mediators and moderators underlying treatment effects will be explored, and cost-effectiveness will be assessed. Results: This study was approved by all relevant domestic and international institutional and ethical review boards. Participant recruitment commenced in January 2023. Data collection is expected to conclude by the end of 2025. Conclusions: By demonstrating the greater efficacy and cost-effectiveness of AM relative to SC, this study has the potential to transform HIV care in Cambodia and prevent tobacco-related diseases. Furthermore, it may be adapted for use in other Cambodian populations and in other low- and middle-income countries. Ultimately, the AM approach to smoking cessation could greatly improve public health in the developing world and beyond. Trial Registration: ClinicalTrials.gov NCT05746442; https://clinicaltrials.gov/ct2/show/NCT05746442 International Registered Report Identifier (IRRID): PRR1-10.2196/48923 
%M 37384390
%R 10.2196/48923
%U https://www.researchprotocols.org/2023/1/e48923
%U https://doi.org/10.2196/48923
%U http://www.ncbi.nlm.nih.gov/pubmed/37384390

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e45162
%T Influencing Factors to mHealth Uptake With Indigenous Populations: Qualitative Systematic Review
%A Goodman,Andrew
%A Mahoney,Ray
%A Spurling,Geoffrey
%A Lawler,Sheleigh
%+ School of Public Health, The University of Queensland, 266 Herston Road, Turrbal, Jagera Country, Herston, 4006, Australia, 61 733655393, Andrew.Goodman@csiro.au
%K mHealth
%K Indigenous
%K Canada
%K Australia
%K New Zealand
%K United States
%K Papua New Guinea
%K Samoa
%K qualitative
%K systematic review
%K feasibility
%K acceptability
%K users
%K design
%K workflow
%D 2023

%7 23.6.2023
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The advancements and abundance of mobile phones and portable health devices have created an opportunity to use mobile health (mHealth) for population health systems. There is increasing evidence for the feasibility and acceptance of mHealth with Indigenous populations. Providing a synthesis of qualitative findings of mHealth with Indigenous populations will gain insights into the strengths and challenges to mHealth use in Indigenous populations. Objective: This review aimed to identify and synthesize qualitative data pertaining to the experiences and perceptions of mHealth from the perspectives of end users (patients and service providers) living in the colonial settler democracies of Canada, Australia, New Zealand, the United States, the Pacific Islands, and the Sápmi region of northern Europe. Methods: In May 2021, systematic searches of peer-reviewed, scientific papers were conducted across the 5 databases of PubMed, CINAHL, Embase, PsycINFO, and Web of Science. Qualitative or mixed method studies were included where a mHealth intervention was the primary focus for responding to health challenges with Indigenous populations. Two authors independently screened papers for eligibility and assessed the risk of bias using a modified version of the Critical Appraisal Skills Programme. A meta-aggregative approach was used to analyze the findings of included studies. Results: Seventeen papers met the eligibility criteria, 8 studies with patients, 7 studies with service providers, and 2 studies that included both patients and service providers. Studies were conducted in Australia (n=10), Canada (n=2), New Zealand (n=2), Papua New Guinea (n=1), the United States (n=1), and Samoa (n=1). Our interpretation of these qualitative findings shows commonalities between Indigenous patients’ and service providers’ perceptions of mHealth. We summarize our findings in six themes: (1) mHealth literacy, (2) mHealth as a facilitator for connection and support, (3) mHealth content needed to be culturally relevant, (4) mHealth security and confidentiality, (5) mHealth supporting rather than replacing service providers, and (6) workplace and organizational capacity. Conclusions: This research suggests that mHealth can meet the needs of both patients and service providers when the mHealth intervention is culturally relevant, accounts for digital and health literacy, incorporates interactive components, is supported by workplaces, fits into health provider workflows, and meets security and confidentiality standards. Future mHealth research with Indigenous populations should partner with key representatives (eg, patients, service providers, and executive leaders) in the mHealth design appropriate to the purpose, people, setting, and delivery. 
%M 37351947
%R 10.2196/45162
%U https://mhealth.jmir.org/2023/1/e45162
%U https://doi.org/10.2196/45162
%U http://www.ncbi.nlm.nih.gov/pubmed/37351947

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e42775
%T Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial
%A Verma,Neha
%A Buch,Bimal
%A Taralekar,Radha
%A Acharya,Soumyadipta
%+ Intelehealth, 3400 N Charles Street, Suite 208, Baltimore, MD, 21218, United States, 1 4108707146, nverma39@gmail.com
%K telemedicine
%K telehealth
%K eHealth
%K opensource
%K digital assistant
%K diagnostic concordance
%K COVID-19
%K primary care
%K rural health
%K teleconsultation
%K patient care
%D 2023

%7 23.6.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker–assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker–doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care–seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. 
%M 37130015
%R 10.2196/42775
%U https://formative.jmir.org/2023/1/e42775
%U https://doi.org/10.2196/42775
%U http://www.ncbi.nlm.nih.gov/pubmed/37130015

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e41902
%T Evaluation of Diabetes Care Performance in Cambodia Through the Cascade-of-Care Framework: Cross-Sectional Study
%A Te,Vannarath
%A Chhim,Srean
%A Buffel,Veerle
%A Van Damme,Wim
%A van Olmen,Josefien
%A Ir,Por
%A Wouters,Edwin
%+ School of Public Health, National Institute of Public Health, Lot 80, 289 Samdach Penn Nouth St. (289), Phnom Penh, 12152, Cambodia, 855 16524518, vannarath_te@yahoo.com
%K diabetes
%K cascade of care
%K implementation research
%K population-based survey
%K care continuum
%K mobile phone
%D 2023

%7 22.6.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Cambodia has seen an increase in the prevalence of type 2 diabetes (T2D) over the last 10 years. Three main care initiatives for T2D are being scaled up in the public health care system across the country: hospital-based care, health center–based care, and community-based care. To date, no empirical study has systematically assessed the performance of these care initiatives across the T2D care continuum in Cambodia. Objective: This study aimed to assess the performance of the 3 care initiatives—individually or in coexistence—and determine the factors associated with the failure to diagnose T2D in Cambodia. Methods: We used a cascade-of-care framework to assess the T2D care continuum. The cascades were generated using primary data from a cross-sectional population-based survey conducted in 2020 with 5072 individuals aged ≥40 years. The survey was conducted in 5 operational districts (ODs) selected based on the availability of the care initiatives. Multiple logistic regression analysis was used to identify the factors associated with the failure to diagnose T2D. The significance level of P<.05 was used as a cutoff point. Results: Of the 5072 individuals, 560 (11.04%) met the definition of a T2D diagnosis (fasting blood glucose level ≥126 mg/dL and glycated hemoglobin level ≥6.5%). Using the 560 individuals as the fixed denominator, the cascade displayed substantial drops at the testing and control stages. Only 63% (353/560) of the participants had ever tested their blood glucose level in the last 3 years, and only 10.7% (60/560) achieved blood glucose level control with the cutoff point of glycated hemoglobin level <8%. The OD hosting the coexistence of care displayed the worst cascade across all bars, whereas the OD with hospital-based care had the best cascade among the 5 ODs. Being aged 40 to 49 years, male, and in the poorest category of the wealth quintile were factors associated with the undiagnosed status. Conclusions: The unmet needs for T2D care in Cambodia were large, particularly in the testing and control stages, indicating the need to substantially improve early detection and management of T2D in the country. Rapid scale-up of T2D care components at public health facilities to increase the chances of the population with T2D of being tested, diagnosed, retained in care, and treated, as well as of achieving blood glucose level control, is vital in the health system. Specific population groups susceptible to being undiagnosed should be especially targeted for screening through active community outreach activities. Future research should incorporate digital health interventions to evaluate the effectiveness of the T2D care initiatives longitudinally with more diverse population groups from various settings based on routine data vital for integrated care. Trial Registration: International Standard Randomized Controlled Trials Number (ISRCTN) ISRCTN41932064; https://www.isrctn.com/ISRCTN41932064 International Registered Report Identifier (IRRID): RR2-10.2196/36747 
%M 37347529
%R 10.2196/41902
%U https://publichealth.jmir.org/2023/1/e41902
%U https://doi.org/10.2196/41902
%U http://www.ncbi.nlm.nih.gov/pubmed/37347529

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e43855
%T Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data
%A Noholoza,Sandisiwe
%A Phillips,Tamsin K
%A Madwayi,Sindiswa
%A Mrubata,Megan
%A Camlin,Carol S
%A Myer,Landon
%A Clouse,Kate
%+ Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, 9 Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 732901598, sandisiwe.noholoza@uct.ac.za
%K HIV
%K mHealth
%K mobile phone
%K ownership
%K smartphone
%K South Africa
%D 2023

%7 22.6.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. Objective: In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. Methods: We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ≥28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Results: Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Conclusions: Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms—particularly WhatsApp—are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625 
%M 37347521
%R 10.2196/43855
%U https://formative.jmir.org/2023/1/e43855
%U https://doi.org/10.2196/43855
%U http://www.ncbi.nlm.nih.gov/pubmed/37347521

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e39934
%T Using Chatbot Technology to Improve Brazilian Adolescents’ Body Image and Mental Health at Scale: Randomized Controlled Trial
%A Matheson,Emily L
%A Smith,Harriet G
%A Amaral,Ana C S
%A Meireles,Juliana F F
%A Almeida,Mireille C
%A Linardon,Jake
%A Fuller-Tyszkiewicz,Matthew
%A Diedrichs,Phillippa C
%+ Centre for Appearance Research, University of the West of England, Coldharbour Ln, Bristol, BS16 1QY, United Kingdom, 44 1173284398, emily.matheson@uwe.ac.uk
%K adolescent
%K Brazil
%K body image
%K chatbot
%K microintervention
%K randomized controlled trial
%K mobile phone
%D 2023

%7 19.6.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Accessible, cost-effective, and scalable mental health interventions are limited, particularly in low- and middle-income countries, where disparities between mental health needs and services are greatest. Microinterventions (ie, brief, stand-alone, or digital approaches) aim to provide immediate reprieve and enhancements in mental health states and offer a novel and scalable framework for embedding evidence-based mental health promotion techniques into digital environments. Body image is a global public health issue that increases young peoples’ risk of developing more severe mental and physical health issues. Embedding body image microinterventions into digital environments is one avenue for providing young people with immediate and short-term reprieve and protection from the negative exposure effects associated with social media. Objective: This 2-armed, fully remote, and preregistered randomized controlled trial assessed the impact of a body image chatbot containing microinterventions on Brazilian adolescents’ state and trait body image and associated well-being outcomes. Methods: Geographically diverse Brazilian adolescents aged 13-18 years (901/1715, 52.54% girls) were randomized into the chatbot or an assessment-only control condition and completed web-based self-assessments at baseline, immediately after the intervention time frame, and at 1-week and 1-month follow-ups. The primary outcomes were mean change in state (at chatbot entry and at the completion of a microintervention technique) and trait body image (before and after the intervention), with the secondary outcomes being mean change in affect (state and trait) and body image self-efficacy between the assessment time points. Results: Most participants who entered the chatbot (258/327, 78.9%) completed ≥1 microintervention technique, with participants completing an average of 5 techniques over the 72-hour intervention period. Chatbot users experienced small significant improvements in primary (state: P<.001, Cohen d=0.30, 95% CI 0.25-0.34; and trait body image: P=.02, Cohen d range=0.10, 95% CI 0.01-0.18, to 0.26, 95% CI 0.13-0.32) and secondary outcomes across various time points (state: P<.001, Cohen d=0.28, 95% CI 0.22-0.33; trait positive affect: P=.02, Cohen d range=0.15, 95% CI 0.03-0.27, to 0.23, 95% CI 0.08-0.37; negative affect: P=.03, Cohen d range=−0.16, 95% CI −0.30 to −0.02, to −0.18, 95% CI −0.33 to −0.03; and self-efficacy: P=.02, Cohen d range=0.14, 95% CI 0.03-0.25, to 0.19, 95% CI 0.08-0.32) relative to the control condition. Intervention benefits were moderated by baseline levels of concerns but not by gender. Conclusions: This is the first large-scale randomized controlled trial assessing a body image chatbot among Brazilian adolescents. Intervention attrition was high (531/858, 61.9%) and reflected the broader digital intervention literature; barriers to engagement were discussed. Meanwhile, the findings support the emerging literature that indicates microinterventions and chatbot technology are acceptable and effective web-based service provisions. This study also offers a blueprint for accessible, cost-effective, and scalable digital approaches that address disparities between health care needs and provisions in low- and middle-income countries. Trial Registration: Clinicaltrials.gov NCT04825184; http://clinicaltrials.gov/ct2/show/NCT04825184 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-021-12129-1 
%M 37335604
%R 10.2196/39934
%U https://mhealth.jmir.org/2023/1/e39934
%U https://doi.org/10.2196/39934
%U http://www.ncbi.nlm.nih.gov/pubmed/37335604

%0 Journal Article
        
%@ 2562-0959
%I JMIR Publications
%V 6
%N 
%P e46295
%T An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study
%A Yotsu,Rie R
%A Almamy,Diabate
%A Vagamon,Bamba
%A Ugai,Kazuko
%A Itoh,Sakiko
%A Koffi,Yao Didier
%A Kaloga,Mamadou
%A Dizoé,Ligué Agui Sylvestre
%A Kouadio,Kouamé
%A Aka,N’guetta
%A Yeboue,Luc Kowaci Gontran
%A Yao,Koffi Aubin
%A Blanton,Ronald E
%+ Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 504 988 5388, ryotsu@tulane.edu
%K dermatology
%K developing countries
%K digital health tool
%K LMICs
%K low- and middle-income countries
%K skin
%K teledermatology
%K eHealth application
%K skin disease
%K digital health intervention
%K health platform
%K system usability
%D 2023

%7 14.6.2023
%9 Original Paper
%J JMIR Dermatol
%G English
                
%X Background: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. Objective: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d’Ivoire for diagnosing and managing skin NTDs and other skin diseases. Methods: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. Results: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a “dermatosis.” In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. Conclusions: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399 
%M 37632977
%R 10.2196/46295
%U https://derma.jmir.org/2023/1/e46295
%U https://doi.org/10.2196/46295
%U http://www.ncbi.nlm.nih.gov/pubmed/37632977

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e38828
%T Barriers and Facilitators to Implementing a Digital Adherence Technology for Tuberculosis Treatment Supervision in Uganda: Qualitative Study
%A Leddy,Anna
%A Ggita,Joseph
%A Berger,Christopher A
%A Kityamuwesi,Alex
%A Sanyu,Agnes Nakate
%A Tinka,Lynn Kunihira
%A Crowder,Rebecca
%A Turyahabwe,Stavia
%A Katamba,Achilles
%A Cattamanchi,Adithya
%+ Center for Tuberculosis and Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, 550 16th St 3rd floor, San Francisco, CA, 94158, United States, 1 5102385100, Adithya.Cattamanchi@ucsf.edu
%K digital adherence technology
%K gender norms
%K tuberculosis
%K adherence
%K sub-Saharan Africa
%D 2023

%7 30.5.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Ensuring the completion of treatment for tuberculosis (TB) remains a key challenge in many high-burden countries. 99DOTS is a low-cost digital adherence technology that has emerged as a promising tool for monitoring and supporting TB treatment completion. Objective: We aimed to understand the feasibility and acceptability of 99DOTS, a mobile phone–based TB treatment support method, and characterize barriers and facilitators to its implementation during a pragmatic trial in Uganda. Methods: Between April 1 and August 31, 2021, we conducted in-depth interviews with people with TB and key informant interviews with health workers and district and regional TB officers involved in the implementation of 99DOTS at 18 health facilities in Uganda. Semistructured interview guides were informed by the capability, opportunity, motivation, and behavior (COM-B) model and explored perceptions of, and experiences with, 99DOTS, including barriers and facilitators to its use. Qualitative analysis was conducted using the framework approach. Results: Interviews were conducted with 30 people with TB, 12 health workers, and 7 TB officers. All people with TB, health workers, and TB officers noted that 99DOTS supported and encouraged people with TB to take their anti-TB medication, facilitated treatment monitoring, and improved relationships between people with TB and health workers. Participants also liked that the platform was free, easy to use, and improved TB treatment outcomes. Barriers to 99DOTS implementation for some people with TB were related to limited literacy, including technology literacy; limited access to electricity to charge their mobile phone to make dosing confirmation calls; and poor network connection. Gender differences in 99DOTS uptake also emerged. Specifically, women with TB were described to be more concerned that 99DOTS use would expose them to TB stigma and to be more likely to have mobile phone–access issues than men with TB. By contrast, men with TB not only had access to mobile phones but also received substantial support from their female partners to take their anti-TB medication and make 99DOTS dosing confirmation calls. Finally, although women with TB were described to face more barriers to 99DOTS use than men with TB, the women’s narratives centered on the ways the platform facilitated and improved their adherence, whereas the men’s narratives did not. Conclusions: Overall, 99DOTS seems to be a feasible and acceptable strategy to support anti-TB medication adherence in Uganda. However, access to mobile phones, inability to charge mobile phones, and concerns about stigma should be considered and addressed as part of programmatic implementation to maximize uptake among all people with TB, particularly women and those with fewer financial resources. 
%M 37252774
%R 10.2196/38828
%U https://www.jmir.org/2023/1/e38828
%U https://doi.org/10.2196/38828
%U http://www.ncbi.nlm.nih.gov/pubmed/37252774

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e43673
%T Evaluation of an mHealth Intervention (Growin’ Up Healthy Jarjums) Designed With and for Aboriginal and Torres Strait Islander Mothers: Engagement and Acceptability Study
%A Perkes,Sarah Jane
%A Huntriss,Belinda
%A Skinner,Noelene
%A Leece,Bernise
%A Dobson,Rosie
%A Mattes,Joerg
%A Hall,Kerry
%A Bonevski,Billie
%+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Health Sciences Building, Level 2, Sturt Road, Bedford Park,  South Australia, 5042, Australia, 61 8 72218410, billie.bonevski@flinders.edu.au
%K mobile health
%K mHealth
%K co-design
%K Aboriginal and Torres Strait Islander
%K mother
%K baby
%K young children
%K mobile phone
%D 2023

%7 26.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Aboriginal and Torres Strait Islander women have access to and interest in mobile health (mHealth), although few culturally relevant, evidence-based mHealth programs are available. We codeveloped an mHealth program in New South Wales with Aboriginal and Torres Strait Islander women, focusing on women’s and children's health and well-being. Objective: This study aims to assess the engagement with and acceptability of the Growin’ Up Healthy Jarjums program among mothers caring for Aboriginal and Torres Strait Islander children aged <5 years and assess the acceptability of the program among professionals. Methods: Women were given access to Growin’ Up Healthy Jarjums—a web-based application, a Facebook (Meta Platforms, Inc) page, and SMS text messages—for 4 weeks. Short videos of health professionals presenting health information were tested within the application and on the Facebook page. Engagement with the application was examined through the number of log-ins, page views, and links used on the application. Engagement with the Facebook page was examined through likes, follows, comments, and the reach of posts. Engagement with the SMS text messages was examined through the number of mothers who opted out, and engagement with the videos was examined through the number of plays and videos watched and duration of the video watched. The acceptability of the program was examined through posttest interviews with mothers and focus groups with professionals. Results: A total of 47 participants joined the study (n=41, 87%, mothers and n=6, 13%, health professionals). Interviews were completed by 78% (32/41) of the women and 100% (6/6) health professionals. Of the 41 mothers, 31 (76%) women accessed the application, 13 (42%) scrolled the main page only, and 18 (58%) clicked on other pages. There were 48 plays and 6 completions of the 12 videos. The Facebook page received 49 page likes and 51 followers. The post with the most reach was a supportive and affirming cultural post. No participants opted out of the SMS text messages. Almost all mothers (30/32, 94%) reported that Growin’ Up Healthy Jarjums was useful, and all mothers reported that the program was culturally appropriate and easy to use. Of the 32 mothers, 6 (19%) mothers reported technical problems with accessing the application. Moreover, 44% (14/32) of mothers suggested improvements to the application. All the women reported that they would recommend the program to other families. Conclusions: This study demonstrated that the Growin’ Up Healthy Jarjums program was perceived useful and culturally appropriate. SMS text messages had the highest engagement, followed by the Facebook page and then the application. This study identified areas for technical and engagement-related improvements to the application. A trial is needed to assess the effectiveness of the Growin’ Up Healthy Jarjums program at improving health outcomes. 
%M 37234043
%R 10.2196/43673
%U https://pediatrics.jmir.org/2023/1/e43673
%U https://doi.org/10.2196/43673
%U http://www.ncbi.nlm.nih.gov/pubmed/37234043

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e47713
%T So Many Choices, How Do I Choose? Considerations for Selecting Digital Health Interventions to Support Immunization Confidence and Demand
%A Chaney,Sarah Cunard
%A Mechael,Patricia
%+ HealthEnabled, 1401 K Street NW, Suite 900, Washington, DC, 20005, United States, 1 973 222 8252, patty@healthenabled.org
%K immunization
%K social listening
%K mobile messaging
%K service delivery
%K low- and middle-income countries
%K LMIC
%K vaccines
%K demand
%K mHealth
%K vaccine confidence
%K public health system
%K vaccination
%K children
%K community health
%K digital health intervention
%K health promotion
%D 2023

%7 24.5.2023
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X Childhood vaccines are a safe, effective, and essential component of any comprehensive public health system. Successful and complete child immunization requires sensitivity and responsiveness to community needs and concerns while reducing barriers to access and providing respectful quality services. Community demand for immunization is influenced by multiple complex factors, involving attitudes, trust, and the dynamic relationship between caregivers and health workers. Digital health interventions have the potential to help reduce barriers and enhance opportunities for immunization access, uptake, and demand in low- and middle-income countries. But with limited evidence and many interventions to choose from, how do decision makers identify promising and appropriate tools? Early evidence and experiences with digital health interventions for immunization demand are presented in this viewpoint to help stakeholders make decisions, guide investment, coordinate efforts, as well as design and implement digital health interventions to support vaccine confidence and demand.
%M 37223980
%R 10.2196/47713
%U https://www.jmir.org/2023/1/e47713
%U https://doi.org/10.2196/47713
%U http://www.ncbi.nlm.nih.gov/pubmed/37223980

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e43381
%T Disease Burden and the Accumulation of Multimorbidity of Noncommunicable Diseases in a Rural Population in Henan, China: Cross-sectional Study
%A Chen,Ying
%A Pan,Mingming
%A He,Yaling
%A Dong,Xiaokang
%A Hu,Ze
%A Hou,Jian
%A Bao,Yining
%A Yang,Jing
%A Yuchi,Yinghao
%A Li,Ruiying
%A Zhu,Linghui
%A Kang,Ning
%A Liao,Wei
%A Li,Shuoyi
%A Wang,Chongjian
%A Zhang,Lei
%+ China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, No. 76, Yanta West Road, Xi’an, Shaanxi, 710061, China, 86 29 82655135, lei.zhang1@monash.edu
%K multimorbidity
%K prevalence
%K associating factors
%K noncommunicable disease accumulation
%K NCD accumulation
%K public health
%D 2023

%7 22.5.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Multimorbidity causes substantial disease and economic burdens on individuals and the health care system. Objective: This study aimed to explore the disease burden of multimorbidity and the potential correlations among chronic noncommunicable diseases (NCDs) in a rural population in Henan, China. Methods: A cross-sectional analysis was performed using the baseline survey of the Henan Rural Cohort Study. Multimorbidity was defined as the simultaneous occurrence of at least two NCDs in a participant. This study examined the multimorbidity pattern of 6 NCDs, including hypertension, dyslipidemia, type 2 diabetes mellitus, coronary heart disease, stroke, and hyperuricemia. Results: From July 2015 to September 2017, a total of 38,807 participants (aged 18-79 years; 15,354 men and 23,453 women) were included in this study. The overall population prevalence of multimorbidity was 28.1% (10,899/38,807), and the multimorbidity of hypertension and dyslipidemia was the most common (8.1%, 3153/38,807). Aging, higher BMI, and unfavorable lifestyles were significantly associated with a higher risk of multimorbidity (multinomial logistic regression, all P<.05). The analysis of the mean age at diagnosis suggested a cascade of interrelated NCDs and their accumulation over time. Compared with participants without 2 conditional NCDs, participants with 1 conditional NCD would have higher odds of another NCD (1.2-2.5; all P<.05), and those with 2 conditional NCDs would elevate the odds of the third NCD to 1.4-3.5 (binary logistic regression, all P<.05). Conclusions: Our findings indicate a plausible tendency for the coexistence and accumulation of NCDs in a rural population in Henan, China. Early prevention of multimorbidity is essential to reduce the NCD burden in the rural population. 
%M 37213192
%R 10.2196/43381
%U https://publichealth.jmir.org/2023/1/e43381
%U https://doi.org/10.2196/43381
%U http://www.ncbi.nlm.nih.gov/pubmed/37213192

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e40561
%T Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging–Based Information Campaign: Mixed Methods Study
%A Haricharan,Hanne Jensen
%A Hacking,Damian
%A Lau,Yan Kwan
%A Heap,Marion
%+ School of Public Health, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 829656103, hanne.haricharan@uct.ac.za
%K SMS text messages
%K cell phones
%K mobile health
%K mHealth
%K health information
%K health literacy
%K healthy behavior
%K maternal health
%K antenatal care
%K Deaf
%K South Africa
%D 2023

%7 22.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging–based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants’ knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging–based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women’s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people’s health knowledge. However, attention should be paid to Deaf participants’ specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe 
%M 37213174
%R 10.2196/40561
%U https://pediatrics.jmir.org/2023/1/e40561
%U https://doi.org/10.2196/40561
%U http://www.ncbi.nlm.nih.gov/pubmed/37213174

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e44945
%T The Implementation of a GPS-Based Location-Tracking Smartphone App in South Africa to Improve Engagement in HIV Care: Randomized Controlled Trial
%A Clouse,Kate
%A Noholoza,Sandisiwe
%A Madwayi,Sindiswa
%A Mrubata,Megan
%A Camlin,Carol S
%A Myer,Landon
%A Phillips,Tamsin K
%+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 615 343 5351, kate.clouse@vanderbilt.edu
%K mobile health
%K mHealth
%K smartphone
%K mobile phone
%K HIV/AIDS
%K South Africa
%K pregnancy
%D 2023

%7 19.5.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health interventions are common in public health settings in Africa, and our preliminary work showed that smartphones are increasing in South Africa. We developed a novel smartphone app—CareConekta—that used GPS location data to characterize personal mobility to improve engagement in HIV care among pregnant and postpartum women living with HIV in South Africa. The app also used the user’s location to map nearby clinics. Objective: We aimed to describe the feasibility, acceptability, and initial efficacy of using the app in a real-world setting. Methods: We conducted a prospective randomized controlled trial at a public sector clinic near Cape Town, South Africa. We enrolled 200 pregnant (third trimester) women living with HIV who owned a smartphone that met the required specifications. All participants installed the app, designed to collect 2 GPS heartbeats per day to geolocate the participant within a random 1-km fuzzy radius (for privacy). We randomized (1:1) participants to a control arm to receive the app with no additional support or an intervention arm to receive supportive phone calls, WhatsApp (Meta Platforms, Inc) messages, or both from the study team when traveling >50 km from the study area for >7 days. In addition to mobility data collected daily through the phone, participants completed questionnaires at enrollment and follow-up (approximately 6 months post partum). Results: A total of 7 participants were withdrawn at enrollment or shortly after because of app installation failure (6/200, 3%) or changing to an unsuitable phone (1/200, 0.50%). During the study period, no participant’s smartphone recorded at least 1 heartbeat per day, which was our primary feasibility measure. Of the 171 participants who completed follow-up, only half (91/171, 53.2%) reported using the same phone as that used at enrollment, with the CareConekta app still installed on the phone and GPS usually enabled. The top reasons reported for the lack of heartbeat data were not having mobile data, uninstalling the app, and no longer having a smartphone. Acceptability measures were positive, but participants at follow-up demonstrated a lack of understanding of the app’s purpose and function. The clinic finder was a popular feature. Owing to the lack of consistent GPS heartbeats throughout the study, we were unable to assess the efficacy of the intervention. Conclusions: Several key challenges impeded our study feasibility. Although the app was designed to reverse bill participants for any data use, the lack of mobile data was a substantial barrier to our study success. Participants reported purchasing WhatsApp data, which could not support the app. Problems with the web-based dashboard meant that we could not consistently monitor mobility. Our study provides important lessons about implementing an ambitious GPS-based study under real-world conditions in a limited-resource setting. Trial Registration: ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4190-x 
%M 37204838
%R 10.2196/44945
%U https://mhealth.jmir.org/2023/1/e44945
%U https://doi.org/10.2196/44945
%U http://www.ncbi.nlm.nih.gov/pubmed/37204838

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e45440
%T Promoting Well-being Among Informal Caregivers of People With HIV/AIDS in Rural Malawi: Community-Based Participatory Research Approach
%A Sbaffi,Laura
%A Zamani,Efpraxia
%A Kalua,Khumbo
%+ Information School, University of Sheffield, The Wave, 2 Whitham Road, Sheffield, S10 2AH, United Kingdom, 44 1142222686, l.sbaffi@sheffield.ac.uk
%K informal caregivers
%K HIV/AIDS
%K rural Malawi
%K health advisory messages
%K mobile phone
%D 2023

%7 11.5.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: People living with HIV/AIDS and their informal caregivers (usually family members) in Malawi do not have adequate access to patient-centered care, particularly in remote rural areas of the country because of the high burden of HIV/AIDS, coupled with a fragmented and patchy health care system. Chronic conditions require self-care strategies, which are now promoted in both developed and developing contexts but are still only emerging in sub-Saharan African countries. Objective: This study aims to explore the effects of the implementation of a short-term intervention aimed at supporting informal caregivers of people living with HIV/AIDS in Malawi in their caring role and improving their well-being. The intervention includes the dissemination of 6 health advisory messages on topics related to the management of HIV/AIDS over a period of 6 months, via the WhatsApp audio function to 94 caregivers attending peer support groups in the rural area of Namwera. Methods: We adopted a community-based participatory research approach, whereby the health advisory messages were designed and formulated in collaboration with informal caregivers, local medical physicians, social care workers, and community chiefs and informed by prior discussions with informal caregivers. Feedback on the quality, relevance, and applicability of the messages was gathered via individual interviews with the caregivers. Results: The results showed that the messages were widely disseminated beyond the support groups via word of mouth and highlighted a very high level of adoption of the advice contained in the messages by caregivers, who reported immediate (short-term) and long-term self-assessed benefits for themselves, their families, and their local communities. Conclusions: This study offers a novel perspective on how to combine community-based participatory research with a cost-effective, health-oriented informational intervention that can be implemented to support effective HIV/AIDS self-care and facilitate informal caregivers’ role. 
%M 37166971
%R 10.2196/45440
%U https://www.jmir.org/2023/1/e45440
%U https://doi.org/10.2196/45440
%U http://www.ncbi.nlm.nih.gov/pubmed/37166971

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e43961
%T Exploring Social Media Preferences for Healthy Weight Management Interventions Among Adolescents of Color: Mixed Methods Study
%A Alatorre,Selenne
%A Schwarz,Aviva G
%A Egan,Kelsey A
%A Feldman,Amanda R
%A Rosa,Marielis
%A Wang,Monica L
%+ Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, 02118, United States, 1 6179106041, mlwang@bu.edu
%K social media
%K adolescents of color
%K obesity disparities
%K disparity
%K disparities
%K healthy weight management
%K health education
%K child health
%K mHealth
%K mobile health
%K weight
%K obese
%K obesity
%K child
%K pediatric
%K adolescent
%K adolescence
%K preference
%K health behavior
%K mobile phone
%D 2023

%7 8.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Social media holds promise as an intervention platform to engage youths in healthy weight management and target racial inequities in obesity. Objective: This mixed methods study aimed to examine social media habits, preferences, and obesity-related behaviors (eg, diet and physical activity) among adolescents of color and understand preferences for healthy weight management interventions delivered via social media. Methods: This mixed methods study is comprised of a cross-sectional web-based survey and a series of digital focus groups. Study participants (English-speaking youths of color ages 14-18 years) were recruited from high schools and youth-based community settings in Massachusetts and California. For surveys, participants were invited to complete an anonymous web-based survey assessing self-reported sociodemographics, social media habits and preferences, health behaviors (diet, physical activity, sleep, and screen time), and height and weight. For focus groups, participants were invited to participate in 45- to 60-minute web-based group discussions assessing social media habits, preferred social media platforms, and preferences for physical activity and nutrition intervention content and delivery. Survey data were analyzed descriptively; focus group transcripts were analyzed using a directed content analysis approach. Results: A total of 101 adolescents completed the survey and 20 adolescents participated in a total of 3 focus groups. Participants reported most frequently using TikTok, followed by Instagram, Snapchat, and Twitter; preference for platform varied by purpose of use (eg, content consumption, connection, or communication). TikTok emerged as the platform of choice as an engaging way to learn about various topics, including desired health information on physical fitness and diet. Conclusions: Findings from this study suggest that social media platforms can be an engaging way to reach adolescents of color. Data will inform future social media–based interventions to engage adolescents of color in healthy weight management content. 
%M 37155230
%R 10.2196/43961
%U https://pediatrics.jmir.org/2023/1/e43961
%U https://doi.org/10.2196/43961
%U http://www.ncbi.nlm.nih.gov/pubmed/37155230

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 10
%N 
%P e42952
%T Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study
%A Campbell,Jeffrey I
%A Aturinda,Isaac
%A Mwesigwa,Evans
%A Habinka,Annabella
%A Kanyesigye,Michael
%A Holden,Richard J
%A Siedner,Mark J
%A Kraemer,John D
%+ Boston Medical Center, 6th floor, 670, Albany Street, Boston, MA, 02118, United States, 1 617 414 4290, jeffrey.campbell@bmc.org
%K mobile health
%K mHealth
%K HIV
%K intention
%K SMS
%K cellular phone
%K cell phone
%K Africa
%K reminder
%K alert
%K notification
%K prompt
%D 2023

%7 5.5.2023
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: The expansion of cellular phones in sub-Saharan Africa spurred the development of SMS text message–based mobile health (mHealth) technology. Numerous SMS text message–based interventions have attempted to increase retention in care for people living with HIV in sub-Saharan Africa. Many of these interventions have failed to scale. Understanding theory-grounded factors leading to mHealth acceptability is needed to create scalable, contextually appropriate, and user-focused interventions to improve longitudinal HIV care for people living with HIV in sub-Saharan Africa. Objective: In this study, we aimed to understand the relationship between constructs from the Unified Theory of Acceptance and Use of Technology (UTAUT), constructs identified in previous qualitative research, and behavioral intention to use a novel SMS text message–based mHealth intervention designed to improve care retention among people living with HIV initiating treatment in rural Uganda. Methods: We conducted a survey of people living with HIV who were newly initiating HIV care in Mbarara, Uganda, and had agreed to use a novel SMS text message–based system that notified them of abnormal laboratory results and reminded them to return to the clinic. Survey items assessed behavioral intention to use the SMS text messaging system; constructs from UTAUT; and demographics, literacy, SMS text messaging experience, HIV status disclosure, and social support. We used factor analysis and logistic regression to estimate the relationships between UTAUT constructs and the behavioral intention to use the SMS text messaging system. Results: A total of 249 participants completed the surveys, of whom 115 (46.2%) expressed high behavioral intention to use the SMS text messaging intervention. In a multivariable analysis, we found that performance expectancy (adjusted odds ratio [aOR] of the scaled factor score 5.69, 95% CI 2.64-12.25; P<.001), effort expectancy (aOR of the scaled factor score 4.87, 95% CI 1.75-13.51; P=.002), and social influence (measured as a 1-unit Likert score increase in the perception that clinical staff have been helpful in the use of the SMS text messaging program; aOR 3.03, 95% CI 1.21-7.54; P=.02) were significantly associated with high behavioral intention to use the SMS text messaging program. SMS text messaging experience (aOR/1-unit increase 1.48, 95% CI 1.11-1.96; P=.008) and age (aOR/1-year increase 1.07, 95% CI 1.03-1.13; P=.003) were also significantly associated with increased odds of high intention to use the system. Conclusions: Performance expectancy, effort expectancy, and social influence, as well as age and SMS experience, were drivers of high behavioral intention to use an SMS text messaging reminder system among people living with HIV initiating treatment in rural Uganda. These findings highlight salient factors associated with SMS intervention acceptability in this population and indicate attributes that are likely to be key to the successful development and scaling of novel mHealth interventions. 
%M 37145834
%R 10.2196/42952
%U https://humanfactors.jmir.org/2023/1/e42952
%U https://doi.org/10.2196/42952
%U http://www.ncbi.nlm.nih.gov/pubmed/37145834

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e44066
%T Adoption of mHealth Technologies by Community Health Workers to Improve the Use of Maternal Health Services in Sub-Saharan Africa: Protocol for a Mixed Method Systematic Review
%A Kachimanga,Chiyembekezo
%A Divala,Titus H
%A Ket,Johannes C F
%A Kulinkina,Alexandra V
%A Zaniku,Haules R
%A Murkherjee,Joia
%A Palazuelos,Daniel
%A Abejirinde,Ibukun-Oluwa Omolade
%A Akker,Thomas van den
%+ Clinical Department, Partners In Health Malawi, Post Office Box 56, Neno, 265, Malawi, 265 887247777, c.kachimanga@vu.nl
%K community health worker
%K maternal health
%K mobile health
%K sub-Saharan Africa
%K systematic review
%K review method
%K maternal
%K maternity
%K gynecology
%K mHealth
%K narrative synthesis
%K review method
%K antenatal
%K post natal
%K women's health
%K health care provider
%K health worker
%K health care worker
%D 2023

%7 4.5.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Studies have shown that mobile health technologies (mHealth) enhance the use of maternal health services. However, there is limited evidence of the impact of mHealth use by community health workers (CHWs) on the use of maternal health services in sub-Saharan Africa. Objective: This mixed method systematic review will explore the impact of mHealth use by CHWs on the use of the maternal health continuum of care (antenatal care, intrapartum care, and postnatal care [PNC]), as well as barriers and facilitators of mHealth use by CHWs when supporting maternal health services. Methods: We will include studies that report the impact of mHealth by CHWs on the use of antenatal care, facility-based births, and PNC visits in sub-Saharan Africa. We will search 6 databases (MEDLINE, CINAHL, Web of Science, Embase, Scopus, and Africa Index Medicus), with additional articles identified from Google Scholar and manual screening of references of the included studies. The included studies will not be limited by language or year of publication. After study selection, 2 independent reviewers will perform title and abstract screening, followed by full-text screening to identify the final papers to be included. Data extraction and risk-of-bias assessment will be performed using Covidence software by 2 independent reviewers. We will use a Mixed Methods Appraisal Tool to perform risk-of-bias assessments on all included studies. Finally, we will perform a narrative synthesis of the outcomes, integrating information about the effect of mHealth on maternal health use and barriers and facilitators of mHealth use. This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. Results: In September 2022, we conducted an initial search in the eligible databases. After removing duplicates, we identified 1111 studies that were eligible for the title and abstract screening. We will finalize the full-text assessment for eligibility, data extraction, assessment of methodological quality, and narrative synthesis by June 2023. Conclusions: This systematic review will present new and up-to-date evidence on the use of mHealth by CHWs along the pregnancy, childbirth, and PNC continuum of care. We anticipate the results will inform program implementation and policy by highlighting the potential impacts of mHealth and presenting contextual factors that should be addressed to ensure the success of the programs. Trial Registration: PROSPERO CRD42022346364; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346364 International Registered Report Identifier (IRRID): DERR1-10.2196/44066 
%M 37140981
%R 10.2196/44066
%U https://www.researchprotocols.org/2023/1/e44066
%U https://doi.org/10.2196/44066
%U http://www.ncbi.nlm.nih.gov/pubmed/37140981

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e41225
%T Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study
%A Ndlovu,Kagiso
%A Mars,Maurice
%A Scott,Richard E
%+ Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa, 27 0312601075, ndlovuk@ub.ac.bw
%K mobile health
%K mHealth
%K electronic record systems
%K eRecord systems
%K mHealth-eRecord Interoperability Framework
%K mHeRIF
%K interoperability architecture
%K validation
%K Botswana
%K mobile phone
%D 2023

%7 2.5.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts’ suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts’ reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. 
%M 37129939
%R 10.2196/41225
%U https://formative.jmir.org/2023/1/e41225
%U https://doi.org/10.2196/41225
%U http://www.ncbi.nlm.nih.gov/pubmed/37129939

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e37359
%T The Effectiveness of Interactive Text Messaging and Structured Psychosocial Support Groups on Developmental Milestones of Children From Adolescent Pregnancies in Kenya: Quasi-Experimental Study
%A Mwenda,Valerian
%A Makena,Ireen
%A Ogweno,Vincent
%A Obonyo,James
%A Were,Vincent
%+ Department of Non-communicable Diseases, Ministry of Health, PO Box 30016, Nairobi, 00100, Kenya, 254 723992573, valmwenda@gmail.com
%K text messages
%K adolescent pregnancy
%K milestones
%K mHealth
%K psychosocial support
%K Kenya
%K nurturing care
%D 2023

%7 1.5.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: In sub-Saharan Africa, one-quarter of all pregnancies occur in adolescents. Children born to adolescent mothers have poorer physical and socio-cognitive development. One reason may be inadequate knowledge on childcare and psychosocial support during pregnancy and post partum, since adolescent mothers have less antenatal care attendance and overall interaction with the health care system. Mobile health technology has been used to relay health information to special groups; however, psychosocial support commonly requires physical interaction. Objective: We aimed to assess the efficacy of an interactive mobile text messaging platform and support groups in improving adolescent mothers’ knowledge and practices as well as infant growth and development. Methods: This was a quasi-experimental study, conducted among adolescent mothers with infants younger than 3 months, in Homa Bay County, Kenya. Five of the 8 subcounties in Homa Bay County were purposively selected as study clusters. Four subcounties were assigned as intervention clusters and 1 as a control cluster. Adolescent mothers from 2 intervention subcounties received interactive text messaging only (limited package), whereas those from the other 2 subcounties received text messaging and weekly support groups, moderated by a community health extension worker and a counselor (full package); the control cluster only received the end-line evaluation (posttest-only control). The follow-up period was 9 months. Key outcomes were maternal knowledge on childcare and infant development milestones assessed using the Developmental Milestones Checklist (DMC III). Knowledge and DMC III scores were compared between the intervention and control groups, as well as between the 2 intervention groups. Results: We recruited 791 mother-infant pairs into the intervention groups (full package: n=375; limited package: n=416) at baseline and 220 controls at end line. Attrition from the intervention groups was 15.8% (125/791). Compared with the control group, adolescent mothers receiving the full package had a higher knowledge score on infant care and development (9.02 vs 8.01; P<.001) and higher exclusive breastfeeding rates (238/375, 63.5% vs 112/220, 50.9%; P=.004), and their infants had higher average DMC III scores (53.09 vs 48.59; P=.01). The limited package group also had higher knowledge score than the control group (8.73 vs 8.01; P<.001); this group performed better than the full package group on exclusive breastfeeding (297/416, 71.4% vs 112/220, 50.9%; P<.001) and DMC III scores (58.29 vs 48.59; P<.001) when compared with the control group. We found a marginal difference in knowledge scores between full and limited package groups (9.02 vs 8.73; P=.048) but no difference in DMC III scores between the 2 groups (53.09 vs 58.29; P>.99). Conclusions: An interactive text messaging platform improved adolescent mothers’ knowledge on nurturing infant care and the development of their children, even without physical support groups. Such platforms offer a convenient avenue for providing reproductive health information to adolescents. Trial Registration: Pan African Clinical Trials Registry PACTR201806003369302; https://tinyurl.com/kkxvzjse 
%M 37126373
%R 10.2196/37359
%U https://pediatrics.jmir.org/2023/1/e37359
%U https://doi.org/10.2196/37359
%U http://www.ncbi.nlm.nih.gov/pubmed/37126373

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e41005
%T An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country: Pragmatic Randomized Controlled Trial
%A Ghosh,Arka
%A Cherian,Rithwik J
%A Wagle,Surbhit
%A Sharma,Parth
%A Kannan,Karthikeyan R
%A Bajpai,Alok
%A Gupta,Nitin
%+ Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, IIT Campus, Kanpur, 208016, India, 91 5122594384, guptan@iitk.ac.in
%K computerized cognitive behavioral therapy
%K cCBT
%K depression
%K digital intervention
%K mobile phone
%D 2023

%7 26.4.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Globally, most individuals who are susceptible to depression do not receive adequate or timely treatment. Unguided computerized cognitive behavioral therapy (cCBT) has the potential to bridge this treatment gap. However, the real-world effectiveness of unguided cCBT interventions, particularly in low- and middle-income countries (LMICs), remains inconclusive. Objective: In this study, we aimed to report the design and development of a new unguided cCBT–based multicomponent intervention, TreadWill, and its pragmatic evaluation. TreadWill was designed to be fully automated, engaging, easy to use, and accessible to LMICs. Methods: To evaluate the effectiveness of TreadWill and the engagement level, we performed a double-blind, fully remote, and randomized controlled trial with 598 participants in India and analyzed the data using a completer’s analysis. Results: The users who completed at least half of the modules in TreadWill showed significant reduction in depression-related (P=.04) and anxiety-related (P=.02) symptoms compared with the waitlist control. Compared with a plain-text version with the same therapeutic content, the full-featured version of TreadWill showed significantly higher engagement (P=.01). Conclusions: Our study provides a new resource and evidence for the use of unguided cCBT as a scalable intervention in LMICs. Trial Registration: ClinicalTrials.gov NCT03445598; https://clinicaltrials.gov/ct2/show/NCT03445598 
%M 37099376
%R 10.2196/41005
%U https://www.jmir.org/2023/1/e41005
%U https://doi.org/10.2196/41005
%U http://www.ncbi.nlm.nih.gov/pubmed/37099376

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e44720
%T Adapting and Scaling a Digital Health Intervention to Improve Maternal and Child Health Among Ethnic Minority Women in Vietnam Amid the COVID-19 Context: Protocol for the dMOM Project
%A McBride,Bronwyn
%A O'Neil,John
%A Nguyen,Phuong Chi
%A Linh,Dang Thuy
%A Trinh,Hue Thi
%A Vu,Nguyen C
%A Nguyen,Liem T
%+ Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada, 1 6044417162, bronwyn_mcbride@sfu.ca
%K mobile health
%K digital health
%K Vietnam
%K maternal health
%K maternal, newborn, and child health
%K MNCH, health equity, ethnic minority
%K maternal and child health
%K child health
%K ethnography
%K coronavirus
%K COVID-19
%K perinatal
%K antenatal
%K woman
%K mother
%K pregnancy
%K newborn
%K infant
%K baby
%K ethnic
%K ethnicity
%K visible minority
%K culture
%D 2023

%7 24.4.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Due to interconnected structural determinants including low maternal health knowledge, economic marginalization, and remoteness from low-capacity health centers, ethnic minority women in remote areas of Vietnam face severe maternal, newborn, and child health (MNCH) inequities. As ethnic minorities represent 15% of the Vietnamese population, these disparities are significant. mMOM—a pilot mobile health (mHealth) intervention using SMS text messaging to improve MNCH outcomes among ethnic minority women in northern Vietnam—was implemented from 2013-2016 with promising results. Despite mMOM’s findings, exacerbated MNCH inequities, and digital health becoming more salient amid COVID-19, mHealth has not yet been scaled to address MNCH among ethnic minority women in Vietnam. Objective: We describe the protocol for adapting, expanding, and exponentially scaling the mMOM intervention qualitatively through adding COVID-19–related MNCH guidance and novel technological components (mobile app and artificial intelligence chatbots) and quantitatively through broadening the geographical area to reach exponentially more participants, within the evolving COVID-19 context. Methods: dMOM will be conducted in 4 phases. (1) Drawing on a review of international literature and government guidelines on MNCH amid COVID-19, mMOM project components will be updated to respond to COVID-19 and expanded to include a mobile app and artificial intelligence chatbots to more deeply engage participants. (2) Using an intersectionality lens and participatory action research approach, a scoping study and rapid ethnographic fieldwork will explore ethnic minority women’s unmet MNCH needs; acceptability and accessibility of digital health; technical capacity of commune health centers; gendered power dynamics and cultural, geographical, and social determinants impacting health outcomes; and multilevel impacts of COVID-19. Findings will be applied to further refine the intervention. (3) dMOM will be implemented and incrementally scaled across 71 project communes. (4) dMOM will be evaluated to assess whether SMS text messaging or mobile app delivery engenders better MNCH outcomes among ethnic minority women. The documentation of lessons learned and dMOM models will be shared with Vietnam’s Ministry of Health for adoption and further scaling up. Results: The dMOM study was funded by the International Development Research Centre (IDRC) in November 2021, cofacilitated by the Ministry of Health, and is being coimplemented by provincial health departments in 2 mountainous provinces. Phase 1 was initiated in May 2022, and phase 2 is planned to begin in December 2022. The study is expected to be complete in June 2025. Conclusions: dMOM research outcomes will generate important empirical evidence on the effectiveness of leveraging digital health to address intractable MNCH inequities among ethnic minority women in low-resource settings in Vietnam and provide critical information on the processes of adapting mHealth interventions to respond to COVID-19 and future pandemics. Finally, dMOM activities, models, and findings will inform a national intervention led by the Ministry of Health. International Registered Report Identifier (IRRID): PRR1-10.2196/44720 
%M 37058576
%R 10.2196/44720
%U https://www.researchprotocols.org/2023/1/e44720
%U https://doi.org/10.2196/44720
%U http://www.ncbi.nlm.nih.gov/pubmed/37058576

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e38774
%T Effect of the Data Collection Method on Mobile Phone Survey Participation in Bangladesh and Tanzania: Secondary Analyses of a Randomized Crossover Trial
%A Pariyo,George
%A Meghani,Ankita
%A Gibson,Dustin
%A Ali,Joseph
%A Labrique,Alain
%A Khan,Iqbal Ansary
%A Kibria,Gulam Muhammed Al
%A Masanja,Honorati
%A Hyder,Adnan Ali
%A Ahmed,Saifuddin
%+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8141, Baltimore, MD, 21205, United States, 1 4434779403, gkibria1@jhu.edu
%K mobile phone survey
%K interactive voice response survey
%K non-communicable disease surveillance
%K response rate
%K cooperation rate
%K phone
%K risk
%K survey
%K public health
%K interview
%K voice
%K response
%K cooperation
%K female
%K women
%K rural
%K school
%K countries
%K non-communicable disease
%K surveillance
%K interactive survey
%D 2023

%7 20.4.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Mobile phone surveys provide a novel opportunity to collect population-based estimates of public health risk factors; however, nonresponse and low participation challenge the goal of collecting unbiased survey estimates. Objective: This study compares the performance of computer-assisted telephone interview (CATI) and interactive voice response (IVR) survey modalities for noncommunicable disease risk factors in Bangladesh and Tanzania. Methods: This study used secondary data from a randomized crossover trial. Between June 2017 and August 2017, study participants were identified using the random digit dialing method. Mobile phone numbers were randomly allocated to either a CATI or IVR survey. The analysis examined survey completion, contact, response, refusal, and cooperation rates of those who received the CATI and IVR surveys. Differences in survey outcomes between modes were assessed using multilevel, multivariable logistic regression models to adjust for confounding covariates. These analyses were adjusted for clustering effects by mobile network providers. Results: For the CATI surveys, 7044 and 4399 phone numbers were contacted in Bangladesh and Tanzania, respectively, and 60,863 and 51,685 phone numbers, respectively, were contacted for the IVR survey. The total numbers of completed interviews in Bangladesh were 949 for CATI and 1026 for IVR and in Tanzania were 447 for CATI and 801 for IVR. Response rates for CATI were 5.4% (377/7044) in Bangladesh and 8.6% (376/4391) in Tanzania; response rates for IVR were 0.8% (498/60,377) in Bangladesh and 1.1% (586/51,483) in Tanzania. The distribution of the survey population was significantly different from the census distribution. In both countries, IVR respondents were younger, were predominantly male, and had higher education levels than CATI respondents. IVR respondents had a lower response rate than CATI respondents in Bangladesh (adjusted odds ratio [AOR]=0.73, 95% CI 0.54-0.99) and Tanzania (AOR=0.32, 95% CI 0.16-0.60). The cooperation rate was also lower with IVR than with CATI in Bangladesh (AOR=0.12, 95% CI 0.07-0.20) and Tanzania (AOR=0.28, 95% CI 0.14-0.56). Both in Bangladesh (AOR=0.33, 95% CI 0.25-0.43) and Tanzania (AOR=0.09, 95% CI 0.06-0.14), there were fewer completed interviews with IVR than with CATI; however, there were more partial interviews with IVR than with CATI in both countries. Conclusions: There were lower completion, response, and cooperation rates with IVR than with CATI in both countries. This finding suggests that, to increase representativeness in certain settings, a selective approach may be needed to design and deploy mobile phone surveys to increase population representativeness. Overall, CATI surveys may offer a promising approach for surveying potentially under-represented groups like women, rural residents, and participants with lower levels of education in some countries. 
%M 37079373
%R 10.2196/38774
%U https://formative.jmir.org/2023/1/e38774
%U https://doi.org/10.2196/38774
%U http://www.ncbi.nlm.nih.gov/pubmed/37079373

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e44961
%T Long-Acting Injectable Cabotegravir for HIV Preexposure Prophylaxis Among Sexual and Gender Minorities: Protocol for an Implementation Study
%A Grinsztejn,Beatriz
%A Torres,Thiago Silva
%A Hoagland,Brenda
%A Jalil,Emilia Moreira
%A Moreira,Ronaldo Ismerio
%A O'Malley,Gabrielle
%A Shade,Starley B
%A Benedetti,Marcos R
%A Moreira,Julio
%A Simpson,Keila
%A Pimenta,Maria Cristina
%A Veloso,Valdiléa Gonçalves
%A ,
%+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365 Manguinhos, Rio de Janeiro, 21040360, Brazil, 55 21 38659128, gbeatriz@ini.fiocruz.br
%K sexual and gender minorities
%K young
%K Brazil
%K HIV prevention
%K injectable preexposure prophylaxis
%K injectable PrEP
%K cabotegravir
%D 2023

%7 19.4.2023
%9 Protocol
%J JMIR Public Health Surveill
%G English
                
%X Background: Long-acting injectable cabotegravir (CAB-LA) for preexposure prophylaxis (PrEP) has proven efficacious in randomized controlled trials. Further research is critical to evaluate its effectiveness in real-world settings and identify effective implementation approaches, especially among young sexual and gender minorities (SGMs). Objective: ImPrEP CAB Brasil is an implementation study aiming to generate critical evidence on the feasibility, acceptability, and effectiveness of incorporating CAB-LA into the existing public health oral PrEP services in 6 Brazilian cities. It will also evaluate a mobile health (mHealth) education and decision support tool, digital injection appointment reminders, and the facilitators of and barriers to integrating CAB-LA into the existing services. Methods: This type-2 hybrid implementation-effectiveness study includes formative work, qualitative assessments, and clinical steps 1 to 4. For formative work, we will use participatory design methods to develop an initial CAB-LA implementation package and process mapping at each site to facilitate optimal client flow. SGMs aged 18 to 30 years arriving at a study clinic interested in PrEP (naive) will be invited for step 1. Individuals who tested HIV negative will receive mHealth intervention and standard of care (SOC) counseling or SOC for PrEP choice (oral or CAB-LA). Participants interested in CAB-LA will be invited for step 2, and those with undetectable HIV viral load will receive same-day CAB-LA injection and will be randomized to receive digital appointment reminders or SOC. Clinical appointments and CAB-LA injection are scheduled after 1 month and every 2 months thereafter (25-month follow-up). Participants will be invited to a 1-year follow-up to step 3 if they decide to change to oral PrEP or discontinue CAB-LA and to step 4 if diagnosed with HIV during the study. Outcomes of interest include PrEP acceptability, choice, effectiveness, implementation, and feasibility. HIV incidence in the CAB-LA cohort (n=1200) will be compared with that in a similar oral PrEP cohort from the public health system. The effectiveness of the mHealth and digital interventions will be assessed using interrupted time series analysis and logistic mixed models, respectively. Results: During the third and fourth quarters of 2022, we obtained regulatory approvals; programmed data entry and management systems; trained sites; and performed community consultancy and formative work. Study enrollment is programmed for the second quarter of 2023. Conclusions: ImPrEP CAB Brasil is the first study to evaluate CAB-LA PrEP implementation in Latin America, one of the regions where PrEP scale-up is most needed. This study will be fundamental to designing programmatic strategies for implementing and scaling up feasible, equitable, cost-effective, sustainable, and comprehensive alternatives for PrEP programs. It will also contribute to maximizing the impact of a public health approach to reducing HIV incidence among SGMs in Brazil and other countries in the Global South. Trial Registration: Clinicaltrials.gov NCT05515770; https://clinicaltrials.gov/ct2/show/NCT05515770 International Registered Report Identifier (IRRID): PRR1-10.2196/44961 
%M 37074775
%R 10.2196/44961
%U https://publichealth.jmir.org/2023/1/e44961
%U https://doi.org/10.2196/44961
%U http://www.ncbi.nlm.nih.gov/pubmed/37074775

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e41984
%T How Older Indigenous Women Living in High-Income Countries Use Digital Health Technology: Systematic Review
%A Henson,Connie
%A Chapman,Felicity
%A Shepherd,Gina
%A Carlson,Bronwyn
%A Rambaldini,Boe
%A Gwynne,Kylie
%+ Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, 75 Talavera Rd, Sydney, 2113, Australia, 61 410598585, connie.henson@mq.edu.au
%K digital health
%K Aboriginal and Torres Strait Islander
%K Indigenous
%K Aboriginal
%K health technology
%K engagement
%K co-design
%K cultural safety
%K older Ingenuous women
%K older women
%K older adult
%K gerontology
%K lived experience
%K patient experience
%K ethic
%K minority
%K minorities
%K elder
%K usability
%K acceptability
%K preference
%K PRISMA
%K systematic review
%K review methodology
%K social media
%K wearable
%D 2023

%7 18.4.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Research associated with digital health technologies similar to the technologies themselves has proliferated in the last 2 decades. There are calls for these technologies to provide cost-effective health care for underserved populations. However, the research community has also underserved many of these populations. Older Indigenous women are one such segment of the population. Objective: Our objective is to systematically review the literature to consolidate and document what we know about how older Indigenous women living in high-income countries use digital health technology to enhance their health. Methods: We analyzed the peer-reviewed literature by systematically searching 8 databases in March 2022. We included studies published between January 2006 and March 2022 with original data specific to older Indigenous women from high-income countries that reported on the effectiveness, acceptability, and usability of some user-focused digital health technology. We incorporated 2 measures of quality for each study. We also conducted a thematic analysis and a lived experience analysis, which examined each paper from the perspectives of older Indigenous women. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in this study. Results: Three papers met the inclusion criteria. The key findings were that older Indigenous women do not see themselves reflected in mainstream health messaging or other digital health offerings. They prefer an approach that considers their uniqueness and diversity. We also identified 2 significant gaps in the literature. First, research reporting on older Indigenous women from high-income countries’ experiences with digital health technology is minimal. Second, the limited research related to older Indigenous women has not consistently engaged Indigenous people in the research process or governance. Conclusions: Older Indigenous women want digital health technologies to respond to their needs and preferences. Research is needed to understand their requirements and preferences to ensure equity as we move toward greater adoption of digital health technology. Engaging older Indigenous women throughout the research is essential to ensuring that digital health products and services are safe, usable, effective, and acceptable for older Indigenous women. 
%M 37071466
%R 10.2196/41984
%U https://www.jmir.org/2023/1/e41984
%U https://doi.org/10.2196/41984
%U http://www.ncbi.nlm.nih.gov/pubmed/37071466

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e38688
%T Improving Bystander Self-efficacy to Prevent Violence Against Women Through Interpersonal Communication Using Mobile Phone Entertainment Education: Randomized Controlled Trial
%A Pant,Ichhya
%A Kang,Bee-Ah
%A Rimal,Rajiv
%+ Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 404 461 9851, ipant@gwu.edu
%K mHealth
%K voice-response
%K entertainment education
%K rural
%K bystander
%K self-efficacy
%K violence against women
%K interpersonal communication
%K violence
%K women
%K society
%D 2023

%7 14.4.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Violence against women is a major challenge worldwide and in India. Patriarchal social and gender norms suppress disclosure of violence experienced by women. Stimulating interpersonal communication about a normatively stigmatized but prevalent topic could offer an avenue toward boosting bystander self-efficacy to intervene and prevent violence against women. Objective: In this study, to reduce violence against women as the distal goal, we adopted a two-pronged strategy grounded in Carey’s model of communication, approaching the issue in an incremental way. First, we aimed to explore whether the intervention promoted interpersonal communication about violence against women as an initial step. Second, we examined whether the intervention improved women’s self-efficacy to intervene when they witness violence in their community through interpersonal communication. Our model is based on the social cognitive theory that posits observational learning (ie, hearing about other women interfering to stop violence) fosters self-efficacy, a proxy for behavior change. Methods: We conducted a randomized controlled trial of women of reproductive age using a 2-arm study design embedded within a parent trial implemented in Odisha, India. In total, 411 participants were randomly assigned to the violence against women intervention arm or a control arm if they were active mobile phone owners and assigned to the treatment arm of the parent trial. Participants received 13 entertainment education episodes daily as phone calls. The intervention included program-driven, audience-driven, and responsive interaction strategies to facilitate the active engagement of participants. Audience-driven interactions were incorporated throughout the episodes using an interactive voice response system, which allowed participants to like or replay individual episodes through voice-recognition or touch-tone keypad. Our primary analysis involved a structural equation model with interpersonal communication as a potential mediator on the pathway between intervention exposure and bystander self-efficacy to prevent violence against women. Results: The findings from structural equation modeling demonstrated the significant mediating effect of interpersonal communication on the relationship between program exposure and bystander self-efficacy. Exposure was positively related to interpersonal communication (β=.21, SE=.05; z=4.31; P<.001) and bystander self-efficacy (β=.19, SE=.05; z=3.82; P<.001). Conclusions: Our results demonstrate participant engagement in interpersonal communication following exposure to a “light” entertainment education program with audio-only format via feature phones in rural settings can result in improved self-efficacy to prevent violence against women. This elevates the role of interpersonal communication as a mechanism of behavior change in mobile phone–based interventions, given that most entertainment education interventions tend to be mass media based. Our findings also show the potential of changing the environment where witnesses of violence deem it worthy of intervention and perceive higher efficacy to stop violence in the community, rather than putting the onus on the perpetrator, to prevent any counterproductive effects. Trial Registration: Clinical Trials Registry-India CTRI/2018/10/016186; https://tinyurl.com/bddp4txc 
%M 37058330
%R 10.2196/38688
%U https://formative.jmir.org/2023/1/e38688
%U https://doi.org/10.2196/38688
%U http://www.ncbi.nlm.nih.gov/pubmed/37058330

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e45301
%T Digital Adherence Technologies and Mobile Money Incentives for Management of Tuberculosis Medication Among People Living With Tuberculosis: Mixed Methods Formative Study
%A Musiimenta,Angella
%A Tumuhimbise,Wilson
%A Atukunda,Esther
%A Mugaba,Aaron
%A Linnemayr,Sebastian
%A Haberer,Jessica
%+ Faculty of Computing and Informatics, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda, 256 776820598, amusiimenta@must.ac.ug
%K digital adherence technologies
%K real-time monitoring
%K SMS reminders
%K mobile money
%K financial incentives
%K tuberculosis
%K medication adherence
%K user-centered approach
%K mobile wallet
%K support medication
%K mobile phone
%D 2023

%7 12.4.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Although there is an increasing use of digital adherence technologies (DATs), such as real-time monitors and SMS reminders in tuberculosis medication adherence, suboptimal patient engagement with various DATs has been reported. Additionally, financial constraints can limit DAT’s utility. The perceived usefulness and the design mechanisms of DATs linked to mobile money financial incentives for tuberculosis medication management remain unclear. Objective: The aim of this study is to describe the perceived usefulness and design mechanisms for a DAT intervention called My Mobile Wallet, which is composed of real-time adherence monitors, SMS reminders, and mobile money incentives to support tuberculosis medication adherence in a low-income setting. Methods: This study used mixed methods approaches among persons with tuberculosis recruited from the Tuberculosis Clinic in the Mbarara Regional Referral Hospital. We purposively sampled 21 persons with tuberculosis aged 18 years and older, who owned cell phones and were able to use SMS text messaging interventions. We also enrolled 9 participants who used DATs in our previous study. We used focus group discussions with the 30 participants to solicit perceptions about the initial version of the My Mobile Wallet intervention, and then iteratively refined subsequent versions of the intervention following a user-centered design approach until the beta version of the intervention that suited their needs was developed. Surveys eliciting information about participants’ cell phone use and perceptions of the intervention were also administered. Content analysis was used to inductively analyze qualitative data to derive categories describing the perceived usefulness of the intervention, concerns, and design mechanisms. Stata (version 13; StataCorp) was used to analyze survey data. Results: Participants expressed the perceived usefulness of the My Mobile Wallet intervention in terms of being reminded to take medication, supported with transport to the clinic, and money to meet other tuberculosis medication–related costs, all of which were perceived to imply care, which could create a sense of connectedness to health care workers. This could consequently cause participants to develop a self-perceived need to prove their commitment to adherence to health care workers who care for them, thereby motivating medication adherence. For fear of unintended tuberculosis status disclosure, 20 (67%) participants suggested using SMS language that is confidential—not easily related to tuberculosis. To reduce the possibilities of using the money for other competing demands, 25 (83%) participants preferred sending the money 1-2 days before the appointment to limit the time lag between receiving the money and visiting the clinic. Conclusions: DATs complemented with mobile money financial incentives could potentially provide acceptable approaches to remind, support, and motivate patients to adhere to taking their tuberculosis medication. Trial Registration: ClinicalTrials.gov NCT05656287; https://clinicaltrials.gov/ct2/show/NCT05656287 
%M 37043263
%R 10.2196/45301
%U https://formative.jmir.org/2023/1/e45301
%U https://doi.org/10.2196/45301
%U http://www.ncbi.nlm.nih.gov/pubmed/37043263

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42161
%T Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation
%A Till,Sarina
%A Mkhize,Mirriam
%A Farao,Jaydon
%A Shandu,Londiwe Deborah
%A Muthelo,Livhuwani
%A Coleman,Toshka Lauren
%A Mbombi,Masenyani
%A Bopape,Mamara
%A Klingberg,Sonja
%A van Heerden,Alastair
%A Mothiba,Tebogo
%A Densmore,Melissa
%A Verdezoto Dias,Nervo Xavier
%A ,
%+ School of Information Technology, Independent Institute of Education, 12 Radar Drive, Durban, South Africa, 27 718682991, ctill@varsitycollege.co.za
%K maternal health
%K child health
%K digital health
%K community
%K scoping review
%K low- and middle-income countries
%K LMIC
%K technology
%K co-design
%K mobile phone
%D 2023

%7 7.4.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Maternal and child health (MCH) is a global health concern, especially impacting low- and middle-income countries (LMIC). Digital health technologies are creating opportunities to address the social determinants of MCH by facilitating access to information and providing other forms of support throughout the maternity journey. Previous reviews in different disciplines have synthesized digital health intervention outcomes in LMIC. However, contributions in this space are scattered across publications in different disciplines and lack coherence in what digital MCH means across fields. Objective: This cross-disciplinary scoping review synthesized the existing published literature in 3 major disciplines on the use of digital health interventions for MCH in LMIC, with a particular focus on sub-Saharan Africa. Methods: We conducted a scoping review using the 6-stage framework by Arksey and O’Malley across 3 disciplines, including public health, social sciences applied to health, and human-computer interaction research in health care. We searched the following databases: Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS. A stakeholder consultation was undertaken to inform and validate the review. Results: During the search, 284 peer-reviewed articles were identified. After removing 41 duplicates, 141 articles met our inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from human-computer interaction research in health care. These articles were then tagged (labeled) by 3 researchers using a custom data extraction framework to obtain the findings. First, the scope of digital MCH was found to target health education (eg, breastfeeding and child nutrition), care and follow-up of health service use (to support community health workers), maternal mental health, and nutritional and health outcomes. These interventions included mobile apps, SMS text messaging, voice messaging, web-based applications, social media, movies and videos, and wearable or sensor-based devices. Second, we highlight key challenges: little attention has been given to understanding the lived experiences of the communities; key role players (eg, fathers, grandparents, and other family members) are often excluded; and many studies are designed considering nuclear families that do not represent the family structures of the local cultures. Conclusions: Digital MCH has shown steady growth in Africa and other LMIC settings. Unfortunately, the role of the community was negligible, as these interventions often do not include communities early and inclusively enough in the design process. We highlight key opportunities and sociotechnical challenges for digital MCH in LMIC, such as more affordable mobile data; better access to smartphones and wearable technologies; and the rise of custom-developed, culturally appropriate apps that are more suited to low-literacy users. We also focus on barriers such as an overreliance on text-based communications and the difficulty of MCH research and design to inform and translate into policy. 
%M 37027199
%R 10.2196/42161
%U https://www.jmir.org/2023/1/e42161
%U https://doi.org/10.2196/42161
%U http://www.ncbi.nlm.nih.gov/pubmed/37027199

%0 Journal Article
        
%@ 2561-1011
%I JMIR Publications
%V 7
%N 
%P e38900
%T Engagement in Self-measured Blood Pressure Monitoring Among Medically Underresourced Participants (the Reach Out Trial): Digital Framework Qualitative Study
%A Hellem,Abby Katherine
%A Whitfield,Candace
%A Casetti,Amanda
%A Robles,Maria Cielito
%A Dinh,Mackenzie
%A Meurer,William
%A Skolarus,Lesli
%+ Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave Suite 11500, Chicago, IL, 60611, United States, 1 312 503 0399, lesli.skolarus@northwestern.edu
%K mobile health
%K mHealth
%K cardiovascular disease
%K hypertension
%K blood pressure
%K semistructured interviews
%K intervention engagement
%K social determinants of health
%K DBCI framework
%D 2023

%7 7.4.2023
%9 Original Paper
%J JMIR Cardio
%G English
                
%X Background: Mobile health (mHealth) interventions serve as a scalable opportunity to engage people with hypertension in self-measured blood pressure (SMBP) monitoring, an evidence-based approach to lowering blood pressure (BP) and improving BP control. Reach Out is an SMS text messaging–based SMBP mHealth trial that aims to reduce BP among hypertensive patients recruited from the emergency department of a safety net hospital in a low-income, predominately Black city. Objective: As the benefits of Reach Out are predicated on participants’ engagement with the intervention, we sought to understand participants’ determinants of engagement via prompted SMBP with personalized feedback (SMBP+feedback). Methods: We conducted semistructured telephone interviews based on the digital behavior change interventions framework. Participants were purposively sampled from 3 engagement categories: high engagers (≥80% response to SMBP prompts), low engagers (≤20% response to BP prompts), and early enders (participants who withdrew from the trial). Results: We conducted interviews with 13 participants, of whom 7 (54%) were Black, with a mean age of 53.6 (SD 13.25) years. Early enders were less likely to be diagnosed with hypertension prior to Reach Out, less likely to have a primary care provider, and less likely to be taking antihypertensive medications than their counterparts. Overall, participants liked the SMS text messaging design of the intervention, including the SMBP+feedback. Several participants across all levels of engagement expressed interest in and identified the benefit of enrolling in the intervention with a partner of their choice. High engagers expressed the greatest understanding of the intervention, the least number of health-related social needs, and the greatest social support to engage in SMBP. Low engagers and early enders shared a mixed understanding of the intervention and less social support compared to high engagers. Participation decreased as social needs increased, with early enders sharing the greatest amount of resource insecurity apart from a notable exception of a high engager with high health-related social needs. Conclusions: Prompted SMBP+feedback was perceived favorably by all participants. To enhance SMBP engagement, future studies could consider greater support in the initiation of SMBP, evaluating and addressing participants’ unmet health-related social needs, as well as strategies to cultivate social norms. 
%M 37027200
%R 10.2196/38900
%U https://cardio.jmir.org/2023/1/e38900
%U https://doi.org/10.2196/38900
%U http://www.ncbi.nlm.nih.gov/pubmed/37027200

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e43224
%T Lessons for Vietnam on the Use of Digital Technologies to Support Patient-Centered Care in Low- and Middle-Income Countries in the Asia-Pacific Region: Scoping Review
%A Kosowicz,Leona
%A Tran,Kham
%A Khanh,Toan Tran
%A Dang,Thu Ha
%A Pham,Van An
%A Ta Thi Kim,Hue
%A Thi Bach Duong,Hoang
%A Nguyen,Tran Dong
%A Phuong,Anh Tuyet
%A Le,Trong Hieu
%A Ta,Van Anh
%A Wickramasinghe,Nilmini
%A Schofield,Penelope
%A Zelcer,John
%A Pham Le,Tuan
%A Nguyen,Tuan Anh
%+ Social Gerontology Division, National Ageing Research Institute, Gate 4, Building 8, 34-54 Poplar Road, Parkville, 3052, Australia, 61 3 8387 2305, t.nguyen@nari.edu.au
%K digital health technologies
%K digital health
%K eHealth
%K mobile health
%K mHealth
%K patient-centered care
%K Vietnam
%K Asia-Pacific region
%K digital
%K disease
%K technology
%K database
%K self-management
%K clinical
%K users
%D 2023

%7 5.4.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: A rapidly aging population, a shifting disease burden and the ongoing threat of infectious disease outbreaks pose major concerns for Vietnam’s health care system. Health disparities are evident in many parts of the country, especially in rural areas, and the population faces inequitable access to patient-centered health care. Vietnam must therefore explore and implement advanced solutions to the provision of patient-centered care, with a view to reducing pressures on the health care system simultaneously. The use of digital health technologies (DHTs) may be one of these solutions. Objective: This study aimed to identify the application of DHTs to support the provision of patient-centered care in low- and middle-income countries in the Asia-Pacific region (APR) and to draw lessons for Vietnam. Methods: A scoping review was undertaken. Systematic searches of 7 databases were conducted in January 2022 to identify publications on DHTs and patient-centered care in the APR. Thematic analysis was conducted, and DHTs were classified using the National Institute for Health and Care Excellence evidence standards framework for DHTs (tiers A, B, and C). Reporting was in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: Of the 264 publications identified, 45 (17%) met the inclusion criteria. The majority of the DHTs were classified as tier C (15/33, 45%), followed by tier B (14/33, 42%) and tier A (4/33, 12%). At an individual level, DHTs increased accessibility of health care and health-related information, supported individuals in self-management, and led to improvements in clinical and quality-of-life outcomes. At a systems level, DHTs supported patient-centered outcomes by increasing efficiency, reducing strain on health care resources, and supporting patient-centered clinical practice. The most frequently reported enablers for the use of DHTs for patient-centered care included alignment of DHTs with users’ individual needs, ease of use, availability of direct support from health care professionals, provision of technical support as well as user education and training, appropriate governance of privacy and security, and cross-sectorial collaboration. Common barriers included low user literacy and digital literacy, limited user access to DHT infrastructure, and a lack of policies and protocols to guide the implementation and use of DHTs. Conclusions: The use of DHTs is a viable option to increase equitable access to quality, patient-centered care across Vietnam and simultaneously reduce pressures on the health care system. Vietnam can take advantage of the lessons learned by other low- and middle-income countries in the APR when developing a national road map to digital health transformation. Recommendations that Vietnamese policy makers may consider include emphasizing stakeholder engagement, strengthening digital literacy, supporting the improvement of DHT infrastructure, increasing cross-sectorial collaboration, strengthening governance of cybersecurity, and leading the way in DHT uptake. 
%M 37018013
%R 10.2196/43224
%U https://www.jmir.org/2023/1/e43224
%U https://doi.org/10.2196/43224
%U http://www.ncbi.nlm.nih.gov/pubmed/37018013

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e44122
%T Centering Frontline Health Care Workers in Digital Innovation Design to Inform the Optimization of an App for Improved Male Circumcision Follow-up in South Africa: Qualitative Usability Study
%A Day,Sarah
%A Ncube,Vuyolwethu
%A Maja,Lactricia
%A Wasunna,Beatrice
%A Pienaar,Jacqueline
%A Setswe,Geoffrey
%A Waweru,Evelyn
%A Feldacker,Caryl
%+ International Training and Education Center for Health, University of Washington, 908 Jefferson Street, 13th Floor, Seattle, WA, 98104-2499, United States, 1 (314) 600 6743, cfeld@uw.edu
%K digital health innovation
%K usability
%K health care workers perspectives
%K low- and middle-income countries
%K two-way texting
%K postoperative telehealth
%K male circumcision
%K South Africa
%K mobile phone
%D 2023

%7 22.3.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Voluntary medical male circumcision (VMMC) is a safe and effective HIV prevention strategy. However, adherence to recommended in-person, postoperative follow-up is inefficient for procedures with few adverse events. Two-way texting (2wT)–based follow-up appears to be a safe and an efficient alternative to scheduled clinic visits for low-risk patients who underwent VMMC. To ensure that 2wT responds to the needs of health care workers (HCWs) and patients, HCWs were closely involved in app design using a human-centered design (HCD) approach. Objective: Embedded within an ongoing randomized controlled trial of 2wT in South Africa and complementary HCD processes of 2wT app optimization, this qualitative study aimed to use key informant interviews (KIIs) to explore the thoughts, suggestions, and opinions on and perceptions of 2wT’s usability and acceptability among HCWs involved in 2wT implementation in both urban and rural South Africa. Methods: A total of 7 HCWs using 2wT in Gauteng and the North West province participated in KIIs regarding the usability and acceptability of 2wT. HCWs were asked for their opinions on 2wT as a viable, useful, appropriate, and accessible method of postoperative VMMC care. They were also asked about 2wT-related working, exploring areas where 2wT could add to or reduce their daily tasks. The KII data were explored, coded, and analyzed by 3 qualitative researchers using thematic content analysis and the ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) software. Results: Most HCWs felt confident, comfortable, satisfied, and well supported using a 2wT-based follow-up as an alternative to in-person clinical reviews. They felt that 2wT was easy to use and required little technical support after initial mentoring on how to use the 2wT system. Few noted safety concerns, as men can receive clinical guidance, reassurance, and referral via 2wT. Although fewer in-person visits reduced the in-person review workload and eased clinical flow, HCWs noted the added burden of having to interact with clients via SMS text messages on evenings or weekends. HCWs reinforced the need for enhanced postoperative counseling to ensure that 2wT patients could recognize and understood how to respond to early signs of complications. HCWs suggested a rotation to spread the evening and weekend workload and ensure swift patient responses. Conclusions: In this formative qualitative study focused on HCWs, 2wT was a highly usable alternative to in-person postoperative reviews for patients who underwent VMMC in South Africa. The HCD processes likely improved the usability and acceptability of 2wT for HCWs. HCWs supported the scale-up of 2wT given the distance from the clinic to the men’s homes and the potential for reducing workload. To ensure success, providers urged sensitizing patients to the fact that 2wT augments, but does not replace, the existing after-hours and emergency care services. 
%M 36947127
%R 10.2196/44122
%U https://formative.jmir.org/2023/1/e44122
%U https://doi.org/10.2196/44122
%U http://www.ncbi.nlm.nih.gov/pubmed/36947127

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e45389
%T Co-designing a Sexual Health App With Immigrant Adolescents: Protocol for a Qualitative Community-Based Participatory Action Research Study
%A Meherali,Salima
%A Munro,Sarah
%A Puinean,Giulia
%A Salami,Bukola
%A Wong,Josephine Pui-Hing
%A Vandermorris,Ashley
%A Benoit,James Russell Andrew
%A Flicker,Sarah
%A Okeke-Ihejirika,Philomina
%A Stroulia,Eleni
%A Norman,Wendy V
%A Scott,Shannon D
%+ University of Alberta, 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada, 1 780 248 1401, meherali@ualberta.ca
%K adolescent health
%K health promotion
%K immigrants
%K information needs
%K mHealth
%K sexual and reproductive health
%K access to care
%D 2023

%7 22.3.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Canada is one of the world’s most ethnically diverse countries, with over 7 million individuals out of a population of 38 million being born in a foreign country. Immigrant adolescents (aged 10 to 19 years) make up a substantial proportion of newcomers to Canada. Religious and cultural practices can influence adolescents’ sexual attitudes and behaviors, as well as the uptake of sexual and reproductive health (SRH) services among this population. Adolescence is a time to establish lifelong healthy behaviors. Research indicates an alarming gap in adolescents’ SRH knowledge, yet there is limited research on the SRH needs of immigrant adolescents in Canada. Objective: The purpose of this study is to actively engage with immigrant adolescents to develop, implement, and evaluate a mobile health (mHealth) intervention (ie, mobile app). The interactive mobile app will aim to deliver accurate and evidence-based SRH information to adolescents. Methods: We will use community-based participatory action research to guide our study. This research project will be conducted in 4 stages based on user-centered co-design principles. In Stage 1 (Empathize), we will recruit and convene 3 adolescent advisory groups in Edmonton, Toronto, and Vancouver. Members will be engaged as coresearchers and receive training in qualitative and quantitative methodologies, sexual health, and the social determinants of health. In Stage 2 (Define and Ideate), we will explore SRH information and service needs through focus group discussions with immigrant adolescents. In Stage 3 (Prototype),  we will collaborate with mobile developers to build and iteratively design the app with support from the adolescent advisory groups. Finally, in Stage 4 (Test), we will return to focus group settings to share the app prototype, gather feedback on usability, and refine and release the app. Results: Recruitment and data collection will be completed by February 2023, and mobile app development will begin in March 2023. The mHealth app will be our core output and is expected to be released in the spring of 2024. Conclusions: Our study will advance the limited knowledge base on SRH and the information needs of immigrant adolescents in Canada as well as the science underpinning participatory action research methods with immigrant adolescents. This study will address gaps by exploring SRH priorities, health information needs, and innovative strategies to improve the SRH of immigrant adolescents. Engaging adolescents throughout the study will increase their involvement in SRH care decision-making, expand efficiencies in SRH care utilization, and ultimately improve adolescents' SRH outcomes. The app we develop will be transferable to all adolescent groups, is scalable in international contexts, and simultaneously leverages significant economies of scale. International Registered Report Identifier (IRRID): PRR1-10.2196/45389 
%M 36947124
%R 10.2196/45389
%U https://www.researchprotocols.org/2023/1/e45389
%U https://doi.org/10.2196/45389
%U http://www.ncbi.nlm.nih.gov/pubmed/36947124

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 10
%N 
%P e43066
%T Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis
%A Kim,Jiyeong
%A Aryee,Lois M D
%A Bang,Heejung
%A Prajogo,Steffi
%A Choi,Yong K
%A Hoch,Jeffrey S
%A Prado,Elizabeth L
%+ Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 5307522793, jiykim@ucdavis.edu
%K digital mental health
%K mHealth
%K mobile health
%K digital health
%K low- and middle-income country
%K depression
%K anxiety
%K mobile phone
%D 2023

%7 20.3.2023
%9 Review
%J JMIR Ment Health
%G English
                
%X Background: Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. Objective: We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. Results: Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were −0.61 (95% CI −0.78 to −0.44; n=67 comparisons) for depression and −0.73 (95% CI −0.93 to −0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. Conclusions: Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. Trial Registration: PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709 
%M 36939820
%R 10.2196/43066
%U https://mental.jmir.org/2023/1/e43066
%U https://doi.org/10.2196/43066
%U http://www.ncbi.nlm.nih.gov/pubmed/36939820

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e37873
%T Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study
%A Fuentes A,Patricia María del Carmen
%A Jiménez Tapia,Alberto
%A Ruiz-Cortés,Eunice M
%A Bolaños-Ceballos,Fernando
%A Flores Castro,Julio César
%A Gutiérrez,Rafael
%A González-Forteza,Catalina
%+ Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada Mexico Xochimilco, 101, Mexico City, 14370, Mexico, 52 5541605154, alberjt1969@gmail.com
%K adolescents
%K students
%K risk perception
%K tobacco
%K alcohol
%K marijuana
%K mobile apps
%K apps
%K substance use
%K prevention
%D 2023

%7 9.3.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. Objective: In this study, we aimed to test the short-term effectiveness of a mobile intervention app (“What Happens if you Go Too Far?” [“¿Qué pasa si te pasas?”]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. Methods: A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, “What Happens If You Go Too Far?” The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. Results: The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. Conclusions: The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents. 
%M 36892918
%R 10.2196/37873
%U https://mhealth.jmir.org/2023/1/e37873
%U https://doi.org/10.2196/37873
%U http://www.ncbi.nlm.nih.gov/pubmed/36892918

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42660
%T Aboriginal and Torres Strait Islander Women’s Access to and Interest in mHealth: National Web-based Cross-sectional Survey
%A Perkes,Sarah Jane
%A Bonevski,Billie
%A Hall,Kerry
%A Mattes,Joerg
%A Chamberlain,Catherine
%A Bennett,Jessica
%A Whittaker,Robyn
%A Palazzi,Kerrin
%A Lambkin,David
%A Kennedy,Michelle
%+ College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, 5042, Australia, 61 0451994827, sarah.perkes@newcastle.edu.au
%K mHealth
%K Aboriginal
%K Torres Strait Islander
%K public health
%K health literacy
%K digital literacy
%K Australia
%K native
%K cross-sectional
%K national survey
%K technology use
%K technology ownership
%K digital device
%K mobile device
%K usage
%K adoption
%K acceptance
%K digital divide
%D 2023

%7 6.3.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. Objective: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women’s ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. Methods: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. Results: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. Conclusions: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions). 
%M 36877565
%R 10.2196/42660
%U https://www.jmir.org/2023/1/e42660
%U https://doi.org/10.2196/42660
%U http://www.ncbi.nlm.nih.gov/pubmed/36877565

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 7
%N 
%P e36619
%T Evaluating the Feasibility, Acceptability, and Preliminary Efficacy of SupportMoms-Uganda, an mHealth-Based Patient-Centered Social Support Intervention to Improve the Use of Maternity Services Among Pregnant Women in Rural Southwestern Uganda: Randomized Controlled Trial
%A Atukunda,Esther C
%A Siedner,Mark J
%A Obua,Celestino
%A Musiimenta,Angella
%A Ware,Norma C
%A Mugisha,Samuel
%A Najjuma,Josephine N
%A Mugyenyi,Godfrey R
%A Matthews,Lynn T
%+ Mbarara University of Science and Technology, P.O Box 1410, Kabale Road, Mbarara, 256, Uganda, 256 702949832, eatukunda@must.ac.ug
%K mobile health app
%K mHealth app
%K feasibility and acceptability
%K messaging
%K health education
%K health promotion
%K app development
%K mobile phone
%D 2023

%7 2.3.2023
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: SMS text messaging and other mobile health (mHealth) interventions may improve knowledge transfer, strengthen access to social support (SS), and promote positive health behaviors among women in the perinatal period. However, few mHealth apps have been taken to scale in sub-Saharan Africa. Objective: We evaluated the feasibility, acceptability, and preliminary efficacy of a novel, mHealth-based, and patient-centered messaging app designed using behavioral science frameworks to promote maternity service use among pregnant women in Uganda. Methods: We performed a pilot randomized controlled trial between August 2020 and May 2021 at a referral hospital in Southwestern Uganda. We included 120 adult pregnant women enrolled in a 1:1:1 ratio to receive routine antenatal care (ANC; control), scheduled SMS text or audio messages from a novel messaging prototype (scheduled messaging [SM]), and SM plus SMS text messaging reminders to 2 participant-identified social supporters (SS). Participants completed face-to-face surveys at enrollment and in the postpartum period. The primary outcomes were feasibility and acceptability of the messaging prototype. Other outcomes included ANC attendance, skilled delivery, and SS. We conducted qualitative exit interviews with 15 women from each intervention arm to explore the intervention mechanisms. Quantitative and qualitative data were analyzed using STATA and NVivo, respectively. Results: More than 85% and 75% of participants received ≥85% of the intended SMS text messages or voice calls, respectively. More than 85% of the intended messages were received within 1 hour of the expected time; 18% (7/40) of women experienced network issues for both intervention groups. Over 90% (36/40) of the intervention participants found this app useful, easy to use, engaging, and compatible and strongly recommended it to others; 70% (28/40), 78% (31/40), and 98% (39/40; P=.04) of women in the control, SM, and SS arms, respectively, had a skilled delivery. Half (20/40), 83% (33/40), and all (40/40; P=.001) of the women in the control, SM, and SS arms attended ≥4 ANC visits, respectively. Women in the SS arm reported the highest support (median 3.4, IQR 2.8-3.6; P=.02); <20% (8/40; P=.002) missed any scheduled ANC visit owing to lack of transportation. Qualitative data showed that women liked the app; they were able to comprehend ANC and skilled delivery benefits and easily share and discuss tailored information with their significant others, who in turn committed to providing them the needed support to prepare and seek help. Conclusions: We demonstrated that developing a novel patient-centered and tailored messaging app that leverages SS networks and relationships is a feasible, acceptable, and useful approach to communicate important targeted health-related information and support pregnant women in rural Southwestern Uganda to use available maternity care services. Further evaluation of maternal-fetal outcomes and integration of this intervention into routine care is needed. Trial Registration: ClinicalTrials.gov NCT04313348; https://clinicaltrials.gov/ct2/show/NCT04313348 
%M 36862461
%R 10.2196/36619
%U https://formative.jmir.org/2023/1/e36619
%U https://doi.org/10.2196/36619
%U http://www.ncbi.nlm.nih.gov/pubmed/36862461

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e42719
%T Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review
%A Whitehead,Lara
%A Talevski,Jason
%A Fatehi,Farhad
%A Beauchamp,Alison
%+ School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, 15 Sargeant St, Warragul, VIC 3820, Australia, 61 414411296, alison.beauchamp@monash.edu
%K culturally and linguistically diverse
%K ethnicity
%K indigenous
%K digital health
%K technology
%K eHealth
%K qualitative
%K mobile phone
%D 2023

%7 28.2.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Health care systems have become increasingly more reliant on patients’ ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. Objective: This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. Methods: A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. Results: Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants’ views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. Conclusions: This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health. 
%M 36853742
%R 10.2196/42719
%U https://www.jmir.org/2023/1/e42719
%U https://doi.org/10.2196/42719
%U http://www.ncbi.nlm.nih.gov/pubmed/36853742

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e42023
%T Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review
%A Greuel,Merlin
%A Sy,Frithjof
%A Bärnighausen,Till
%A Adam,Maya
%A Vandormael,Alain
%A Gates,Jennifer
%A Harling,Guy
%+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 17625498934, merlin.greuel@gmail.com
%K mobile health
%K community health workers
%K smart phones
%K tablets
%K health promotion
%K public health
%K health worker
%K smart devices
%K health behaviour
%K smart technology
%K health message
%K health outcome
%D 2023

%7 22.2.2023
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Community health workers (CHWs) have become essential to the promotion of healthy behaviors, yet their work is complicated by challenges both within and beyond their control. These challenges include resistance to the change of existing behaviors, disbelief of health messages, limited community health literacy, insufficient CHW communication skills and knowledge, lack of community interest and respect for CHWs, and CHWs’ lack of adequate supplies. The rising penetration of “smart” technology (eg, smartphones and tablets) in low- and middle-income countries facilitates the use of portable electronic devices in the field. Objective: This scoping review examines to what extent mobile health in the form of smart devices may enhance the delivery of public health messages in CHW-client interactions, thereby addressing the aforementioned challenges and inducing client behavior change. Methods: We conducted a structured search of the PubMed and LILACS databases using subject heading terms in 4 categories: technology user, technology device, use of technology, and outcome. Eligibility criteria included publication since January 2007, CHWs delivering a health message aided by a smart device, and face-to-face communication between CHWs and clients. Eligible studies were analyzed qualitatively using a modified version of the Partners in Health conceptual framework. Results: We identified 12 eligible studies, 10 (83%) of which used qualitative or mixed methods approaches. We found that smart devices mitigate challenges encountered by CHWs by improving their knowledge, motivation, and creativity (eg, through self-made videos); their status within the community; and the credibility of their health messages. The technology stimulated interest in both CHWs and clients—and sometimes even in bystanders and neighbors. Media content produced locally or reflecting local customs was strongly embraced. Yet, the effect of smart devices on the quality of CHW-client interactions was inconclusive. Interactions suffered as CHWs were tempted to replace educational conversations with clients by passively watching video content. Furthermore, a series of technical difficulties experienced especially by older and less educated CHWs compromised some of the advantages brought about by mobile devices. Adequate CHW training ameliorated these difficulties. Only 1 study (8%) considered client health behavior change as an end point, thus revealing a major research gap. Conclusions: Smart mobile devices may augment CHWs’ field performance and enhance face-to-face interactions with clients, yet they also generate new challenges. The available evidence is scarce, mostly qualitative, and focused on a limited range of health outcomes. Future research should include larger-scale interventions across a wide range of health outcomes and feature client health behavior change as an end point. 
%M 36811947
%R 10.2196/42023
%U https://mhealth.jmir.org/2023/1/e42023
%U https://doi.org/10.2196/42023
%U http://www.ncbi.nlm.nih.gov/pubmed/36811947

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 6
%N 
%P e40269
%T Evaluation of a Mobile-Based Immunization Decision Support System for Scheduling Age-Appropriate Vaccine Schedules for Children Younger Than 2 Years in Pakistan and Bangladesh: Lessons From a Multisite, Mixed Methods Study
%A Siddiqi,Danya Arif
%A Ali,Rozina Feroz
%A Shah,Mubarak Taighoon
%A Dharma,Vijay Kumar
%A Khan,Anokhi Ali
%A Roy,Tapash
%A Chandir,Subhash
%+ IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145, Singapore, 1 4109295557, subhash.chandir@ird.global
%K missed opportunities for vaccination
%K mobile-based immunization decision support system
%K catch-up immunizations
%D 2023

%7 17.2.2023
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Missed opportunities for vaccination (MOVs), that is, when children interact with the health system but fail to receive age-eligible vaccines, pose a crucial challenge for equitable and universal immunization coverage. Inaccurate interpretations of complex catch-up schedules by health workers contribute to MOVs. Objective: We assessed the feasibility of a mobile-based immunization decision support system (iDSS) to automatically construct age-appropriate vaccination schedules for children and to prevent MOVs. Methods: A sequential exploratory mixed methods study was conducted at 6 immunization centers in Pakistan and Bangladesh. An android-based iDSS that is packaged in the form of an application programming interface constructed age-appropriate immunization schedules for eligible children. The diagnostic accuracy of the iDSS was measured by comparing the schedules constructed by the iDSS with the gold standard of evaluation (World Health Organization–recommended Expanded Programme on Immunization schedule constructed by a vaccines expert). Preliminary estimates were collected on the number of MOVs among visiting children (caused by inaccurate vaccination scheduling by vaccinators) that could be reduced through iDSS by comparing the manual schedules constructed by vaccinators with the gold standard. Finally, the vaccinators’ understanding, perceived usability, and acceptability of the iDSS were determined through interviews with key informants. Results: From July 5, 2019, to April 11, 2020, a total of 6241 immunization visits were recorded from 4613 eligible children. Data were collected for 17,961 immunization doses for all antigens. The iDSS correctly scheduled 99.8% (17,932/17,961) of all age-appropriate immunization doses compared with the gold standard. In comparison, vaccinators correctly scheduled 96.8% (17,378/17,961) of all immunization doses. A total of 3.2% (583/17,961) of all due doses (across antigens) were missed in age-eligible children by the vaccinators across both countries. Vaccinators reported positively on the usefulness of iDSS, as well as the understanding and benefits of the technology. Conclusions: This study demonstrated the feasibility of a mobile-based iDSS to accurately construct age-appropriate vaccination schedules for children aged 0 to 23 months across multicountry and low- and middle-income country settings, and underscores its potential to increase immunization coverage and timeliness by eliminating MOVs. 
%M 36800221
%R 10.2196/40269
%U https://pediatrics.jmir.org/2023/1/e40269
%U https://doi.org/10.2196/40269
%U http://www.ncbi.nlm.nih.gov/pubmed/36800221

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 11
%N 
%P e44468
%T Clinic-Integrated Smartphone App (JomPrEP) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Mixed Methods Evaluation of Usability and Acceptability
%A Shrestha,Roman
%A Altice,Frederick L
%A Khati,Antoine
%A Azwa,Iskandar
%A Gautam,Kamal
%A Gupta,Sana
%A Sullivan,Patrick Sean
%A Ni,Zhao
%A Kamarulzaman,Adeeba
%A Phiphatkunarnon,Panyaphon
%A Wickersham,Jeffrey A
%+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu
%K men who have sex with men
%K mHealth
%K HIV prevention
%K pre-exposure prophylaxis
%K mobile phone
%K Malaysia
%K MSM
%K mobile health
%K HIV
%K prevention
%K usability
%K acceptability
%K sexual minority
%K gay
%K homosexual
%D 2023

%7 16.2.2023
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: HIV disproportionately affects men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, including in health care settings, mobile health (mHealth) platforms have the potential to open new frontiers in HIV prevention. Objective: We developed an innovative, clinic-integrated smartphone app called JomPrEP, which provides a virtual platform for Malaysian MSM to engage in HIV prevention services. In collaboration with the local clinics in Malaysia, JomPrEP offers a range of HIV prevention (ie, HIV testing and pre-exposure prophylaxis [PrEP]) and other support services (eg, referral to mental health support) without having to interface face to face with clinicians. This study evaluated the usability and acceptability of JomPrEP to deliver HIV prevention services for MSM in Malaysia. Methods: In total, 50 PrEP-naive MSM without HIV in Greater Kuala Lumpur, Malaysia, were recruited between March and April 2022. Participants used JomPrEP for a month and completed a postuse survey. The usability of the app and its features were assessed using self-report and objective measures (eg, app analytics, clinic dashboard). Acceptability was evaluated using the System Usability Scale (SUS). Results: The participants’ mean age was 27.9 (SD 5.3) years. Participants used JomPrEP for an average of 8 (SD 5.0) times during 30 days of testing, with each session lasting an average of 28 (SD 38.9) minutes. Of the 50 participants, 42 (84%) ordered an HIV self-testing (HIVST) kit using the app, of whom 18 (42%) ordered an HIVST more than once. Almost all participants (46/50, 92%) initiated PrEP using the app (same-day PrEP initiation: 30/46, 65%); of these, 16/46 (35%) participants chose PrEP e-consultation via the app (vs in-person consultation). Regarding PrEP dispensing, 18/46 (39%) participants chose to receive their PrEP via mail delivery (vs pharmacy pickup). The app was rated as having high acceptability with a mean score of 73.8 (SD 10.1) on the SUS. Conclusions: JomPrEP was found to be a highly feasible and acceptable tool for MSM in Malaysia to access HIV prevention services quickly and conveniently. A broader, randomized controlled trial is warranted to evaluate its efficacy on HIV prevention outcomes among MSM in Malaysia. Trial Registration: ClinicalTrials.gov NCT05052411; https://clinicaltrials.gov/ct2/show/NCT05052411 International Registered Report Identifier (IRRID): RR2-10.2196/43318 
%M 36795465
%R 10.2196/44468
%U https://mhealth.jmir.org/2023/1/e44468
%U https://doi.org/10.2196/44468
%U http://www.ncbi.nlm.nih.gov/pubmed/36795465

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 9
%N 
%P e40311
%T Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions
%A Ogbudebe,Chidubem
%A Jeong,Dohyo
%A Odume,Bethrand
%A Chukwuogo,Ogoamaka
%A Dim,Cyril
%A Useni,Sani
%A Okuzu,Okey
%A Malolan,Chenchita
%A Kim,Dohyeong
%A Nwariaku,Fiemu
%A Nwokoye,Nkiru
%A Gande,Stephanie
%A Nongo,Debby
%A Eneogu,Rupert
%A Odusote,Temitayo
%A Oyelaran,Salewa
%A Chijioke-Akaniro,Obioma
%A Nihalani,Nrip
%A Anyaike,Chukwuma
%A Gidado,Mustapha
%+ Technical Division, KNCV Tuberculosis Foundation, Plot 564/565 Independence Avenue, Central Business District, Abuja, Nigeria, 234 8038926544, cogbudebe@kncvnigeria.org
%K early warning outbreak recognition system
%K active case finding
%K WHO-four-symptom screen
%K GeneXpert
%K active case
%K cluster
%K early warning
%K hot spot
%K mapping
%K disease spread
%K infection spread
%K retrospective study
%K retrospective analysis
%K surveillance
%K outbreak
%K TB
%K tuberculosis
%K infectious disease
%K case finding
%K communicable disease
%D 2023

%7 8.2.2023
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people. 
%M 36753328
%R 10.2196/40311
%U https://publichealth.jmir.org/2023/1/e40311
%U https://doi.org/10.2196/40311
%U http://www.ncbi.nlm.nih.gov/pubmed/36753328

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 12
%N 
%P e42919
%T Mobile Mental Health in Women’s Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial
%A Bhat,Amritha
%A Goud,B Ramakrishna
%A Kalidindi,Bharat
%A Ruben,Johnson Pradeep
%A Devadass,Dhinagaran
%A Waghmare,Abijeet
%A Collins,Pamela Y
%A Raj,Tony
%A Srinivasan,Krishnamachari
%+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States, 1 2065433117, amritha@uw.edu
%K mobile mental health
%K women
%K community-based
%K depression
%K rural
%K stepped care
%D 2023

%7 8.2.2023
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources. Objective: We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women’s self-help groups (SHGs) in rural India. Methods: We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual. Results: This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development. Conclusions: Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe. International Registered Report Identifier (IRRID): DERR1-10.2196/42919 
%M 36753310
%R 10.2196/42919
%U https://www.researchprotocols.org/2023/1/e42919
%U https://doi.org/10.2196/42919
%U http://www.ncbi.nlm.nih.gov/pubmed/36753310

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 10
%N 
%P e41861
%T Evaluating Clinician Expectations of mHealth Solutions to Increase Rapid-Screening for HIV and Hepatitis in Migrant Populations in France: Qualitative Study
%A Brown,Carter
%A Roucoux,Guillaume
%A Dimi,Svetlane
%A Fahmi,Saleh
%A Jeevan,Raj-Banou
%A Chassany,Olivier
%A Chaplin,John
%A Duracinsky,Martin
%+ Patient-Reported Outcomes Unit, UMR 1123, Inserm, Université de Paris, 1 Parvis Notre Dame - Place Jean-Paul II, Paris, 75004, France, 33 0140274664, carter.brown@inserm.fr
%K app development
%K acceptability
%K mobile health
%K mHealth
%K user-centered design
%K communication barriers
%K migrants
%K HIV
%K AIDS
%K hepatitis
%K rapid diagnostic testing
%K public health
%K communication tool
%K screening
%K language barrier
%D 2023

%7 3.2.2023
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Migrants underuse screening opportunities for HIV, hepatitis B, and hepatitis C despite elevated risk factors for contracting these infections. Language barriers are an often given as reasons for limiting access to services. Translation and communication apps increase communication and overall patient satisfaction in the patient-provider relationship. In the development and adoption of new technology, expectations play an important role. Objective: This study aimed to explore health care professionals’ opinions and attitudes regarding their screening practices with migrants and their expectations for a new communication tool that could improve migrants’ screening use. Methods: In this qualitative study, a purposive (diverse) sampling method was used to invite doctors and nurses who conduct rapid screening tests with migrants from 4 centers of the French Office of Immigration and Integration in 3 geographic regions of France. Semistructured interviews were conducted to survey their opinions on the rapid testing of migrants, the use of telephone interpreters, the concept of health literacy, and their expectations of a new communication tool that could overcome language barriers and promote rapid screening in the new migrant population. Results: In all, 20 interviews were conducted with 11 doctors and 9 nurses with a median age of 58 (range 25-67) years. Participants favored the integration of an innovative communication tool in the context of rapid screening of migrants. However, there were concerns related to the implementation and added value of the tool while migrants were already reluctant to be screened. Expectations were for a tool that would present information in simplified French or a chosen language but also supports a positive attitude toward screening. Health professionals also expressed the wish that the technology could help with the collection of health data. Conclusions: Feedback from health professionals provides a better understanding of potential formats, characteristics, functions, content, and use of an innovative, digital method to communicate with migrants with limited French proficiency. Findings contribute to the conceptual development of an electronic app and its implementation within the ApiDé study, which aims to validate a digital app to address language barriers to increase the use of screening among migrants with limited French proficiency in France. 
%M 36735323
%R 10.2196/41861
%U https://humanfactors.jmir.org/2023/1/e41861
%U https://doi.org/10.2196/41861
%U http://www.ncbi.nlm.nih.gov/pubmed/36735323

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e40630
%T The Use of Digital Health Interventions for Cardiometabolic Diseases Among South Asian and Black Minority Ethnic Groups: Realist Review
%A Goswami,Aumeya
%A Poole,Lydia
%A Thorlu-Bangura,Zareen
%A Khan,Nushrat
%A Hanif,Wasim
%A Khunti,Kamlesh
%A Gill,Paramjit
%A Sajid,Madiha
%A Blandford,Ann
%A Stevenson,Fiona
%A Banerjee,Amitava
%A Ramasawmy,Mel
%+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 0203 108 8828, m.ramasawmy@ucl.ac.uk
%K digital health
%K health inequality
%K cardiometabolic disease
%K cardiometabolic
%K ethnic
%K minority
%K cardiology
%K heart
%K eHealth
%K review
%K realist
%K context-mechanism-outcome
%K South Asia
%K Black
%K migrant
%K systematic search
%K literature search
%K African American
%K CVD
%K cardiovascular
%K diabetes
%K diabetic
%K type 2
%K mobile phone
%D 2023

%7 6.1.2023
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Digital health interventions (DHIs) for the prevention and management of cardiometabolic diseases have become increasingly common. However, there is limited evidence for the suitability of these approaches in minority ethnic populations, who are at an increased risk of these diseases. Objective: This study aimed to investigate the use of DHIs for cardiovascular disease and type 2 diabetes among minority ethnic populations in countries with a majority of White, English-speaking populations, focusing on people who identified as South Asian, Black, or African American. Methods: A realist methodology framework was followed. A literature search was conducted to develop context-mechanism-outcome configurations, including the contexts in which DHIs work for the target minority ethnic groups, mechanisms that these contexts trigger, and resulting health outcomes. After systematic searches, a qualitative analysis of the included studies was conducted using deductive and inductive coding. Results: A total of 15 studies on the uptake of DHIs for cardiovascular disease or diabetes were identified, of which 13 (87%) focused on people with an African-American background. The review found evidence supporting the use of DHIs in minority ethnic populations when specific factors are considered in implementation and design, including patients’ beliefs, health needs, education and literacy levels, material circumstances, culture, social networks, and wider community and the supporting health care systems. Conclusions: Our context-mechanism-outcome configurations provide a useful guide for the future development of DHIs targeted at South Asian and Black minority ethnic populations, with specific recommendations for improving cultural competency and promoting accessibility and inclusivity of design. 
%M 36607732
%R 10.2196/40630
%U https://www.jmir.org/2023/1/e40630
%U https://doi.org/10.2196/40630
%U http://www.ncbi.nlm.nih.gov/pubmed/36607732

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 25
%N 
%P e38818
%T Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff
%A Schuetze,Leon
%A Srivastava,Siddharth
%A Missenye,Abdallah Mtiba
%A Rwezaula,Elizeus Josephat
%A Stoermer,Manfred
%A De Allegri,Manuela
%+ Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 0931 201 31141, leon.schuetze@uni-heidelberg.de
%K health financing
%K qualitative
%K digital health intervention
%K low-resource setting
%K strategic purchasing
%K scale
%K mobile phone
%D 2023

%7 6.1.2023
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. Objective: This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. Methods: We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. Results: Respondents appreciated IMIS’s intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. Conclusions: Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage. 
%M 36607708
%R 10.2196/38818
%U https://www.jmir.org/2023/1/e38818
%U https://doi.org/10.2196/38818
%U http://www.ncbi.nlm.nih.gov/pubmed/36607708

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 9
%N 4
%P e34823
%T Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study
%A Koech,Angela
%A Musitia,Peris Muoga
%A Mwashigadi,Grace Mkanjala
%A Kinshella,Mai-Lei Woo
%A Vidler,Marianne
%A Temmerman,Marleen
%A Craik,Rachel
%A von Dadelszen,Peter
%A Noble,J Alison
%A Papageorghiou,Aris T
%A ,
%+ Centre of Excellence in Women & Child Health, Aga Khan University, 3rd Parklands Avenue, Limuru Road, P.O. Box 30270-00100, Nairobi, 4100, Kenya, 254 722 502602, angela.koech@aku.edu
%K gestational age
%K gestation
%K gynecology
%K gynecologist
%K prenatal
%K antenatal
%K maternal
%K fetus
%K fetal
%K ultrasound
%K imaging
%K pregnancy dating
%K handheld
%K portable
%K trust
%K artificial intelligence
%K sub-Saharan Africa
%K Africa
%K low cost
%K LMIC
%K low income
%K feasibility
%K acceptability
%K AI
%K pregnancy
%K pregnant
%K maternity
%K women's health
%K obstetrics
%K obstetrician
%K rural
%K remote
%K remote location
%K misconception
%K eHealth
%K digital health
%D 2022

%7 27.12.2022
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods: A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results: Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions: This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended. 
%M 36574278
%R 10.2196/34823
%U https://humanfactors.jmir.org/2022/4/e34823
%U https://doi.org/10.2196/34823
%U http://www.ncbi.nlm.nih.gov/pubmed/36574278

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 12
%P e40771
%T Factors Influencing Adoption and Use of Telemedicine Services in Rural Areas of China: Mixed Methods Study
%A Du,Yumeng
%A Zhou,Qiru
%A Cheng,Weibin
%A Zhang,Zhang
%A Hoelzer,Samantha
%A Liang,Yizhi
%A Xue,Hao
%A Ma,Xiaochen
%A Sylvia,Sean
%A Tian,Junzhang
%A Tang,Weiming
%+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No.466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 15920567132, weiming_tang@med.unc.edu
%K telemedicine
%K telehealth
%K rural residents
%K mixed methods
%K China
%K mobile phone
%D 2022

%7 23.12.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: The shortage of medical resources in rural China reflects the health inequity in resource-limited settings, whereas telemedicine could provide opportunities to fill this gap. However, evidence of patient acceptance of telemedicine services from low- and middle-income countries is still lacking. Objective: We aimed to understand the profile of patient end-user telemedicine use and identify factors influencing telemedicine service use in rural China. Methods: Our study followed a mixed methods approach, with a quantitative cross-sectional survey followed by in-depth semistructured interviews to describe telemedicine use and its associated factors among rural residents in Guangdong Province, China. In the quantitative analysis, explanatory variables included environmental and context factors, household-level factors, individual sociodemographic factors, access to digital health care, and health needs and demand factors. We conducted univariate and multivariate analyses using Firth logistic regression to examine the correlations of telemedicine uptake. A thematic approach was used, guided by the Social Cognitive Theory for the qualitative analysis. Results: A total of 2101 households were recruited for the quantitative survey. With a mean age of 61.4 (SD 14.41) years, >70% (1364/2101, 72.94%) of the household respondents were male. Less than 1% (14/2101, 0.67%) of the respondents reported experience of using telemedicine. The quantitative results supported that villagers living with family members who had a fever in the past 2 weeks (adjusted odds ratio 6.96, 95% CI 2.20-21.98; P=.001) or having smartphones or computers (adjusted odds ratio 3.71, 95% CI 0.64-21.32; P=.14) had marginally higher telemedicine uptake, whereas the qualitative results endorse these findings. The results of qualitative interviews (n=27) also supplemented the potential barriers to telemedicine use from the lack of knowledge, trust, demand, low self-efficacy, and sufficient physical and social support. Conclusions: This study found extremely low use of telemedicine in rural China and identified potential factors affecting telemedicine uptake. The main barriers to telemedicine adoption among rural residents were found, including lack of knowledge, trust, demand as well as low self-efficacy, and insufficient physical and social support. Our study also suggests strategies to facilitate telemedicine engagement in low-resource settings: improving digital literacy and self-efficacy, building trust, and strengthening telemedicine infrastructure support. 
%M 36563026
%R 10.2196/40771
%U https://publichealth.jmir.org/2022/12/e40771
%U https://doi.org/10.2196/40771
%U http://www.ncbi.nlm.nih.gov/pubmed/36563026

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 12
%P e42939
%T Ethical Issues in the Use of Smartphone Apps for HIV Prevention in Malaysia: Focus Group Study With Men Who Have Sex With Men
%A Khati,Antoine
%A Wickersham,Jeffrey A
%A Rosen,Aviana O
%A Luces,Jeffrey Ralph B
%A Copenhaver,Nicholas
%A Jeri-Wahrhaftig,Alma
%A Ab Halim,Mohd Akbar
%A Azwa,Iskandar
%A Gautam,Kamal
%A Ooi,Kai Hong
%A Shrestha,Roman
%+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862834, roman.shrestha@uconn.edu
%K HIV
%K mobile health
%K mHealth
%K mobile app
%K HIV prevention
%K men who have sex with men
%K privacy
%K confidentiality
%K Malaysia
%K mobile apps
%K ethics
%K focus group
%K implementation
%K user privacy
%K mobile phone
%D 2022

%7 23.12.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The use of smartphone apps can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, mobile health app-based strategies have the potential to open new frontiers for HIV prevention. However, little guidance is available to inform researchers about the ethical concerns that are unique to the development and implementation of app-based HIV prevention programs. Objective: This study aimed to fill this gap by characterizing the attitudes and concerns of Malaysian MSM regarding HIV prevention mobile apps, particularly regarding the ethical aspects surrounding their use. Methods: We conducted web-based focus group discussions with 23 MSM between August and September 2021. Using in-depth semistructured interviews, participants were asked about the risks and ethical issues they perceived to be associated with using mobile apps for HIV prevention. Each session was digitally recorded and transcribed. Transcripts were inductively coded using the Dedoose software (SocioCultural Research Consultants) and analyzed to identify and interpret emerging themes. Results: Although participants were highly willing to use app-based strategies for HIV prevention, they raised several ethical concerns related to their use. Prominent concerns raised by participants included privacy and confidentiality concerns, including fear of third-party access to personal health information (eg, friends or family and government agencies), issues around personal health data storage and management, equity and equitable access, informed consent, and regulation. Conclusions: The study’s findings highlight the role of ethical concerns related to the use of app-based HIV prevention programs. Given the ever-growing nature of such technological platforms that are intermixed with a complex ethical-legal landscape, mobile health platforms must be safe and secure to minimize unintended harm, safeguard user privacy and confidentiality, and obtain public trust and uptake. 
%M 36563046
%R 10.2196/42939
%U https://formative.jmir.org/2022/12/e42939
%U https://doi.org/10.2196/42939
%U http://www.ncbi.nlm.nih.gov/pubmed/36563046

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 12
%P e43318
%T Clinic-Integrated Mobile Health Intervention (“JomPrEP” App) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and Multiphase Trial
%A Shrestha,Roman
%A Wickersham,Jeffrey A
%A Khati,Antoine
%A Azwa,Iskandar
%A Ni,Zhao
%A Kamarulzaman,Adeeba
%A Sullivan,Patrick Sean
%A Jadkarim,Luzan
%A Eger,William H
%A Gautam,Kamal
%A Altice,Frederick L
%+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 8604862446, roman.shrestha@uconn.edu
%K men who have sex with men
%K mHealth
%K HIV prevention
%K pre-exposure prophylaxis
%K smartphone app
%K Malaysia
%D 2022

%7 21.12.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic in Malaysia and globally. Cross-cutting prevention strategies such as mobile health (mHealth), particularly smartphone apps, hold great promise for HIV prevention efforts among Malaysian MSM, especially when linked to HIV testing and pre-exposure prophylaxis (PrEP). Objective: This study aims to adapt an existing app to create and test a clinic-integrated app (JomPrEP), a virtual platform to deliver HIV testing and PrEP services for MSM in Malaysia. Methods: The JomPrEP project involves developing and testing an app-based platform for HIV prevention among Malaysian MSM and will be conducted in 2 phases. In phase I (development phase), we will adapt an existing mHealth app (HealthMindr) to create a new clinic-integrated app called “JomPrEP” to deliver holistic HIV prevention services (eg, HIV testing, PrEP, support services for mental health and substance use) among MSM in Malaysia. During phase II (testing phase), we will use a type I hybrid implementation science trial design to test the efficacy of JomPrEP while gathering information on implementation factors to guide future scale-up in real-world settings. Results: As of September 2022, we have completed phase I of the proposed study. Based on a series of formative work completed during phase I, we developed a fully functional, clinic-integrated JomPrEP app, which provides a virtual platform for MSM in Malaysia to facilitate their engagement in HIV prevention in a fast and convenient manner. Based on participant feedback provided during phase I, we are currently optimizing JomPrEP and the research protocols for a large-scale efficacy trial (phase II), which will commence in January 2023. Conclusions: Scant HIV prevention resources coupled with entrenched stigma, discrimination, and criminalization of same-sex sexual behavior and substance use hamper access to HIV prevention services in Malaysia. If found efficacious, JomPrEP can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT05325476; https://clinicaltrials.gov/ct2/show/NCT05325476 International Registered Report Identifier (IRRID): DERR1-10.2196/43318 
%M 36542425
%R 10.2196/43318
%U https://www.researchprotocols.org/2022/12/e43318
%U https://doi.org/10.2196/43318
%U http://www.ncbi.nlm.nih.gov/pubmed/36542425

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 11
%N 2
%P e37036
%T Creating the Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA) Project: Tutorial for the Novel Use of a Store Locator App
%A Etling,Mary Ann
%A Musili,Michael
%A Eastes,Kaytlin
%A Oyungu,Eren
%A McHenry,Megan S
%+ Department of Pediatrics, Indiana University School of Medicine, 340 W 10th St, Indianapolis, IN, 46202, United States, 1 317 274 8157, maetling@iu.edu
%K map
%K virtual
%K interactive
%K disability
%K resources
%K inclusion
%K mHealth
%K Kenya
%K global health
%K public health
%D 2022

%7 8.12.2022
%9 Tutorial
%J Interact J Med Res
%G English
                
%X Background: An estimated 15% of the global population is living with a disability. In Kenya, children with disabilities remain among the most vulnerable populations, experiencing substantial barriers to wellness and inclusion. Smartphone ownership and internet access have been increasing across sub-Saharan Africa, including in Kenya. Despite these advances, online or mobile resources remain limited and difficult to find and navigate. Objective: This paper aims to describe the novel use of a store locator app to develop an interactive map of organizations that provide medical, educational, and socioeconomic resources to individuals with disabilities in Kenya. The target audience is individuals with disabilities, medical professionals, and organization leaders. Methods: A comprehensive list of organizations, government county offices, educational assessment and resource centers, and institutions was compiled. Organizations were contacted via email, WhatsApp, or in person for semistructured interviews. Based on the services offered, each organization was assigned categorical search tags. The data were entered into a third-party store locator app. The resulting map was inserted into a page on the Academic Model Providing Access to Healthcare (AMPATH) website. Results: The Map of Interactive Services Aiding and Assisting Persons With Disabilities (MSAADA; this abbreviation is also Swahili for “help”) was launched in July 2020 in both English and Swahili. The map included 89 organizations across Kenya. Of these, 51 were reached for an interview (for a 57% response rate). Interviewees cited limited paid staff and dependence on grant-based funding as primary challenges to growth and sustainability. Conclusions: MSAADA is an interactive, virtual map that aims to connect individuals with disabilities, medical professionals, and organization leaders to resources in Kenya. The novel use of a store locator app to compile resources in remote settings has the potential to improve access to health care for a wide variety of specialties and patient populations. Innovators in global health should consider the use of store locator apps to connect individuals to resources in regions with limited mapping. 
%M 36480245
%R 10.2196/37036
%U https://www.i-jmr.org/2022/2/e37036
%U https://doi.org/10.2196/37036
%U http://www.ncbi.nlm.nih.gov/pubmed/36480245

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 12
%P e42342
%T Mobile Health–Supported Virtual Reality and Group Problem Management Plus: Protocol for a Cluster Randomized Trial Among Urban Refugee and Displaced Youth in Kampala, Uganda (Tushirikiane4MH, Supporting Each Other for Mental Health)
%A Logie,Carmen H
%A Okumu,Moses
%A Kortenaar,Jean-Luc
%A Gittings,Lesley
%A Khan,Naimul
%A Hakiza,Robert
%A Kibuuka Musoke,Daniel
%A Nakitende,Aidah
%A Katisi,Brenda
%A Kyambadde,Peter
%A Khan,Torsum
%A Lester,Richard
%A Mbuagbaw,Lawrence
%+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M6N 4N3, Canada, 1 416 340 4800 ext 4765, carmen.logie@utoronto.ca
%K adolescents and youth
%K mental health
%K refugee
%K implementation research
%K virtual reality
%K mobile health
%K Uganda
%K urban
%D 2022

%7 8.12.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Although mental health challenges disproportionately affect people in humanitarian contexts, most refugee youth do not receive the mental health support needed. Uganda is the largest refugee-hosting nation in Africa, hosting over 1.58 million refugees in 2022, with more than 111,000 living in the city of Kampala. There is limited information about effective and feasible interventions to improve mental health outcomes and mental health literacy, and to reduce mental health stigma among urban refugee adolescents and youth in low- and middle-income countries (LMICs). Virtual reality (VR) is a promising approach to reduce stigma and improve mental health and coping, yet such interventions have not yet been tested in LMICs where most forcibly displaced people reside. Group Problem Management Plus (GPM+) is a scalable brief psychological transdiagnostic intervention for people experiencing a range of adversities, but has not been tested with adolescents and youth to date. Further, mobile health (mHealth) strategies have demonstrated promise in promoting mental health literacy. Objective: The aim of this study is to evaluate the feasibility and effectiveness of two youth-tailored mental health interventions (VR alone and VR combined with GMP+) in comparison with the standard of care in improving mental health outcomes among refugee and displaced youth aged 16-24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomized in a 1:1:1 design. Approximately 330 adolescents (110 per cluster) are enrolled and will be followed for approximately 16 weeks. Data will be collected at three time points: baseline enrollment, 8 weeks following enrollment, and 16 weeks after enrollment. Primary (depression) and secondary outcomes (mental health literacy, attitudes toward mental help–seeking, adaptive coping, mental health stigma, mental well-being, level of functioning) will be evaluated. Results: The study will be conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (#40965; May 12, 2021), Mildmay Uganda Research Ethics Committee (MUREC-2021-41; June 24, 2021), and Uganda National Council for Science & Technology (SS1021ES; January 1, 2022). A qualitative formative phase was conducted using focus groups and in-depth, semistructured key informant interviews to understand contextual factors influencing mental well-being among urban refugee and displaced youth. Qualitative findings will inform the VR intervention, SMS text check-in messages, and the adaptation of GPM+. Intervention development was conducted in collaboration with refugee youth peer navigators. The trial launched in June 2022 and the final follow-up survey will be conducted in November 2022. Conclusions: This study will contribute to the knowledge of youth-tailored mental health intervention strategies for urban refugee and displaced youth living in informal settlements in LMIC contexts. Findings will be shared in peer-reviewed publications, conference presentations, and with community dissemination. Trial Registration: ClinicalTrials.gov NCT05187689; https://clinicaltrials.gov/ct2/show/NCT05187689 International Registered Report Identifier (IRRID): DERR1-10.2196/42342 
%M 36480274
%R 10.2196/42342
%U https://www.researchprotocols.org/2022/12/e42342
%U https://doi.org/10.2196/42342
%U http://www.ncbi.nlm.nih.gov/pubmed/36480274

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 12
%P e39393
%T Assessing the Quality of the World Health Organization’s Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study
%A Frej,Asmae
%A Cano,Mireia
%A Ruiz-Postigo,José A
%A Macharia,Paul
%A Phillips,Richard Odame
%A Amoako,Yaw Ampem
%A Carrion,Carme
%+ eHealth Lab Research Group, eHealth Center & School of Health Sciences, Universitat Oberta de Catalunya, Avenue Tibidabo 39, Barcelona, 08035, Spain, 34 630983328, mcarrionr@uoc.edu
%K Skin NTDs App
%K mHealth
%K mobile health
%K neglected tropical diseases
%K skin neglected tropical diseases
%K low- and middle-income countries
%D 2022

%7 8.12.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, the majority of them belonging to impoverished populations in low- and middle-income countries (LMICs). Skin NTDs are a subgroup of NTDs that manifest primarily as skin lesions. The diagnosis and treatment of skin NTDs entail considerable resources, including trained personnel and financial backing. Many interventions are being launched and evaluated, particularly mobile health (mHealth) interventions, such as Skin NTDs App, a training and decision support tool offered by the World Health Organization (WHO) for frontline health workers (FHWs). As most digital health guidelines prioritize the thorough evaluation of mHealth interventions, it is essential to conduct a rigorous and validated assessment of Skin NTDs App. Objective: We aim to assess the quality of version 3 of Skin NTDs App, developed for the WHO by Universal Doctor and Netherlands Leprosy Relief as a training and decision support tool for FHWs. Methods: A cross-sectional study will be conducted in 2 LMICs: Ghana and Kenya. We will use snowball sampling recruitment to select 48 participants from the target population of all FHWs dealing with skin NTDs. The sample group of FHWs will be asked to download and use Skin NTDs App for at least 5 days before answering a web-based survey containing demographic variables and the user Mobile App Rating Scale (uMARS) questionnaire. A semistructured interview will then be conducted. Quantitative and qualitative data will be analyzed using SPSS (version 25; SPSS Inc), with statistical significance for all tests set at a 95% CI and P≤.05 considered significant. Data derived from the semistructured interviews will be clustered in themes and coded to enable analysis of various dimensions using ATLAS.ti. Results: The estimated completion date of the study is in the third quarter of 2022. The results are expected to show that Skin NTDs App version 3 has a good reported user experience, as assessed using the uMARS scale. No differences are expected to be found, except for those related to experience in dermatology and the use of mobile technology that could influence the final score. Semistructured interviews are expected to complete the results obtained on the uMARS scale. Moreover, they will be the previous step before assessing other aspects of the app, such as its efficiency and how it should be disseminated or implemented. Conclusions: This study is the first step in a qualitative and quantitative assessment of Skin NTDs App as a training and support tool for FHWs diagnosing and managing skin NTDs. Our results will serve to improve future versions of the App. International Registered Report Identifier (IRRID): PRR1-10.2196/39393 
%M 36480252
%R 10.2196/39393
%U https://www.researchprotocols.org/2022/12/e39393
%U https://doi.org/10.2196/39393
%U http://www.ncbi.nlm.nih.gov/pubmed/36480252

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 12
%P e36829
%T Perceptions and Attitudes Toward an Interactive Voice Response Tool (Call for Life Uganda) Providing Adherence Support and Health Information to HIV-Positive Ugandans: Qualitative Study
%A Kajubi,Phoebe
%A Parkes-Ratanshi,Rosalind
%A Twimukye,Adelline
%A Bwanika Naggirinya,Agnes
%A Nabaggala,Maria Sarah
%A Kiragga,Agnes
%A Castelnuovo,Barbara
%A King,Rachel
%+ Infectious Diseases Institute, College of Health Sciences, Makerere University, PO Box 22418, Kampala, Uganda, 256 312 307000, phoebekajubi@yahoo.com
%K mobile health
%K mHealth
%K mobile communication technologies
%K people living with HIV
%K antiretroviral therapy
%K quality of life
%K Uganda
%D 2022

%7 6.12.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The continuing decline in AIDS-related deaths in the African region is largely driven by the steady scale-up of antiretroviral therapy. However, there are challenges to retaining people living with HIV on treatment. Call for Life Uganda (CFLU) is an interactive voice response tool using simple analogue phones. CFLU supports patients with daily pill reminders, preappointment reminders, symptom reporting and management, and weekly health promotion tips. Mobile health tools are being increasingly used in resource-limited settings but are often adopted without rigorous evaluation. Objective: This qualitative study conducted at 12 months after enrollment assessed patients’ experiences, perceptions, and attitudes regarding CLFU. Methods: We conducted a qualitative substudy within an open-label randomized controlled trial titled “Improving outcomes in HIV patients using mobile phone based interactive software support.” Data were collected through 6 focus group discussions with participants sampled based on proportion of calls responded to—<25%, between 25% and 50%, and >50%—conducted at the Infectious Diseases Institute, Mulago, and the Kasangati Health Centre IV. NVivo (version 11; QSR International) was used in the management of the data and in the coding of the emerging themes. The data were then analyzed using content thematic analysis. Results: There was consensus across all groups that they had more positive than negative experiences with the CFLU system. Participants who responded to >50% of the calls reported more frequent use of the specific elements of the CFLU tool and, consequently, experienced more benefits from the system than those who responded to calls less frequently. Irrespective of calls responded to, participants identified pill reminders as the most important aspect in improved quality of life, followed by health promotion tips. The most common challenge faced was difficulty with the secret personal identification number. Conclusions: Findings showed participants’ appreciation, high willingness, and interest in the intervention, CFLU, that demonstrated great perceived potential to improve their access to health care; adherence to treatment; health awareness; and, consequently, quality of life. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 
%M 36472904
%R 10.2196/36829
%U https://formative.jmir.org/2022/12/e36829
%U https://doi.org/10.2196/36829
%U http://www.ncbi.nlm.nih.gov/pubmed/36472904

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 11
%P e26041
%T Digital mHealth and Virtual Care Use During COVID-19 in 4 Countries: Rapid Landscape Review
%A Müller,Alison
%A Cau,Alessandro
%A Muhammed,Semakula
%A Abdullahi,Osman
%A Hayward,Andrew
%A Nsanzimana,Sabin
%A Lester,Richard
%+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 575 - Vancouver General Hospital Research Pavilion, 828 W 10th Ave, Vancouver, BC, V5Z1M9, Canada, 1 604 875 4111 ext 66294, amuller8@mail.ubc.ca
%K COVID-19
%K virtual care
%K public health
%K mHealth
%K contact tracing
%K telehealth
%K Canada
%K United Kingdom
%K Kenya
%K Rwanda
%K global health
%K apps
%D 2022

%7 30.11.2022
%9 Review
%J JMIR Form Res
%G English
                
%X Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close contacts, as well as disseminate accurate information regarding COVID-19 to the public. This has led to an unprecedented rapid expansion of digital tools to provide digitized virtual care globally, especially mobile phone–facilitated health interventions, called mHealth. To help keep abreast of different mHealth and virtual care technologies being used internationally to facilitate patient care and public health during the COVID-19 pandemic, we carried out a rapid investigation of solutions being deployed and considered in 4 countries. Objective: The aim of this paper was to describe mHealth and the digital and contact tracing technologies being used in the health care management of the COVID-19 pandemic among 2 high-income and 2 low-middle income countries. Methods: We compared virtual care interventions used for COVID-19 management among 2 high-income countries (the United Kingdom and Canada) and 2 low-middle income (Kenya and Rwanda) countries. We focused on interventions used to facilitate patient care and public health. Information regarding specific virtual care technologies was procured from a variety of resources including gray literature, government and health organization websites, and coauthors’ personal experiences as implementers of COVID-19 virtual care strategies. Search engine queries were performed to find health information that would be easily accessible to the general public, with keywords including “COVID-19,” “contact-tracing,” “tool-kit,” “telehealth,” and “virtual care,” in conjunction with corresponding national health authorities. Results: We identified a variety of technologies in Canada, the United Kingdom, Rwanda, and Kenya being used for patient care and public health. These countries are using both video and text message–based platforms to facilitate communication with health care providers (eg, WelTel and Zoom). Nationally developed contact tracing apps are provided free to the public, with most of them using Bluetooth-based technology. We identified that often multiple complimentary technologies are being utilized for different aspects of patient care and public health with the common purpose to disseminate information safely. There was a negligible difference among the types of technologies used in both high-income and low-middle income countries, although the latter implemented virtual care interventions earlier during the pandemic’s first wave, which may account for their effective response. Conclusions: Virtual care and mHealth technologies have evolved rapidly as a tool for health care support for both patient care and public health. It is evident that, on an international level, a variety of mHealth and virtual care interventions, often in combination, are required to be able to address patient care and public health concerns during the COVID-19 pandemic, independent of a country’s economic standing. 
%M 34932498
%R 10.2196/26041
%U https://formative.jmir.org/2022/11/e26041
%U https://doi.org/10.2196/26041
%U http://www.ncbi.nlm.nih.gov/pubmed/34932498

%0 Journal Article
        
%@ 2369-2529
%I JMIR Publications
%V 9
%N 4
%P e40374
%T Systematic Development of the ReWin Application: A Digital Therapeutic Rehabilitation Innovation for People With Stroke-related Disabilities in India
%A Kamalakannan,Sureshkumar
%A Karunakaran,Vijay
%A Kaliappan,Ashwin Balaji
%A Nagarajan,Ramakumar
%+ South Asia Centre for Disability Inclusive Development and Research, Indian Institute of Public Health Hyderabad, Public Health Foundation of India, Plot No: 1, ANV Arcade, Amar Cooperative Society, Kavuri Hills, Madhapur, Hyderabad, 500033, India, 91 9676333412, sureshkumar.kamalakannan@northumbria.ac.uk
%K stroke
%K telerehabilitation
%K neurological rehabilitation
%K disability
%K India
%K rehabilitation
%K recovery
%K stroke care
%K patient care
%K digital technology
%K feasibility
%K acceptability
%K digital therapy
%D 2022

%7 24.11.2022
%9 Viewpoint
%J JMIR Rehabil Assist Technol
%G English
                
%X This is a viewpoint paper that aims to describe the systematic approach to the development of a technology-driven stroke rehabilitation innovation to manage disabilities following a stroke at home in India. This paper intends to sensitize public health innovators and intervention development experts about the important aspects that need to be considered to develop a culturally sensitive, patient-centered, scalable solution for stroke care using technology. Stroke has been the second-leading cause of death and the third-leading cause of disability globally for the past 3 decades. The emerging technological innovations for stroke care were predominantly designed and developed by digital technology experts as stand-alone products with very minimal efforts to explore their feasibility, acceptability, and, more importantly, scalability. Hence, a digital therapeutic rehabilitation innovation for people with stroke-related disabilities in India was systematically developed and is being evaluated. ReWin is an innovation that is technologically driven and envisions digital therapeutics as a medium for the provision of rehabilitation to persons with disabilities. It is conceptualized and developed based on the International Classification of Functioning, Disability and Health. ReWin encompasses specific technological aspects to enable its scientific framework and conceptualization to suit the context and needs of stroke care providers and consumers. The framework is built with 2 separate applications, one for the providers and one for the patients and caregivers. Each of these applications has a specific inbuilt design to add data about the demographic details of the user, stroke severity using the National Institute of Health Stroke Scale, and self-assessment of disability measured by the modified Barthel Index. Users can communicate with each other and decide on their therapeutic goals, therapy training information, and progress remotely from where they are. The ultimate outcome expected from the ReWin innovation is a continuum of care for stroke survivors that is effective, safe, and of good quality. Systematic development cannot make the intervention scalable. The intervention needs to be evaluated for its feasibility, acceptability, and effectiveness. Currently, ReWin is being evaluated for its feasibility and acceptability. The evaluation of ReWin will provide an opportunity to develop a scalable solution for empowering therapists and persons with disabilities, in general, to objectively self-manage their treatment. Findings from this study will also provide valuable information about the resources required to deliver such interventions in resource-constrained settings like India.
%M 36422867
%R 10.2196/40374
%U https://rehab.jmir.org/2022/4/e40374
%U https://doi.org/10.2196/40374
%U http://www.ncbi.nlm.nih.gov/pubmed/36422867

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 11
%P e36174
%T Developing an mHealth Intervention to Reduce COVID-19–Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study
%A Akinsulore,Adesanmi
%A Aloba,Olutayo
%A Oginni,Olakunle
%A Oloniniyi,Ibidunni
%A Ibigbami,Olanrewaju
%A Seun-Fadipe,Champion Tobi
%A Opakunle,Tolulope
%A Owojuyigbe,Afolabi Muyiwa
%A Olibamoyo,Olushola
%A Mapayi,Boladale
%A Okorie,Victor Ogbonnaya
%A Adewuya,Abiodun Olugbenga
%+ Department of Mental Health, Faculty of Clinical Sciences, Obafemi Awolowo University, College of Health Sciences Building, Road 1, Ile-Ife, 220005, Nigeria, 234 8033968554, sanmilore@oauife.edu.ng
%K COVID-19
%K psychological distress
%K Nigeria
%K health care workers
%K mental health
%K well-being
%K pandemic
%K mHealth
%K mobile health
%K digital health intervention
%K health intervention
%K health care
%K smartphone
%K mobile phone
%D 2022

%7 16.11.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Globally, COVID-19–related psychological distress is seriously eroding health care workers’ mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19–related psychological distress among health care workers in Nigeria. Objective: Our objective is to present a study protocol to determine the level of COVID-19–related psychological distress among health care workers in Nigeria; explore health care workers’ experience of COVID-19–related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). Methods: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. Results: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. Conclusions: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19–related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19–related psychological distress among health care workers in Nigeria. International Registered Report Identifier (IRRID): DERR1-10.2196/36174 
%M 36318638
%R 10.2196/36174
%U https://www.researchprotocols.org/2022/11/e36174
%U https://doi.org/10.2196/36174
%U http://www.ncbi.nlm.nih.gov/pubmed/36318638

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 10
%P e39225
%T Developing a Parenting App to Support Young Children’s Socioemotional and Cognitive Development in Culturally Diverse Low- and Middle-Income Countries: Protocol for a Co-design Study
%A LaMonica,Haley M
%A Crouse,Jacob J
%A Song,Yun J C
%A Alam,Mafruha
%A Ekambareshwar,Mahalakshmi
%A Loblay,Victoria
%A Yoon,Adam
%A Cha,Grace
%A Wilson,Chloe
%A Sweeney-Nash,Madelaine
%A Foo,Nathanael
%A Teo,Melissa
%A Perhirin,Mikael
%A Troy,Jakelin
%A Hickie,Ian B
%+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au
%K child development
%K digital technology
%K global health
%K co-design
%K participatory research
%K stakeholder participation
%K mobile app
%D 2022

%7 31.10.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Digital technologies are widely recognized for their equalizing effect, improving access to affordable health care regardless of gender, ethnicity, socioeconomic status, or geographic region. The Thrive by Five app is designed to promote positive interactions between children and their parents, extended family, and trusted members of the community to support socioemotional and cognitive development in the first 5 years of life and to strengthen connections to culture and community. Objective: This paper aims to describe the iterative co-design process that underpins the development and refinement of Thrive by Five’s features, functions, and content. Minderoo Foundation commissioned this work as a quality improvement activity to support an engaging user experience and inform the development of culturally appropriate and relevant content for parents and caregivers in each country where the app is implemented. Methods: The app content, referred to as Collective Actions, comprises “The Why,” that presents scientific principles that underpin socioemotional and cognitive development in early childhood. The scientific information is coupled with childrearing activities for parents, extended family, and members of the community to engage in with the children to support their healthy development and to promote positive connections between parents, families, and communities and these young children. Importantly, the initial content is designed and iteratively refined in collaboration with a subject matter expert group from each country (ie, alpha testing). This content is then configured into the app (either a beta version or localized version) for testing (ie, beta testing) by local parents and caregivers as well as experts who are invited to provide their feedback and suggestions for improvements in app content, features, and functions via a brief web-based survey and a series of co-design workshops. The quantitative survey data will be analyzed using descriptive statistics, whereas the analysis of qualitative data from the workshops will follow established thematic techniques. Results: To date, the co-design protocol has been completed with subject matter experts, parents, and caregivers from 9 countries, with the first results expected to be published by early 2023. The protocol will be implemented serially in the remaining 21 countries. Conclusions: Mobile technologies are the primary means of internet connection in many countries worldwide, which underscores the potential for mobile health programs to improve access to valuable, evidence-based, and previously unavailable parenting information. However, for maximum impact, it is critically important to ensure that mobile health programs are designed in collaboration with the target audience to support the alignment of content with parents’ cultural values and traditions and its relevance to their needs and circumstances. International Registered Report Identifier (IRRID): DERR1-10.2196/39225 
%M 36315237
%R 10.2196/39225
%U https://www.researchprotocols.org/2022/10/e39225
%U https://doi.org/10.2196/39225
%U http://www.ncbi.nlm.nih.gov/pubmed/36315237

%0 Journal Article
        
%@ 2561-3278
%I JMIR Publications
%V 7
%N 2
%P e40066
%T Accuracy of Fully Automated 3D Imaging System for Child Anthropometry in a Low-Resource Setting: Effectiveness Evaluation in Malakal, South Sudan
%A Leidman,Eva
%A Jatoi,Muhammad Ali
%A Bollemeijer,Iris
%A Majer,Jennifer
%A Doocy,Shannon
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States, 1 4049085125, eleidman@jhu.edu
%K mobile health
%K mHealth
%K child nutrition
%K anthropometry
%K 3D imaging
%K imaging
%K accuracy
%K measurement
%K child stature
%K software
%K algorithm
%K automated
%K device
%K child health
%K pediatric health
%K height
%K length
%K arm circumference
%D 2022

%7 21.10.2022
%9 Original Paper
%J JMIR Biomed Eng
%G English
                
%X Background: Adoption of 3D imaging systems in humanitarian settings requires accuracy comparable with manual measurement notwithstanding additional constraints associated with austere settings. Objective: This study aimed to evaluate the accuracy of child stature and mid–upper arm circumference (MUAC) measurements produced by the AutoAnthro 3D imaging system (third generation) developed by Body Surface Translations Inc. Methods: A study of device accuracy was embedded within a 2-stage cluster survey at the Malakal Protection of Civilians site in South Sudan conducted between September 2021 and October 2021. All children aged 6 to 59 months within selected households were eligible. For each child, manual measurements were obtained by 2 anthropometrists following the protocol used in the 2006 World Health Organization Child Growth Standards study. Scans were then captured by a different enumerator using a Samsung Galaxy 8 phone loaded with a custom software, AutoAnthro, and an Intel RealSense 3D scanner. The scans were processed using a fully automated algorithm. A multivariate logistic regression model was fit to evaluate the adjusted odds of achieving a successful scan. The accuracy of the measurements was visually assessed using Bland-Altman plots and quantified using average bias, limits of agreement (LoAs), and the 95% precision interval for individual differences. Key informant interviews were conducted remotely with survey enumerators and Body Surface Translations Inc developers to understand challenges in beta testing, training, data acquisition and transmission. Results: Manual measurements were obtained for 539 eligible children, and scan-derived measurements were successfully processed for 234 (43.4%) of them. Caregivers of at least 10.4% (56/539) of the children refused consent for scan capture; additional scans were unsuccessfully transmitted to the server. Neither the demographic characteristics of the children (age and sex), stature, nor MUAC were associated with availability of scan-derived measurements; team was significantly associated (P<.001). The average bias of scan-derived measurements in cm was −0.5 (95% CI −2.0 to 1.0) for stature and 0.7 (95% CI 0.4-1.0) for MUAC. For stature, the 95% LoA was −23.9 cm to 22.9 cm. For MUAC, the 95% LoA was −4.0 cm to 5.4 cm. All accuracy metrics varied considerably by team. The COVID-19 pandemic–related physical distancing and travel policies limited testing to validate the device algorithm and prevented developers from conducting in-person training and field oversight, negatively affecting the quality of scan capture, processing, and transmission. Conclusions: Scan-derived measurements were not sufficiently accurate for the widespread adoption of the current technology. Although the software shows promise, further investments in the software algorithms are needed to address issues with scan transmission and extreme field contexts as well as to enable improved field supervision. Differences in accuracy by team provide evidence that investment in training may also improve performance. 
%M 38875695
%R 10.2196/40066
%U https://biomedeng.jmir.org/2022/2/e40066
%U https://doi.org/10.2196/40066
%U http://www.ncbi.nlm.nih.gov/pubmed/38875695

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 10
%P e36260
%T Developing Population Health Surveillance Using mHealth in Low-Resource Settings: Qualitative Assessment and Pilot Evaluation
%A Benda,Natalie C
%A Zawtha,Sakie
%A Anderson,Kyrie
%A Sharma,Mohit Manoj
%A Lin,Phoe Be
%A Zawtha,Beichotha
%A Masterson Creber,Ruth
%+ Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61st Street, Suite 301, New York, NY, 10065, United States, 1 5635432222, ncb4001@med.cornell.edu
%K mobile health
%K mHealth
%K low- and middle-income countries
%K population health surveillance
%K user-centered design
%K mobile phone
%D 2022

%7 14.10.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Population surveillance data are essential for understanding population needs and evaluating health programs. Governmental and nongovernmental organizations in western Myanmar did not previous have means for conducting robust, electronic population health surveillance. Objective: This study involved developing mobile health (mHealth)–based population health surveillance in a rural, low-resource setting with minimal cellular infrastructure in western Myanmar. This was an early formative study in which our goal was to establish the initial feasibility of conducting mHealth population health surveillance, optimizing procedures, and building capacity for future work. Methods: We used an iterative design process to develop mHealth-based population health surveillance focused on general demographics (eg, total census, age category, sex, births, and deaths). Interviews were conducted with international consultants (nurse midwives) and local clinicians (nurses and physicians) in Myanmar. Our analytic approach was informed by the Systems Engineering Initiative for Patient Safety work systems model to capture the multilevel user needs for developing health interventions, which was used to create a prototype data collection tool. The prototype was then pilot-tested in 33 villages to establish an initial proof of concept. Results: We conducted 7 interviews with 5 participants who provided feedback regarding the domains of the work system, including environmental, organizational, sociocultural, technological, informational, and task- and people-based considerations, for adapting an mHealth tool. Environmental considerations included managing limited electricity and internet service. Organizational needs involved developing agreements to work within existing government infrastructure as well as leveraging the communal nature of societies to describe the importance of surveillance data collection and gain buy-in. Linguistic diversity and lack of experience with technology were both cited as people- and technology-based aspects to inform prototype design. The use of mobile tools was also viewed as a means to improve the quality of the data collected and as a feasible option for working in settings with limited internet access. Following the prototype design based on the findings of initial interviews, the mHealth tool was piloted in 33 villages, allowing our team to collect census data from 11,945 people for an initial proof of concept. We also detected areas of potentially missing data, which will need to be further investigated and mitigated in future studies. Conclusions: Previous studies have not focused heavily on the early stages of developing population health surveillance capacity in low- and middle-income countries. Findings related to key design considerations using a work systems lens may be informative to others developing technology-based solutions in extremely low-resource settings. Future work will involve collecting additional health-related data and further evaluating the quality of the data collected. Our team established an initial proof of concept for using an mHealth tool to collect census-related information in a low-resource, extremely rural, and low-literacy environment. 
%M 36239997
%R 10.2196/36260
%U https://formative.jmir.org/2022/10/e36260
%U https://doi.org/10.2196/36260
%U http://www.ncbi.nlm.nih.gov/pubmed/36239997

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 9
%P e38368
%T Mobile for Mothers mHealth Intervention to Augment Maternal Health Awareness and Behavior of Pregnant Women in Tribal Societies: Randomized Quasi-Controlled Study
%A Choudhury,Avishek
%A Choudhury,Murari
%+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1306 Evansdale Drive, PO Box 6107, Morgantown, WV, 26506-6107, United States, 1 3042939431, avishek.choudhury@mail.wvu.edu
%K maternal health
%K mHealth
%K digital divide
%K disparity
%K socioeconomic
%K India
%K health
%K awareness
%K mobile
%K intervention
%K adherence
%K health behaviors
%K tribal
%K community
%K education
%D 2022

%7 21.9.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite several initiatives taken by government bodies, disparities in maternal health have been noticeable across India’s socioeconomic gradient due to poor health awareness. Objective: The aim of this study was to implement an easy-to-use mobile health (mHealth) app—Mobile for Mothers (MfM)—as a supporting tool to improve (1) maternal health awareness and (2) maternal health–related behavioral changes among tribal and rural communities in India. Methods: Pregnant women, aged 18 to 45 years, were selected from two rural villages of Jharkhand, India: (1) the intervention group received government-mandated maternal care through an mHealth app and (2) the control group received the same government-mandated care via traditional means (ie, verbally). A total of 800 accredited social health activists (ASHAs) were involved, of which 400 were allocated to the intervention group. ASHAs used the MfM app to engage with pregnant women during each home visit in the intervention group. The mHealth intervention commenced soon after the baseline survey was completed in February 2014. The end-line data were collected between November 2015 and January 2016. We calculated descriptive statistics related to demographics and the percentage changes for each variable between baseline and end line per group. The baseline preintervention groups were compared to the end-line postintervention groups using Pearson chi-square analyses. Mantel-Haenszel tests for conditional independence were conducted to determine if the pre- to postintervention differences in the intervention group were significantly different from those in the control group. Results: Awareness regarding the five cleans (5Cs) in the intervention group increased (P<.001) from 143 (baseline) to 555 (end line) out of 740 participants. Awareness about tetanus vaccine injections and the fact that pregnant women should receive two shots of tetanus vaccine in the intervention group significantly increased (P<.001) from 73 out of 740 participants (baseline) to 372 out of 555 participants (end line). In the intervention group, awareness regarding the fact that problems like painful or burning urination and itchy genitals during pregnancy are indicative of a reproductive tract infection increased (P<.001) from 15 (baseline) to 608 (end line) out of 740 participants. Similarly, knowledge about HIV testing increased (P<.001) from 39 (baseline) to 572 (end line) out of 740 participants. We also noted that the number of pregnant women in the intervention group who consumed the prescribed dosage of iron tablets increased (P<.001) from 193 (baseline) out of 288 participants to 612 (end line) out of 663 participants. Conclusions: mHealth interventions can augment awareness of, and persistence in, recommended maternal health behaviors among tribal communities in Jharkhand, India. In addition, mHealth could act as an educational tool to help tribal societies break away from their traditional beliefs about maternal health and take up modern health care recommendations. Trial Registration: OSF Registries 9U8D5; https://doi.org/10.17605/OSF.IO/9U8D5 
%M 36129749
%R 10.2196/38368
%U https://mhealth.jmir.org/2022/9/e38368
%U https://doi.org/10.2196/38368
%U http://www.ncbi.nlm.nih.gov/pubmed/36129749

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 9
%P e39867
%T The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in Côte d’Ivoire
%A Yotsu,Rie R
%A Itoh,Sakiko
%A Yao,Koffi Aubin
%A Kouadio,Kouamé
%A Ugai,Kazuko
%A Koffi,Yao Didier
%A Almamy,Diabate
%A Vagamon,Bamba
%A Blanton,Ronald E
%+ Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, United States, 1 504 988 5388, ryotsu@tulane.edu
%K skin diseases
%K neglected diseases
%K skin NTDs
%K teledermatology
%K telemedicine
%K remote consultation
%D 2022

%7 21.9.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. Objective: This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d’Ivoire. Methods: A mixed methods pilot trial will be conducted in Côte d’Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d’Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d’Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d’Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d’Ivoire and by Tulane University in 2021. Results: This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. Conclusions: Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. Trial Registration: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399 International Registered Report Identifier (IRRID): DERR1-10.2196/39867 
%M 35922062
%R 10.2196/39867
%U https://www.researchprotocols.org/2022/9/e39867
%U https://doi.org/10.2196/39867
%U http://www.ncbi.nlm.nih.gov/pubmed/35922062

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 9
%P e30372
%T Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial
%A Kuringe,Evodius
%A Christensen,Alice
%A Materu,Jacqueline
%A Drake,Mary
%A Majani,Esther
%A Casalini,Caterina
%A Mjungu,Deusdedit
%A Mbita,Gaspar
%A Kalage,Esther
%A Komba,Albert
%A Nyato,Daniel
%A Nnko,Soori
%A Shao,Amani
%A Changalucha,John
%A Wambura,Mwita
%+ Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, Box 1462, Mwanza, 33104, United Republic of Tanzania, 255 0282500399, evokur@gmail.com
%K adolescent
%K female
%K HIV infections/epidemiology
%K HIV infections/prevention and control
%K herpes simplex virus type 2
%K incidence
%K motivation
%K Tanzania
%D 2022

%7 19.9.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243 
%M 36121686
%R 10.2196/30372
%U https://publichealth.jmir.org/2022/9/e30372
%U https://doi.org/10.2196/30372
%U http://www.ncbi.nlm.nih.gov/pubmed/36121686

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 9
%P e31996
%T Effect of Face-to-Face and WhatsApp Communication of a Theory-Based Health Education Intervention on Breastfeeding Self-Efficacy (SeBF Intervention): Cluster Randomized Controlled Field Trial
%A Mohamad Pilus,Farahana
%A Ahmad,Norliza
%A Mohd Zulkefli,Nor Afiah
%A Mohd Shukri,Nurul Husna
%+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Hospital Serdang, Serdang, 43400, Malaysia, 60 97692424, lizaahmad@upm.edu.my
%K self-efficacy
%K breastfeeding
%K intervention
%K social cognitive theory
%D 2022

%7 14.9.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The exclusive breastfeeding rate in Malaysia is still not satisfactory. Previous studies have shown that breastfeeding self-efficacy is one of the determinants of exclusive breastfeeding, and it can be improved using social cognitive theory. WhatsApp, which is widely used among Malaysians, could be leveraged as a platform to deliver health education interventions. Objective: This study aimed to develop, implement, and evaluate the effect of using a face-to-face and WhatsApp-based health education intervention based on social cognitive theory, namely the Self-Efficacy in Breastfeeding (SeBF) module, on mothers' self-efficacy, knowledge, and attitudes in a district in Selangor state. Methods: This study was a 2-arm, parallel, single-blind, cluster randomized controlled field trial with an intervention and a control group involving primigravida or multigravida mothers who reside in a district in Selangor state and did not exclusively breastfeed during their previous pregnancy. All 12 maternity and pediatric clinics in this district were randomly divided into 6 intervention and 6 control groups. A total of 172 pregnant mothers were randomly assigned to the intervention group (n=86) or the control group (n=86). The control group received usual routine care. The primary outcome was breastfeeding self-efficacy, while secondary outcomes were knowledge and attitude toward breastfeeding. Each subject was assessed at 4 time points: at baseline, immediately after the intervention, 4 weeks post partum, and 8 weeks post partum. Generalized mixed model analysis was applied to measure the effect of health education on breastfeeding self-efficacy, knowledge, and attitude after the intervention. Results: The response rate was 81% (139/172), with the dropout rate being 7% (6/86) in the intervention group and 31% (27/86) in the control group. In the intent-to-treat analysis, the intervention group showed a significant increase in the mean total breastfeeding self-efficacy score 8 weeks after delivery compared with the control group (F21,601=111.73, P<.001). In addition, the mean total score for breastfeeding knowledge increased significantly in the intervention group after the intervention compared to the control group (F21,601=8.33, P<.001). However, no significant difference was found in the mean total score for breastfeeding attitude after the intervention (F21,602=5.50, P=.47). Conclusions: Face-to-face and WhatsApp-based participation in the SeBF program, designed on the basis of social cognitive theory, contributed to improved self-efficacy and knowledge about breastfeeding. Further studies need to be conducted with a longer duration (until 6 months post partum) to evaluate its effectiveness in increasing exclusive breastfeeding. Furthermore, new strategies in health education need to be developed to improve breastfeeding attitudes. Trial Registration: Thaiclinicaltrials.org TCTR20200213004; https://www.thaiclinicaltrials.org/show/TCTR20200213004 
%M 36103244
%R 10.2196/31996
%U https://mhealth.jmir.org/2022/9/e31996
%U https://doi.org/10.2196/31996
%U http://www.ncbi.nlm.nih.gov/pubmed/36103244

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 9
%P e40046
%T Examining the Delivery of a Tailored Chinese Mind-Body Exercise to Low-Income Community-Dwelling Older Latino Individuals for Healthy Aging: Feasibility and Acceptability Study
%A Du,Yan
%A Patel,Neela
%A Hernandez,Arthur
%A Zamudio-Samano,Maria
%A Li,Shiyu
%A Zhang,Tianou
%A Fernandez,Roman
%A Choi,Byeong Yeob
%A Land,William M
%A Ullevig,Sarah
%A Estrada Coats,Vanessa
%A Moussavou,Jessh Mondesir Mavoungou
%A Parra-Medina,Deborah
%A Yin,Zenong
%+ Center on Smart and Connected Health Technology, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 5044931202, duy@uthscsa.edu
%K qigong
%K mind-body exercise
%K Five Animal Frolics
%K health technology
%K older adults
%K Hispanics
%K Latinos
%K low-income
%K healthy aging
%K aging in place
%K independent living
%D 2022

%7 13.9.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Older Latino individuals are disproportionally affected by various chronic conditions including impairments in physical and cognitive functions, which are essential for healthy aging and independent living. Objective: This study aimed to evaluate the feasibility and acceptability of FITxOlder, a 12-week mind-body exercise program, in community-dwelling low-income, predominantly older Latino individuals, and assess its preliminary effects on health parameters relevant to healthy aging and independent living. Methods: This 12-week, single-arm, stage 1B feasibility study had a pre- and poststudy design. A total of 13 older adults (mean age 76.4, SD 7.9 years; 11/13, 85% Latino) of a congregate meal program in a senior center were enrolled. FITxOlder was a tailored Chinese mind-body exercise program using Five Animal Frolics led by a bilingual community health worker (CHW) participating twice a week at the senior center and facilitated by mobile health technology for practice at home, with incrementally increasing goals moving from once a week to at least 3 times a week. The feasibility and acceptability of the study were examined using both quantitative and qualitative data. Healthy aging–related outcomes (eg, physical and cognitive function) were assessed using paired 2-tailed t tests. Qualitative interview data were analyzed using thematic analysis. Results: The attendance rate for the 24 exercise sessions was high (22.7/24, 95%), ranging from 93% (1.8/2) to 97% (1.9/2) over the 12 weeks. Participants were compliant with the incremental weekly exercise goals, with 69.2% (9/13) and 75.0% (9/12) meeting the home and program goals in the last 4 weeks, respectively. Approximately 83% (10/12) to 92% (11/12) of the participants provided favorable feedback on survey questions regarding the study and program implementation, such as program content and support, delivery by the CHW, enjoyment and appeal of the Five Animal Frolics, study burden and incentives, and safety concerns. The qualitative interview data revealed that FITxOlder was well accepted; participants reported enjoyment and health benefits and the desire to continue to practice and share it with others. The 5-time sit-to-stand test (mean change at posttest assessment=−1.62; P<.001; Cohen d=0.97) and 12-Item Short Form Health Survey physical component scores (mean change at post intervention=5.71; P=.01; Cohen d=0.88) exhibited changes with large effect sizes from baseline to 12 weeks; the other parameters showed small or medium effect sizes. Conclusions: The research findings indicated that the CHW-led and mobile health–facilitated Chinese qigong exercise program is feasible and acceptable among low-income Latino older adults. The trending health benefits of the 12-week FITxOlder program suggest it is promising to promote physical activity engagement in underserved older populations to improve health outcomes for healthy aging and independent living. Future research with larger samples and longer interventions is warranted to assess the health benefits and suitability of FITxOlder. 
%M 35997685
%R 10.2196/40046
%U https://formative.jmir.org/2022/9/e40046
%U https://doi.org/10.2196/40046
%U http://www.ncbi.nlm.nih.gov/pubmed/35997685

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 9
%P e32795
%T Design, Development, and Testing of BEST4Baby, an mHealth Technology to Support Exclusive Breastfeeding in India: Pilot Study
%A Ma,Tony
%A Chang,Katie
%A Alyusuf,Amal
%A Bajracharya,Elina
%A Washio,Yukiko
%A Kelly,Patricia J
%A Bellad,Roopa M
%A Mahantashetti,Niranjana S
%A Charantimath,Umesh
%A Short,Vanessa L
%A Lalakia,Parth
%A Jaeger,Frances
%A Goudar,Shivaprasad
%A Derman,Richard
%+ Benten Technologies, Inc, 9408 Grant Avenue, Suite 206, Manassas, VA, 20110-1816, United States, 1 703 662 5858 ext 143, tonyma@bententech.com
%K mobile health
%K mHealth
%K peer counselors
%K breastfeeding
%K rural
%K usability
%K low- and middle-income countries
%K agile
%K task shifting
%K user-centered design
%K mobile phone
%D 2022

%7 8.9.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Exclusive breastfeeding (EBF) at 6 months of age in most low- and middle-income countries, including India, is surprisingly low. There is a relative lack of mobile health apps that specifically focus on leveraging the use of peer counselors (PCs) to support mothers as a means of increasing EBF practices in low- and middle-income countries. Objective: This study aimed to design, develop, and test the usability of Breastfeeding Education Support Tool for Baby (BEST4Baby), a mobile health app specifically designed to support PCs in providing in-home breastfeeding counseling support to mothers in rural India on optimal breastfeeding practices. Methods: A user-centered design process with an agile development methodology was used. The approach involved stakeholders and mothers who were trained to serve as PCs to guide BEST4Baby’s design and development, including the app’s content and features. PCs were engaged through focus groups with interactive wireframes. During the 24-month pilot study period, we conducted a feasibility test of the BEST4Baby app with 22 PCs who supported home visits with mothers residing in rural India. The intervention protocol required PCs to provide education and follow mothers using the BEST4Baby app, with 9 scheduled home visits from the late prenatal stage to 6 months post partum. BEST4Baby’s usability from the PCs’ perspective was assessed using the translated System Usability Scale (SUS). Results: The findings of this study align with best practices in user-centered design (ie, understanding user experience, including context with iterative design with stakeholders) to address EBF barriers. This led to the cultural tailoring and contextual alignment of an evidence-based World Health Organization breastfeeding program with an iterative design and agile development of the BEST4Baby app. A total of 22 PCs tested and rated the BEST4Baby app as highly usable, with a mean SUS score of 85.3 (SD 9.1), placing it over the 95th percentile for SUS scores. The approach translated into a highly usable BEST4Baby app for use by PCs in breastfeeding counseling, which also statistically increased EBF practices. Conclusions: The findings suggest that BEST4Baby was highly usable and accepted by mothers serving as PCs to support other mothers in their EBF practices and led to positive outcomes in the intervention group’s EBF rates. The pilot study demonstrated that using the specially designed BEST4Baby app was an important support tool for mothers to serve as PCs during the 9 home visits. Trial Registration: Clinicaltrials.gov NCT03533725; https://clinicaltrials.gov/ct2/show/NCT03533725 
%M 36074546
%R 10.2196/32795
%U https://formative.jmir.org/2022/9/e32795
%U https://doi.org/10.2196/32795
%U http://www.ncbi.nlm.nih.gov/pubmed/36074546

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 10
%N 8
%P e29431
%T An mHealth-Based Health Management Information System Among Health Workers in Volta and Eastern Regions of Ghana: Pre-Post Comparison Analysis
%A Lee,Young-ji
%A Lee,Seohyun
%A Kim,SeYeon
%A Choi,Wonil
%A Jeong,Yoojin
%A Rhim,Nina Jin Joo
%A Seo,Ilwon
%A Kim,Sun-Young
%+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak Campus, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 28802768, sykim22@snu.ac.kr
%K mobile health
%K mHealth
%K e-Tracker
%K health information system
%K HIS
%K health information management system
%K HIMS
%K District Health Information Management System
%K DHIMS
%K maternal and child health
%K MCH
%K electronic health record
%K EHR
%K health workers
%D 2022

%7 31.8.2022
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Despite the increasing attention to electronic health management information systems (HMISs) in global health, most African countries still depend on inefficient paper-based systems. Good Neighbors International and Evaluate 4 Health have recently supported the Ghana Health Service on the rollout of a mobile health–based HMIS called the e-Tracker system in 2 regions in Ghana. The e-Tracker is an Android-based tracker capture app that electronically manages maternal and child health (MCH) data. The Ghana Health Service has implemented this new system in Community Health Planning and Services in the 2 regions (Volta and Eastern). Objective: This study aims to evaluate changes in health workers’ capacity and behavior after using the e-Tracker to deliver MCH services. Specifically, the study assesses the changes in knowledge, attitude, and practice (KAP) of the health workers toward the e-Tracker system by comparing the pre- and postsurvey results. Methods: The KAP of frontline health workers was measured through self-administered surveys before and after using the e-Tracker system to assess their capacity and behavioral change toward the system. A total of 1124 health workers from the Volta and Eastern regions responded to the pre-post surveys. This study conducted the McNemar chi-square test and Wilcoxon signed-rank test for a pre-post comparison analysis. In addition, random-effects ordered logistic regression analysis and random-effects panel analysis were conducted to identify factors associated with KAP level. Results: The pre-post comparison analysis showed significant improvement in health workers’ capacity, with higher knowledge and practice levels after using the e-Tracker system. As for knowledge, there was a 9.9%-point increase (from 559/1109, 50.41% to 669/1109, 60.32%) in the proportion of the respondents who were able to generate basic statistics on the number of children born in a random month within 30 minutes. In the practice section, the percentage of respondents who had scheduled clientencounters increased from 91.41% (968/1059) to 97.83% (1036/1059). By contrast, responses to the attitude (acceptability) became less favorable after experiencing the actual system. For instance, 48.53% (544/1121) initially expressed their preferences for an electronic system; however, the proportion decreased to 33.45% (375/1121) after the intervention. Random-effects ordered logistic regression showed that days of overwork were significantly associated with health workers’ attitudes toward the e-Tracker system. Conclusions: This study provides empirical evidence that the e-Tracker system is conducive to enhancing capacity in MCH data management for providing necessary MCH services. However, the change in attitude implies that the users appear to feel less comfortable using the new system. As Ghana plans to scale up the electronic HMIS system using the e-Tracker to the national level, strategies to enhance health workers’ attitudes are necessary to sustain this new system. 
%M 36044256
%R 10.2196/29431
%U https://medinform.jmir.org/2022/8/e29431
%U https://doi.org/10.2196/29431
%U http://www.ncbi.nlm.nih.gov/pubmed/36044256

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 8
%P e25735
%T Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study
%A Tahsina,Tazeen
%A Iqbal,Afrin
%A Rahman,Ahmed Ehsanur
%A Chowdhury,Suman Kanti
%A Chowdhury,Atique Iqbal
%A Billah,Sk Masum
%A Rahman,Ataur
%A Parveen,Monira
%A Ahmed,Lubana
%A Rahman,Qazi Sadequr
%A Ashrafi,Shah Ali Akbar
%A Arifeen,Shams El
%+ International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 9827077, tahsina.tazeen@gmail.com
%K notification
%K registration
%K birth
%K death
%K CRVS
%K mobile phone
%K mobile app
%K mobile technology
%K technology-based platform
%K community health
%K low- and middle-income countries
%K mHealth
%K Bangladesh
%D 2022

%7 29.8.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. Objective: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. Methods: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology–based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey–based assessment at the end of the notification period. Results: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92% of the births and 93% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. Conclusions: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source. 
%M 36036979
%R 10.2196/25735
%U https://publichealth.jmir.org/2022/8/e25735
%U https://doi.org/10.2196/25735
%U http://www.ncbi.nlm.nih.gov/pubmed/36036979

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 8
%P e35631
%T Cell Phone Availability and Usage for mHealth and Intervention Delivery to Persons Living With HIV in a Low-Resource Setting: Cross-sectional Study
%A Adong,Julian
%A Fatch,Robin
%A Emenyonu,Nneka
%A Muyindike,Winnie
%A Ngabirano,Christine
%A Cheng,Debbie
%A Hahn,Judith
%+ Faculty of Medicine, Mbarara University of Science and Technology, Plot 8-18, Kabale Road, P.O.Box 1410, Mbarara, +256, Uganda, 256 755553595, adongjulian@gmail.com
%K cell phone use
%K phone usage
%K cell phone
%K mHealth
%K HIV
%K low resource setting
%K low resource
%K mobile health
%K antiretroviral
%K Uganda
%K Africa
%K alcohol
%K text message
%K text messaging
%K cellphone
%K mobile health
%K low income
%K LMIC
%K TB
%K tuberculosis
%K viral infection
%K infectious disease
%K sexually transmitted
%K STD
%D 2022

%7 23.8.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone–delivered services for medical and public health practice. Objective: Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods: We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use—a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. Results: A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions: There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. 
%M 35998023
%R 10.2196/35631
%U https://formative.jmir.org/2022/8/e35631
%U https://doi.org/10.2196/35631
%U http://www.ncbi.nlm.nih.gov/pubmed/35998023

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 8
%P e37309
%T Evaluation of a Text Messaging Intervention to Promote Preconception Micronutrient Supplement Use: Feasibility Study Nested in the Healthy Life Trajectories Initiative Study in South Africa
%A Soepnel,Larske M
%A McKinley,Michelle C
%A Klingberg,Sonja
%A Draper,Catherine E
%A Prioreschi,Alessandra
%A Norris,Shane A
%A Ware,Lisa J
%+ SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Private Bag X3, Wits, Johannesburg, 2050, South Africa, 27 010 447 3721, larske.soepnel@gmail.com
%K preconception health
%K micronutrient supplements
%K adherence
%K behavioral
%K SMS text messaging intervention
%K mobile health
%K mHealth
%K radio serial
%K mobile phone
%D 2022

%7 18.8.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Social messaging strategies such as SMS text messaging and radio are promising avenues for health promotion and behavior change in low- to middle-income settings. However, evidence of their acceptability, feasibility, and impact in the context of young women’s health and micronutrient deficiencies is lacking. Objective: This study aimed to evaluate the feasibility of an automated 2-way text messaging intervention nested in an ongoing preconception health trial, the Healthy Life Trajectories Initiative (HeLTI; HeLTI Bukhali) in Soweto, South Africa. Second, we aimed to evaluate the acceptability of a health promotion radio serial, which aired concurrently in the region. Methods: In this feasibility study, 120 participants enrolled in HeLTI Bukhali between November 2020 and February 2021 received the 6-month 2-way text messaging intervention. Quantitative and qualitative data on intervention acceptability, usability, interaction, perceived benefit, and fidelity were collected during 5 focus group discussions (FGDs) and from study data logs. During the FGDs, data were collected on the acceptability of the radio serial. Following the text messaging intervention, capillary hemoglobin levels were assessed, and a participant questionnaire provided information on adherence and attitudes toward supplements. The text messaging control group comprised the first 120 women recruited from November 2019 to February 2020, who received the Bukhali intervention but not the text messages. Statistical significance testing and a linear mixed model were used for indicative effect comparisons between the text message–receiving and control groups. Results: The text messaging intervention was found to be acceptable and to have perceived benefits, including being reminded to take supplements, gaining knowledge, and feeling supported by the study team. The use of the 2-way text messaging reply function was limited, with only a 10.8% (13/120) response rate by week 24. Barriers to replying included a lack of interest or phone credit and technical issues. Regarding the indicative effect, participants receiving the text messages had higher self-reported adherence at follow-up than the text messaging control group (42/63, 67% vs 33/85, 39% taking supplements every time; P=.02), and altitude-adjusted hemoglobin increased more between baseline and follow-up in the SMS text message–receiving group than in the text messaging control group (1.03, 95% CI 0.49-1.57; P<.001). The radio serial content was acceptable, although few participants reported exposure before the FGD. Conclusions: Women reported that the text messaging intervention was useful and described the benefits of receiving the messages. Examination of hemoglobin status indicated a promising beneficial effect of text messaging support on adherence to micronutrient supplementation, requiring further exploration through randomized controlled studies. Health promotion through radio and text messages were both found to be acceptable, although more research into the radio serial reach among young women is needed. Trial Registration: Pan African Clinical Trials Registry (PACTR) PACTR201903750173871; https://tinyurl.com/4x6n32ff 
%M 35980731
%R 10.2196/37309
%U https://formative.jmir.org/2022/8/e37309
%U https://doi.org/10.2196/37309
%U http://www.ncbi.nlm.nih.gov/pubmed/35980731

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 8
%P e37163
%T Delivering an mHealth Adherence Support Intervention for Patients With HIV: Mixed Methods Process Evaluation of the Philippines Connect for Life Study
%A O'Connor,Cara
%A Leyritana,Katerina
%A Doyle,Aoife M
%A Birdthistle,Isolde
%A Lewis,James J
%A Gill,Randeep
%A Salvaña,Edsel Maurice
%+ Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 791336248, caraoc@gmail.com
%K mobile health
%K mHealth
%K adherence
%K HIV
%K antiretroviral therapy
%K process evaluation
%K Philippines
%K men who have sex with men
%K MSM
%K mobile phone
%D 2022

%7 12.8.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The Philippines HIV epidemic is one of the fastest growing epidemics globally, and infections among men who have sex with men are increasing at an alarming rate. Connect for Life Philippines is a mobile health (mHealth) intervention that supports antiretroviral therapy (ART) adherence in this key population through individualized voice calls and SMS text messages. Objective: The objective of this process evaluation is to assess the intervention reach, dose delivered and received, fidelity, and acceptability and to describe contextual factors affecting the implementation of an mHealth adherence support intervention for patients on ART in a clinic in Metro Manila, Philippines. Methods: A mixed methods process evaluation approach was used in an observational cohort study. Quantitative data sources for the process evaluation were call and SMS text message logs obtained from the mHealth platform and questionnaires collected at 12-, 24-, and 48-week study visits. Qualitative data were collected from process reports and through a series of focus group discussions conducted with a subset of participants during the intervention development phase, after an initial 8-week pilot phase, and at the end of the study. Results: The 462 study participants received 31,095 interactive voice calls and 8234 SMS text messages during the study. Owing to technical issues, intervention fidelity was low, with only 22.1% (102/462) of the participants receiving reminders via voice calls and others (360/462, 77.9%) receiving only SMS text messages during the intervention. After 48 weeks in the study, 63.5% (293/462) of the participants reported that they would be quite likely or very likely to recommend the program to a friend, and 53.8% (249/462) of the participants reported that they benefited quite a bit or very much from the intervention. Participants who were on ART for <6 months at the beginning of the study and those who received the daily or weekly pill reminders were more likely to report that they benefited from the intervention (P=.02 and P=.01, respectively). Conclusions: The Connect for Life intervention had high participant satisfaction and acceptability, especially among those who received high dose of the intervention. However, poor reliability of local telecommunication networks had a large impact on the intervention’s usability, fidelity, and dose received. 
%M 35969425
%R 10.2196/37163
%U https://formative.jmir.org/2022/8/e37163
%U https://doi.org/10.2196/37163
%U http://www.ncbi.nlm.nih.gov/pubmed/35969425

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 8
%P e37314
%T Chronic Kidney Disease Awareness Campaign and Mobile Health Education to Improve Knowledge, Quality of Life, and Motivation for a Healthy Lifestyle Among Patients With Chronic Kidney Disease in Bangladesh: Randomized Controlled Trial
%A Sarker,Mohammad Habibur Rahman
%A Moriyama,Michiko
%A Rashid,Harun Ur
%A Rahman,Md Moshiur
%A Chisti,Mohammod Jobayer
%A Das,Sumon Kumar
%A Saha,Samir Kumar
%A Arifeen,Shams El
%A Ahmed,Tahmeed
%A Faruque,A S G
%+ Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shaheed Tajuddin Ahmed Sarani,  Mohakhali, Dhaka, 1212, Bangladesh, 880 1775170533, habibur.rahman@icddrb.org
%K Bangladesh
%K health education
%K health knowledge
%K quality of life
%K motivation
%K randomized controlled trial
%K RCT
%K campaign
%K chronic kidney disease
%K knowledge
%K mobile health
%K mHealth
%K kidney
%K chronic disease
%K chronic condition
%K patient education
%K patient knowledge
%K low- and middle-income countries
%K LMIC
%D 2022

%7 11.8.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Chronic kidney disease (CKD) is linked to major health consequences and a poor quality of life. Despite the fact that CKD is becoming more prevalent, public knowledge of the disease remains low. Objective: This study aimed to evaluate the outcome of a health education intervention designed to enhance knowledge, health-related quality of life (QOL), and motivation about healthy lifestyle among adults with CKD. Methods: This study was a parallel-group (1:1), randomized controlled trial in the Mirzapur subdistrict of Bangladesh that compared 2 groups of patients with CKD. Adults with CKD (stages 1-3) were enrolled in November 2020 and randomly assigned the intervention or control group. The intervention group received health education through a CKD awareness campaign and mobile health technologies and was observed for 6 months, whereas the control group received standard treatment. The primary outcome was the evaluation of improved scores on the CKD knowledge questionnaire, and the secondary outcomes were improved QOL and changes in the levels of blood pressure (BP), BMI, serum creatinine, fasting blood sugar (FBS), hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen (BUN), and albumin-to-creatinine ratio. Results: The study enrolled 126 patients (control: n=63; intervention: n=63) and performed intention-to-treat analysis. The analyses included repeated measures ANOVA, and the results were observed to be significantly different from within groups (P<.001), between groups (P<.001), and the interaction of group × time factor (P<.001) for knowledge score. Diastolic BP and BMI showed significant differences arising from within groups (P<.001 and P=.01, respectively) and the interaction of group × time factor (P=.001 and P=.02, respectively); food salinity and hip circumferences showed significant differences arising from within groups (P=.001 and P=.03, respectively) and between groups (P=.001 and P=.02, respectively). Moreover, systolic BP and waist circumference showed significant differences from within groups (P<.001 and P=.003, respectively). However, no significant differences were found arising from within groups, between groups, and the interactions of group × time for QOL, urine salinity, and mid-upper arm circumference. Regarding the laboratory findings, from baseline to 6 months, the mean (SD) FBS decreased by 0.51 (3.77) mmol/L in the intervention group and 0.10 (1.44) mmol/L in the control group (P=.03); however, blood urea nitrogen increased by 3.64 (7.17) mg/dL in the intervention group and 1.68 (10.10) mg/dL in the control group (P=.01). Conclusions: The health education strategy, which included a campaign and mobile health, showed promise for enhancing CKD knowledge among patients with CKD. This strategy may also aid patients with CKD in controlling their FBS and BP. The combined health education initiatives give evidence for scaling them up in Bangladesh and possibly other low- and middle-income countries, particularly in rural and peri-urban settings. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831. International Registered Report Identifier (IRRID): RR2-10.2196/30191 
%M 35969429
%R 10.2196/37314
%U https://www.jmir.org/2022/8/e37314
%U https://doi.org/10.2196/37314
%U http://www.ncbi.nlm.nih.gov/pubmed/35969429

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 7
%P e32286
%T Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe
%A Chabata,Sungai T
%A Makandwa,Rumbidzo
%A Hensen,Bernadette
%A Mushati,Phillis
%A Chiyaka,Tarisai
%A Musemburi,Sithembile
%A Busza,Joanna
%A Floyd,Sian
%A Birdthistle,Isolde
%A Hargreaves,James R
%A Cowan,Frances M
%+ Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Belgravia, Harare, Zimbabwe, 263 773577686, sungaichabata@gmail.com
%K respondent-driven sampling
%K peer outreach
%K female sex worker
%K young women who sell sex
%K HIV prevention
%K Zimbabwe
%K sub-Saharan Africa
%D 2022

%7 27.7.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. Objective: We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. Methods: We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 “seed” participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. Results: Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6% vs 930/5386, 17.3%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3% vs 243/930, 26.1%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8% vs 396/930, 42.6%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US $7.46 for peer outreach and US $52.81 for RDS. Conclusions: Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5085-6 
%M 35896024
%R 10.2196/32286
%U https://publichealth.jmir.org/2022/7/e32286
%U https://doi.org/10.2196/32286
%U http://www.ncbi.nlm.nih.gov/pubmed/35896024

%0 Journal Article
        
%@ 2562-0959
%I JMIR Publications
%V 5
%N 3
%P e35254
%T Evaluation of WhatsApp as a Platform for Teledermatology in Botswana: Retrospective Review and Survey
%A Koh,Erika
%A Maranga,Abena
%A Yane,Tshepo
%A Ndlovu,Kagiso
%A Jereni,Bwanali
%A Nwako-Mohamadi,Maitseo Kuno
%A Kovarik,Carrie
%A Forrestel,Amy
%A Williams,Victoria L
%+ Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th floor, Portland, OR, 97239, United States, 1 503 997 3251, erikasawka@gmail.com
%K dermatology
%K teledermatology
%K telehealth
%K eHealth
%K mHealth
%K WhatsApp
%K developing countries
%K Botswana
%K Africa
%K low income
%K retrospective review
%K instant messaging
%D 2022

%7 27.7.2022
%9 Original Paper
%J JMIR Dermatol
%G English
                
%X Background: In emerging market countries in sub-Saharan Africa, access to specialty services such as dermatology is limited. Teledermatology is an innovative solution to address this issue; however, many initiatives have been tried without sustained success. Recently, WhatsApp has been used as a store-and-forward telemedicine communication platform for consultation and education in Botswana. Objective: This study aims to describe the utilization of WhatsApp for teledermatology and the satisfaction levels of participating providers. Methods: A 2-part pilot study was conducted. First, a retrospective review was performed of WhatsApp communications received by participating dermatologists in Gaborone, Botswana, from January 2016 to December 2019. Sender information, patient demographics and history, response time, diagnoses made, and follow-up recommendations were collected. Second, a 12-question cross-sectional survey was distributed to health care providers who utilized WhatsApp for teledermatology during this period. Descriptive statistics were then performed. Results: There were 811 communication threads over the study period. The majority (503/811, 62%) of communications were consultations from providers inquiring about a specific patient, followed by multidisciplinary care coordination communications (90/811, 11%). Our in-depth analysis focused on the former. In 323 (64%) provider consultations, dermatologists responded within 1 hour. A diagnosis was made in 274 (55%) consultations. Dermatologists gave treatment recommendations remotely in 281 (56%) consultations and recommended an in-person dermatology visit in 163 (32%). Of the 150 health care providers surveyed, 23 (15%) responded. All respondents (100%) felt that there was a need for teledermatology and improved teledermatology education in Botswana. Moreover, 17 (74%) respondents strongly felt that the guidance received via WhatsApp was high quality, and 22 (96%) were satisfied with WhatsApp as a platform for teledermatology. Conclusions: This retrospective review and survey demonstrated that WhatsApp is a quick, well-received, and sustainable method of communication between dermatologists and providers across Botswana. The app may offer a solution to the challenges providers face in accessing specialty referral systems, point-of-care education, and medical decision-making support for complex dermatologic cases in Botswana. The information gained from this pilot study can serve as the basis for future telemedicine studies to improve the implementation of teledermatology in Botswana and other resource-limited countries. 
%M 39475709
%R 10.2196/35254
%U https://derma.jmir.org/2022/3/e35254
%U https://doi.org/10.2196/35254
%U http://www.ncbi.nlm.nih.gov/pubmed/39475709

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 7
%P e34423
%T Detection of Potential Arbovirus Infections and Pregnancy Complications in Pregnant Women in Jamaica Using a Smartphone App (ZIKApp): Pilot Evaluation Study
%A Ruiz-Burga,Elisa
%A Bruijning-Verhagen,Patricia
%A Palmer,Paulette
%A Sandcroft,Annalisa
%A Fernandes,Georgina
%A de Hoog,Marieke
%A Bryan,Lenroy
%A Pierre,Russell
%A Bailey,Heather
%A Giaquinto,Carlo
%A Thorne,Claire
%A Christie,Celia D C
%A ,
%+ Population, Policy & Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, 30 Guilford St,, London, WC1N 1EH, United Kingdom, 44 02079052396, e.burga@ucl.ac.uk
%K mHealth
%K digital health
%K arbovirus
%K pregnancy
%K adherence
%K compliance
%K low- and middle-income countries
%K LMIC
%K maternal health
%K pregnancy complications
%K prenatal care
%K pregnancy outcomes
%K mobile phone
%D 2022

%7 27.7.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is growing evidence of the benefits of mobile health technology, which include symptom tracking apps for research, surveillance, and prevention. No study has yet addressed arbovirus symptom tracking in pregnancy. Objective: This study aimed to evaluate the use of a smartphone app (ZIKApp) to self-report arbovirus symptoms and pregnancy complications and to assess compliance with daily symptom diaries during pregnancy in a cohort of women in an arbovirus-endemic, subtropical, middle-income country (Jamaica). Methods: Pregnant women aged ≥16 years, having a smartphone, and planning on giving birth at the recruiting center were enrolled between February 2020 and July 2020. ZIKApp comprised a daily symptom diary based on algorithms to identify potential episodes of arbovirus infection and pregnancy complications. Sociodemographic, epidemiological, and obstetric information was collected at enrollment, with additional review of medical records, and users’ perception was collected through an exit survey. Descriptive analyses and logistic regression analysis of possible factors associated with diary adherence were performed. Results: Of the 173 women enrolled, 157 (90.8%) used ZIKApp for a median duration of 155 (IQR 127-173) days until pregnancy end, 6 (3.5%) used the app for <7 days, and 10 (5.8%) exited the study early. For each successive 30-day period from enrollment up to 150 days after enrollment, of these 157 women, 121 (77.1%) to 129 (82.2%) completed their daily symptom diary; 50 (31.8%) to 56 (35.7%) did so on the same day. Overall, 31.8% (50/157) of the women had good adherence to diary reporting (ie, they completed the task on the same day or 2 to 3 days later for ≥80% of the days enrolled). There were 3-fold higher odds of good adherence for participants aged >34 years versus those aged 25 to 29 years (adjusted odds ratio 3.14, 95% CI 1.10-8.98) and 2-fold higher odds for women with tertiary versus secondary education (adjusted odds ratio 2.26, 95% CI 1.06-4.83). Of the 161 women who ever made a diary entry, 5454 individual symptom reports were made (median 17 per woman; IQR 4-42; range 0-278); 9 (5.6%) women reported symptom combinations triggering a potential arbovirus episode (none had an adverse pregnancy outcome) and 55 (34.2%) reported painful uterine contractions or vaginal bleeding, mainly in the month before delivery. Overall, 51.8% (71/137) of the women rated the app as an excellent experience and were less likely to be poor diary adherers (P=.04) and 99.3% (138/139) reported that the app was easy to understand and use. Conclusions: This pilot found a high adherence to ZIKApp. It demonstrated the feasibility and usability of the app in an arbovirus-endemic region, supporting its future development to contribute to surveillance and diagnosis of arbovirus infections in pregnancy and to optimize maternal care. 
%M 35896029
%R 10.2196/34423
%U https://formative.jmir.org/2022/7/e34423
%U https://doi.org/10.2196/34423
%U http://www.ncbi.nlm.nih.gov/pubmed/35896029

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 9
%N 3
%P e32330
%T The Role of mHealth Interventions in Changing Gender Relations: Systematic Review of Qualitative Findings
%A Kirkwood,Elizabeth K
%A Clymer,Caitlin
%A Imbulana,Kheminda
%A Mozumder,Sumaya
%A Dibley,Michael J
%A Alam,Neeloy Ashraful
%+ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, 328 Edward Ford, Camperdown, 2006, Australia, 61 0410517874, elizabeth.kirkwood@sydney.edu.au
%K mobile health
%K mHealth
%K gender relations
%K systematic review
%K low- and middle-income countries
%K mobile phone
%D 2022

%7 21.7.2022
%9 Review
%J JMIR Hum Factors
%G English
                
%X Background: The rapid and widespread growth of mobile technologies in low- and middle-income countries can offer groundbreaking ways of disseminating public health interventions. However, gender-based inequalities present a challenge for women in accessing mobile technology. Research has shown that mobile health (mHealth) interventions can affect gender relations in both positive and negative ways; however, few mHealth programs use a gender-sensitive lens when designing, implementing, or analyzing programs. Objective: This systematic review aims to identify and summarize the findings of qualitative research studies that explore the impact of mHealth interventions on gender relations as a result of participating in such initiatives in low- and middle-income countries. Methods: We performed a systematic literature review to examine empirical evidence of changes in gender relations attributed to participation in an mHealth intervention in low- and middle-income countries. Peer-reviewed articles were included based on whether they evaluated an mHealth intervention and were published between 2013 and 2020. Articles using mHealth that solely targeted health workers, did not assess a specific intervention, used mobile technology for data collection only, or were formative or exploratory in nature were excluded. The search terms were entered into 4 key electronic databases—MEDLINE, EMBASE, PsycINFO, and Scopus—generating a comprehensive list of potentially relevant peer-reviewed articles. Thematic analysis was used to identify, analyze, and report the themes that emerged from our data. Results: Of the 578 full-text articles retrieved, 14 (2.4%) were eligible for inclusion in the study. None of the articles appraised gender from the outset. The articles uncovered findings on gender relations through the course of the intervention or postprogram evaluation. Most studies took place in sub-Saharan Africa, with the remainder in South and Southeast Asia. The articles focused on maternal and child health, HIV diagnosis and treatment, and reproductive health. This review found that mHealth programs could enhance spousal communication, foster emotional support between couples, improve women’s self-efficacy and autonomy in seeking health information and services, and increase their involvement in health-related decision-making. Despite the positive impacts, some mHealth interventions had an adverse effect, reinforcing the digital divide, upholding men as gatekeepers of information and sole decision-makers, and exacerbating relationship problems. Conclusions: These results suggest that given the rapid and persistent upscale of mHealth interventions in low- and middle-income settings, it is imperative to design interventions that consider their impact on power dynamics and gender relations. Future research is needed to fill the evidence gaps on gender and mHealth, acknowledging that women are not passive beneficiaries and that they need to actively participate and be empowered by mHealth interventions. 
%M 35862143
%R 10.2196/32330
%U https://humanfactors.jmir.org/2022/3/e32330
%U https://doi.org/10.2196/32330
%U http://www.ncbi.nlm.nih.gov/pubmed/35862143

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 7
%P e35197
%T Exploring an Artificial Intelligence–Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study
%A C Braga,Bianca
%A Nguyen,Phuong H
%A Aberman,Noora-Lisa
%A Doyle,Frank
%A Folson,Gloria
%A Hoang,Nga
%A Huynh,Phuong
%A Koch,Bastien
%A McCloskey,Peter
%A Tran,Lan
%A Hughes,David
%A Gelli,Aulo
%+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 6176363777, curi.bianca@tufts.edu
%K adolescent
%K dietary quality
%K food choice
%K gamification
%K low- and middle-income country
%K smartphone app
%K mobile phone
%D 2022

%7 21.7.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices. Objective: This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app. Methods: A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory. Results: Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability. Conclusions: A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale. 
%M 35862147
%R 10.2196/35197
%U https://formative.jmir.org/2022/7/e35197
%U https://doi.org/10.2196/35197
%U http://www.ncbi.nlm.nih.gov/pubmed/35862147

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 7
%P e33541
%T Development of a Maternal and Child mHealth Intervention With Aboriginal and Torres Strait Islander Mothers: Co-design Approach
%A Perkes,Sarah Jane
%A Huntriss,Belinda
%A Skinner,Noelene
%A Leece,Bernise
%A Dobson,Rosie
%A Mattes,Joerg
%A Hall,Kerry
%A Bonevski,Billie
%+ Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 451994827, sarah.perkes@newcastle.edu.au
%K mHealth
%K co-design
%K Aboriginal and Torres Strait Islander
%K mother
%K baby
%K young children
%K mobile phone
%D 2022

%7 8.7.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite their growing popularity, there are very few mobile health (mHealth) interventions for Aboriginal and Torres Strait Islander people that are culturally safe and evidence based. A co-design approach is considered a suitable methodology for developing health interventions with Aboriginal and Torres Strait Islander people. Objective: The aim of this study was to co-design an mHealth intervention to improve health knowledge, health behaviors, and access to health services for women caring for young Aboriginal and Torres Strait Islander children. Methods: Aboriginal researchers led engagement and recruitment with health services and participants in 3 Aboriginal and Torres Strait Islander communities in New South Wales, Australia. Focus groups and interviews were facilitated by researchers and an app developer to gather information on 3 predetermined themes: design characteristics, content modules, and features and functions. Findings from the co-design led to the development of an intervention prototype. Theories of health behavior change were used to underpin intervention components. Existing publicly available evidence-based information was used to develop content. Governance was provided by an Aboriginal advisory group. Results: In total, 31 mothers and 11 health professionals participated in 8 co-design focus groups and 12 interviews from June 2019 to September 2019. The 6 design characteristics identified as important were credibility, Aboriginal and Torres Strait Islander designs and cultural safety, family centeredness, supportive, simple to use, and confidential. The content includes 6 modules for women’s health: Smoke-free families, Safe drinking, Feeling good, Women’s business, Eating, and Exercising. The content also includes 6 modules for children’s health: Breathing well; Sleeping; Milestones; Feeding and eating; Vaccinations and medicines; and Ears, eyes, and teeth. In addition, 6 technology features and functions were identified: content feed, social connection, reminders, rewards, communication with health professionals, and use of videos. Conclusions: An mHealth intervention that included app, Facebook page, and SMS text messaging modalities was developed based on the co-design findings. The intervention incorporates health behavior change theory, evidence-based information, and the preferences of Aboriginal and Torres Strait Islander women and health professionals. A pilot study is now needed to assess the acceptability and feasibility of the intervention. 
%M 35802404
%R 10.2196/33541
%U https://formative.jmir.org/2022/7/e33541
%U https://doi.org/10.2196/33541
%U http://www.ncbi.nlm.nih.gov/pubmed/35802404

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 7
%P e37600
%T Pilot Implementation of a User-Driven, Web-Based Application Designed to Improve Sexual Health Knowledge and Communication Among Young Zambians: Mixed Methods Study
%A Sharma,Anjali
%A Mwamba,Chanda
%A Ng'andu,Mwila
%A Kamanga,Vikwato
%A Zoonadi Mendamenda,Mayamiko
%A Azgad,Yael
%A Jabbie,Zainab
%A Chipungu,Jenala
%A Pry,Jake M
%+ Department of Public Health Sciences, University of California, Medical Sciences 1-C, One Shield's Ave, Davis, CA, 95616, United States, 1 9366616885, Jmpry@ucdavis.edu
%K sexual and reproductive health
%K web application
%K digital health intervention
%K pilot study
%K quasi-experiment
%K adolescent
%K young people
%K Zambia
%K sub-Saharan Africa
%K mobile phone
%D 2022

%7 7.7.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital health interventions show promise in improving the uptake of HIV services among adolescents and young people aged 15 to 24 years in sub-Saharan Africa. Objective: This study aimed to pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices among young Zambians. Methods: We conducted a pre-post quasi-experimental evaluation of the user-driven Be in the Know Zambia (BITKZ) web application using web-based surveys and in-depth interviews (IDIs) on the phone. We enrolled participants using social media advertisements. Our final analysis set comprised 46.04% (749/1627) of participants in the intervention group (which received the BITKZ link) and 53.96% (878/1627) of participants in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5 weeks after the first enrollment in each group. Approximately 85% (637/749) of BITKZ users completed a user survey, of whom 9.3% (59/637) participated in IDIs. We calculated the time interfacing with BITKZ using the application log files. We conducted descriptive analyses to describe baseline characteristics and the user experience. At the endline, we assessed association using a t test and adjusted logistic regression for binary outcomes and ordinal regression for ordered outcomes, conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effects (aATE) to assess the effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts in Microsoft Excel, sorting the data by theme, gender, and experience rating. Results: Users rated BITKZ highly (excellent: 352/609, 57.8%; good: 218/609, 35.8%). At the endline, the intervention group had a higher level of knowledge related to condoms (adjusted odds ratio [aOR]: 1.35, 95% CI 1.06-1.69) and on wearing condoms correctly (aOR: 1.23, 95% CI 1.02-1.49). Those who had full-time employment had increased odds of knowing how to wear condoms correctly (aOR: 1.67, 95% CI 1.06-2.63) compared with those who reported being unemployed, as did men when compared with women (aOR: 1.92, 95% CI 1.59-2.31). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs; aATE 0.21; P=.01) and HIV (aATE 0.32; P=.05), as well as for resisting peer pressure (aATE 2.64; P=.02). IDIs corroborated increased knowledge on correct condom use among men and female condoms among women, awareness of STIs and testing, and resistance to peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing others to adopt healthier behaviors. Conclusions: Despite the high baseline awareness of SRH among Zambian adolescents and young people with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and HIV. 
%M 35797099
%R 10.2196/37600
%U https://www.jmir.org/2022/7/e37600
%U https://doi.org/10.2196/37600
%U http://www.ncbi.nlm.nih.gov/pubmed/35797099

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 7
%P e36242
%T Unbalanced Risk of Pulmonary Tuberculosis in China at the Subnational Scale: Spatiotemporal Analysis
%A Hu,Maogui
%A Feng,Yuqing
%A Li,Tao
%A Zhao,Yanlin
%A Wang,Jinfeng
%A Xu,Chengdong
%A Chen,Wei
%+ National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China, 86 010 58900537, chenwei@chinacdc.cn
%K pulmonary tuberculosis
%K infectious disease
%K pattern
%K notification rates
%K Bayesian
%K spatiotemporal pattern
%K tuberculosis
%K public health
%K China
%K disease burden
%K spatial data
%K regional inequality
%K risk
%K TB
%K unbalanced
%K notification data
%K trend
%K cases
%K incidence
%D 2022

%7 1.7.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: China has one of the highest tuberculosis (TB) burdens in the world. However, the unbalanced spatial and temporal trends of TB risk at a fine level remain unclear. Objective: We aimed to investigate the unbalanced risks of pulmonary tuberculosis (PTB) at different levels and how they evolved from both temporal and spatial aspects using PTB notification data from 2851 counties over a decade in China. Methods: County-level notified PTB case data were collected from 2009 to 2018 in mainland China. A Bayesian hierarchical model was constructed to analyze the unbalanced spatiotemporal patterns of PTB notification rates during this period at subnational scales. The Gini coefficient was calculated to assess the inequality of the relative risk (RR) of PTB across counties. Results: From 2009 to 2018, the number of notified PTB cases in mainland China decreased from 946,086 to 747,700. The average number of PTB cases in counties was 301 (SD 26) and the overall average notification rate was 60 (SD 6) per 100,000 people. There were obvious regional differences in the RRs for PTB (Gini coefficient 0.32, 95% CI 0.31-0.33). Xinjiang had the highest PTB notification rate, with a multiyear average of 155/100,000 (RR 2.3, 95% CI 1.6-2.8; P<.001), followed by Guizhou (117/100,000; RR 1.8, 95% CI 1.3-1.9; P<.001) and Tibet (108/100,000; RR 1.7, 95% CI 1.3-2.1; P<.001). The RR for PTB showed a steady downward trend. Gansu (local trend [LT] 0.95, 95% CI 0.93-0.96; P<.001) and Shanxi (LT 0.94, 95% CI 0.92-0.96; P<.001) experienced the fastest declines. However, the RRs for PTB in the western region (such as counties in Xinjiang, Guizhou, and Tibet) were significantly higher than those in the eastern and central regions (P<.001), and the decline rate of the RR for PTB was lower than the overall level (P<.001). Conclusions: PTB risk showed significant regional inequality among counties in China, and western China presented a high plateau of disease burden. Improvements in economic and medical service levels are required to boost PTB case detection and eventually reduce PTB risk in the whole country. 
%M 35776442
%R 10.2196/36242
%U https://publichealth.jmir.org/2022/7/e36242
%U https://doi.org/10.2196/36242
%U http://www.ncbi.nlm.nih.gov/pubmed/35776442

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e34087
%T A Mobile Education and Social Support Group Intervention for Improving Postpartum Health in Northern India: Development and Usability Study
%A El Ayadi,Alison M
%A Duggal,Mona
%A Bagga,Rashmi
%A Singh,Pushpendra
%A Kumar,Vijay
%A Ahuja,Alka
%A Kankaria,Ankita
%A Hosapatna Basavarajappa,Darshan
%A Kaur,Jasmeet
%A Sharma,Preetika
%A Gupta,Swati
%A Pendse,Ruchita S
%A Weil,Laura
%A Swendeman,Dallas
%A Diamond-Smith,Nadia G
%+ Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, United States, 1 4156598367, alison.elayadi@ucsf.edu
%K mHealth
%K group care
%K postpartum
%K postnatal
%K antenatal
%K India
%K pilot
%K mobile phone
%D 2022

%7 29.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Structural and cultural barriers limit Indian women’s access to adequate postnatal care and support despite their importance for maternal and neonatal health. Targeted postnatal education and support through a mobile health intervention may improve postnatal recovery, neonatal care practices, nutritional status, knowledge and care seeking, and mental health. Objective: We sought to understand the feasibility and acceptability of our first pilot phase, a flexible 6-week postnatal mobile health intervention delivered to 3 groups of women in Punjab, India, and adapt our intervention for our next pilot phase, which will formally assess intervention feasibility, acceptability, and preliminary efficacy. Methods: Our intervention prototype was designed to deliver culturally tailored educational programming via a provider-moderated, voice- and text-based group approach to connect new mothers with a social support group of other new mothers, increase their health-related communication with providers, and refer them to care needed. We targeted deployment using feature phones to include participants from diverse socioeconomic groups. We held moderated group calls weekly, disseminated educational audios, and created SMS text messaging groups. We varied content delivery, group discussion participation, and chat moderation. Three groups of postpartum women from Punjab were recruited for the pilot through community health workers. Sociodemographic data were collected at baseline. Intervention feasibility and acceptability were assessed through weekly participant check-ins (N=29), weekly moderator reports, structured end-line in-depth interviews among a subgroup of participants (15/29, 52%), and back-end technology data. Results: The participants were aged 24 to 28 years and 1 to 3 months postpartum. Of the 29 participants, 17 (59%) had their own phones. Half of the participants (14/29, 48%) attended ≥3 of the 6 calls; the main barriers were childcare and household responsibilities and network or phone issues. Most participants were very satisfied with the intervention (16/19, 84%) and found the educational content (20/20, 100%) and group discussions (17/20, 85%) very useful. The participants used the SMS text messaging chat, particularly when facilitator-moderated. Sustaining participation and fostering group interactions was limited by technological and sociocultural challenges. Conclusions: The intervention was considered generally feasible and acceptable, and protocol adjustments were identified to improve intervention delivery and engagement. To address technological issues, we engaged a cloud-based service provider for group calls and an interactive voice response service provider for educational recordings and developed a smartphone app for the participants. We seek to overcome sociocultural challenges through new strategies for increasing group engagement, including targeting midlevel female community health care providers as moderators. Our second pilot will assess intervention feasibility, acceptability, and preliminary effectiveness at 6 months. Ultimately, we seek to support the health and well-being of postpartum women and their infants in South Asia and beyond through the development of efficient, acceptable, and effective intervention strategies. 
%M 35767348
%R 10.2196/34087
%U https://formative.jmir.org/2022/6/e34087
%U https://doi.org/10.2196/34087
%U http://www.ncbi.nlm.nih.gov/pubmed/35767348

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e32089
%T The Effects of Theory-Based Educational Intervention and WhatsApp Follow-up on Papanicolaou Smear Uptake Among Postnatal Women in Malaysia: Randomized Controlled Trial
%A Mohammad,Zaahirah
%A Ahmad,Norliza
%A Baharom,Anisah
%+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Jalan Universiti 1, Seri Kembangan, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my
%K uterine cervical neoplasms
%K Papanicolaou test
%K psychological theory
%K self-efficacy
%K social media
%K health knowledge
%K attitude
%K practice
%K Malaysia
%D 2022

%7 27.6.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite the availability and accessibility of free Papanicolaou (Pap) smear as a screening tool for cervical cancer, the uptake of Pap smear in Malaysia has not changed in the last 15 years. Previous studies have shown that the high uptake of Pap smear reduces the mortality rate of patients with cervical cancer. The low uptake of Pap smear is multifactorial, and the problem could be minimized through the use of mobile technologies. Nevertheless, most intervention studies focused on individual factors, while other important aspects such as mobile technologies, especially WhatsApp, have not been investigated yet. Objective: This study aims to determine the effects of a theory-based educational intervention and WhatsApp follow-up (Pap smear uptake [PSU] intervention) in improving PSU among postnatal women in Seremban, Negeri Sembilan, Malaysia. Methods: A 2-arm, parallel single-blind cluster randomized controlled trial was conducted among postpartum women from the Seremban district. Twelve health clinics were randomly assigned to the intervention and control groups. At baseline, both groups received a self-administered questionnaire. The intervention group received standard care and PSU intervention delivered by a researcher. This 2-stage intervention module was developed based on Social Cognitive Theory, where the first stage was conducted face-to-face and the second stage included a WhatsApp follow-up. The control group received standard care. Participants were observed immediately and at 4, 8, and 12 weeks after the intervention. The primary endpoint was PSU, whereas the secondary endpoints were knowledge, attitude, and self-efficacy scores for Pap smear screening self-assessed using a Google Forms questionnaire. A generalized mixed model was used to determine the effectiveness of the intervention. All data were analyzed using IBM SPSS (version 25), and P value of .05 was considered statistically significant. Results: We analyzed 401 women, of whom 76 (response rate: 325/401, 81%) had withdrawn because of the COVID-19 pandemic, with a total of 162 respondents in the intervention group and 163 respondents in the control group. The proportion of Pap smears at the 12-week follow-up was 67.9% (110/162) in the intervention group versus 39.8% (65/163) in the control group (P<.001). Significant differences between the intervention and control groups were found for Pap smear use (F4,1178; P<.001), knowledge scores (F4,1172=14.946; P<.001), attitude scores (F4,1172=24.417; P<.001), and self-efficacy scores (F1,1172=10.432; P<.001). Conclusions: This study demonstrated that the PSU intervention is effective in increasing the uptake of Pap smear among postnatal women in Seremban district, Malaysia. This intervention module can be tested in other populations of women. Trial Registration: Thai Clinical Trials Registry TCTR20200205001; https://www.thaiclinicaltrials.org/show/TCTR20200205001 
%M 35759319
%R 10.2196/32089
%U https://mhealth.jmir.org/2022/6/e32089
%U https://doi.org/10.2196/32089
%U http://www.ncbi.nlm.nih.gov/pubmed/35759319

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 7
%N 2
%P e37882
%T Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study
%A Mash,Robert
%A Schouw,Darcelle
%A Fischer,Alex Emilio
%+ Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Rd, Tygerberg, Cape Town, 7505, South Africa, 27 219389170, rm@sun.ac.za
%K COVID-19
%K diabetes
%K primary care
%K patient education and counseling
%K mobile health
%K mHealth
%K eHealth
%K telemedicine
%K South Africa
%K mobile phone
%D 2022

%7 24.6.2022
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: In South Africa, diabetes is a leading cause of morbidity and mortality, which was exacerbated during the COVID-19 pandemic. Most education and counseling activities were stopped during the lockdown, and the GREAT4Diabetes WhatsApp Chatbot was innovated to fill this gap. Objective: This study aimed to evaluate the implementation of the chatbot in Cape Town, South Africa, between May and October 2021. Methods: Convergent mixed methods were used to evaluate the implementation outcomes: acceptability, adoption, appropriateness, feasibility, fidelity, cost, coverage, effects, and sustainability. Quantitative data were derived from the chatbot and analyzed using the SPSS. Qualitative data were collected from key informants and analyzed using the framework method assisted by Atlas-ti. The chatbot provided users with 16 voice messages and graphics in English, Afrikaans, or Xhosa. Messages focused on COVID-19 infection and self-management of type 2 diabetes. Results: The chatbot was adopted by the Metro Health Services to assist people with diabetes who had restricted health care during the lockdown and were at a higher risk of hospitalization and death from COVID-19 infection. The chatbot was disseminated via health care workers in primary care facilities and local nonprofit organizations and via local media and television. Two technical glitches interrupted the dissemination but did not substantially affect user behavior. Minor changes were made to the chatbot to improve its utility. Many patients had access to smartphones and were able to use the chatbot via WhatsApp. Overall, 8158 people connected with the chatbot and 4577 (56.1%) proceeded to listen to the messages, with 12.56% (575/4577) of them listening to all 16 messages, mostly within 32 days. The incremental setup costs were ZAR 255,000 (US $16,876) and operational costs over 6 months were ZAR 462,473 (US $30,607). More than 90% of the users who listened to each message found them useful. Of the 533 who completed the whole program, 351 (71.1%) said they changed their self-management a lot and 87.6% (369/421) were more confident. Most users changed their lifestyles in terms of diet (315/414, 76.1%) and physical activity (222/414, 53.6%). Health care workers also saw benefits to patients and recommended that the service continues. Sustainability of the chatbot will depend on the future policy of the provincial Department of Health toward mobile health and the willingness to contract with Aviro Health. There is the potential to go to scale and include other languages and chronic conditions. Conclusions: The chatbot shows great potential to complement traditional health care approaches for people with diabetes and assist with more comprehensive patient education. Further research is needed to fully explore the patient’s experience of the chatbot and evaluate its effectiveness in our context. 
%M 35537057
%R 10.2196/37882
%U https://diabetes.jmir.org/2022/2/e37882
%U https://doi.org/10.2196/37882
%U http://www.ncbi.nlm.nih.gov/pubmed/35537057

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e32577
%T Using the Consolidated Framework for Implementation Research to Inform the Design of the Mobile Inspección Visual con Ácido Acético System: Mixed Methods Case Study
%A Reid,Hadley Woodruff
%A Proeschold-Bell,Rae Jean
%A Makarushka,Christina
%A Melgar Vega,Katherine Dayllan
%A Huchko,Megan
%A Jeronimo,Jose
%A Vasudevan,Lavanya
%+ Department of Family Medicine and Community Health, Duke University, Suite 600, 2200 West Main Street, Durham, NC, 27705, United States, 1 919 613 1423, lavanya.vasudevan@duke.edu
%K cervical cancer
%K mobile health
%K Peru
%K colposcopy
%K implementation science
%K Consolidated Framework for Implementation Research
%K CFIR
%D 2022

%7 23.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is growing evidence supporting the use of mobile health (mHealth) interventions in low- and middle-income countries to address resource limitations in the delivery of health information and services to vulnerable populations. In parallel, there is an increasing emphasis on the use of implementation science tools and frameworks for the early identification of implementation barriers and to improve the acceptability, appropriateness, and adoption of mHealth interventions in resource-limited settings. However, there are limited examples of the application of implementation science tools and frameworks to the formative phase of mHealth design for resource-limited settings despite the potential benefits of this work for enhancing subsequent implementation, scale-up, and sustainability. Objective: We presented a case study on the use of an implementation science framework in mHealth design. In particular, we illustrated the usability of the Consolidated Framework for Implementation Research (CFIR) for organizing and interpreting formative research findings during the design of the mobile Inspección Visual con Ácido Acético (mIVAA) system in Lima, Peru. Methods: We collected formative data from prospective users of the mIVAA intervention using multiple research methodologies, including structured observations, surveys, group and individual interviews, and discussions with local stakeholders at the partnering organization in Peru. These activities enabled the documentation of clinical workflows, perceived barriers to and facilitators of mIVAA, overarching barriers to cervical cancer screening in community-based settings, and related local policies and guidelines in health care. Using a convergent mixed methods analytic approach and the CFIR as an organizing framework, we mapped formative research findings to identify key implementation barriers and inform iterations of the mIVAA system design. Results: In the setting of our case study, most implementation barriers were identified in the CFIR domains of intervention characteristics and inner setting. All but one barrier were addressed before mIVAA deployment by modifying the system design and adding supportive resources. Solutions involved improvements to infrastructure, including cellular data plans to avoid disruption from internet failure; improved process and flow, including an updated software interface; and better user role definition for image capture to be consistent with local health care laws. Conclusions: The CFIR can serve as a comprehensive framework for organizing formative research data and identifying key implementation barriers during mHealth intervention design. In our case study of the mIVAA system in Peru, formative research contributing to the CFIR domains of intervention characteristics and inner setting elicited the most key barriers to implementation. The early identification of barriers enabled design iterations before system deployment. Future efforts to develop mHealth interventions for low- and middle-income countries may benefit from using the approach presented in this case study as well as prioritizing the CFIR domains of intervention characteristics and inner setting. 
%M 35737455
%R 10.2196/32577
%U https://formative.jmir.org/2022/6/e32577
%U https://doi.org/10.2196/32577
%U http://www.ncbi.nlm.nih.gov/pubmed/35737455

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e31011
%T Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study
%A Kasetsuwan,Ngamjit
%A Suwan-Apichon,Olan
%A Lekhanont,Kaevalin
%A Chuckpaiwong,Varintorn
%A Reinprayoon,Usanee
%A Chantra,Somporn
%A Puangsricharern,Vilavun
%A Pariyakanok,Lalida
%A Prabhasawat,Pinnita
%A Tesavibul,Nattaporn
%A Chaidaroon,Winai
%A Tananuvat,Napaporn
%A Hirunpat,Chakree
%A Prakairungthong,Nauljira
%A Sansanayudh,Wiwan
%A Chirapapaisan,Chareenun
%A Phrueksaudomchai,Pakornkit
%+ Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Rama 4 Rd Pathum Wan, Pathumwan District, Bangkok, 10330, Thailand, 66 22564000 ext 81875, ngamjitk@gmail.com
%K blink rate
%K dry eye
%K smartphone application
%K maximum blink interval
%K prevalence
%K mHealth
%K epidemiology
%K screening
%K risk factors
%K symptoms
%K ophthalmology
%K vision
%D 2022

%7 22.6.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The “Dry eye or not?” app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. Objective: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. Methods: This cross-sectional study sourced data from the “Dry eye or not?” smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. Results: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor’s degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). Conclusions: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand. 
%M 35731569
%R 10.2196/31011
%U https://mhealth.jmir.org/2022/6/e31011
%U https://doi.org/10.2196/31011
%U http://www.ncbi.nlm.nih.gov/pubmed/35731569

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e18188
%T A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case
%A Sibuyi,Idon-Nkhenso
%A de la Harpe,Retha
%A Nyasulu,Peter
%+ Faculty of Informatics and Design, Cape Peninsula University of Technology, PO Box 652, Cape Town, 8000, South Africa, 27 833389132, insibuyioptometrist@gmail.com
%K MomConnect
%K mHealth
%K patient-facing eHealth
%K digital health innovation ecosystem
%K practitioner-researcher
%K stakeholder-centered design
%K re-engineering in health services
%K sustainable development goals
%K principles of digital development
%K global digital health index
%K strong structuration theory
%D 2022

%7 16.6.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector’s benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies. Objective: This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa. Methods: This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies. Results: Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government’s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth. Conclusions: This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa. 
%M 35708756
%R 10.2196/18188
%U https://mhealth.jmir.org/2022/6/e18188
%U https://doi.org/10.2196/18188
%U http://www.ncbi.nlm.nih.gov/pubmed/35708756

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e29856
%T Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study
%A Lambert,Yann
%A Galindo,Muriel
%A Suárez-Mutis,Martha
%A Mutricy,Louise
%A Sanna,Alice
%A Garancher,Laure
%A Cairo,Hedley
%A Hiwat,Helene
%A Bordalo Miller,Jane
%A Gomes,José Hermenegildo
%A Marchesini,Paola
%A Adenis,Antoine
%A Nacher,Mathieu
%A Vreden,Stephen
%A Douine,Maylis
%+ Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Avenue des Flamboyants, Cayenne, 97300, French Guiana, 594 594 39 48 64, yann.lambert@ch-cayenne.fr
%K malaria
%K Guiana Shield
%K information system
%K mobile data collection
%K Open Data Kit
%K ODK
%D 2022

%7 16.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. Trial Registration: ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770 
%M 35708763
%R 10.2196/29856
%U https://formative.jmir.org/2022/6/e29856
%U https://doi.org/10.2196/29856
%U http://www.ncbi.nlm.nih.gov/pubmed/35708763

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 6
%P e32964
%T Remote Consulting in Primary Health Care in Low- and Middle-Income Countries: Feasibility Study of an Online Training Program to Support Care Delivery During the COVID-19 Pandemic
%A Downie,Andrew
%A Mashanya,Titus
%A Chipwaza,Beatrice
%A Griffiths,Frances
%A Harris,Bronwyn
%A Kalolo,Albino
%A Ndegese,Sylvester
%A Sturt,Jackie
%A De Valliere,Nicole
%A Pemba,Senga
%+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7HL, United Kingdom, 44 024 7657 4880, F.E.Griffiths@warwick.ac.uk
%K remote consultation
%K mobile consulting
%K digital health
%K telehealth
%K mHealth
%K eHealth
%K mobile health
%K health care
%K cascade
%K train the trainer
%K low- and middle-income countries
%K rural areas
%K Tanzania
%K Kirkpatrick
%K consultation
%K training
%K low- and middle-income
%K rural
%K COVID-19
%D 2022

%7 14.6.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite acceleration of remote consulting throughout the COVID-19 pandemic, many health care professionals are practicing without training to offer teleconsultation to their patients. This is especially challenging in resource-poor countries, where the telephone has not previously been widely used for health care. Objective: As the COVID-19 pandemic dawned, we designed a modular online training program for REmote Consulting in primary Health care (REaCH). To optimize upscaling of knowledge and skills, we employed a train-the-trainer approach, training health workers (tier 1) to cascade the training to others (tier 2) in their locality. We aimed to determine whether REaCH training was acceptable and feasible to health workers in rural Tanzania to support their health care delivery during the pandemic. Methods: We developed and pretested the REaCH training program in July 2020 and created 8 key modules. The program was then taught remotely via Moodle and WhatsApp (Meta Platforms) to 12 tier 1 trainees and cascaded to 63 tier 2 trainees working in Tanzania’s rural Ulanga District (August-September 2020). We evaluated the program using a survey (informed by Kirkpatrick's model of evaluation) to capture trainee satisfaction with REaCH, the knowledge gained, and perceived behavior change; qualitative interviews to explore training experiences and views of remote consulting; and documentary analysis of emails, WhatsApp texts, and training reports generated through the program. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed thematically. Findings were triangulated and integrated during interpretation. Results: Of the 12 tier 1 trainees enrolled in the program, all completed the training; however, 2 (17%) encountered internet difficulties and failed to complete the evaluation. In addition, 1 (8%) opted out of the cascading process. Of the 63 tier 2 trainees, 61 (97%) completed the cascaded training. Of the 10 (83%) tier 1 trainees who completed the survey, 9 (90%) would recommend the program to others, reported receiving relevant skills and applying their learning to their daily work, demonstrating satisfaction, learning, and perceived behavior change. In qualitative interviews, tier 1 and 2 trainees identified several barriers to implementation of remote consulting, including lacking digital infrastructure, few resources, inflexible billing and record-keeping systems, and limited community awareness. The costs of data or airtime emerged as the greatest immediate barrier to supporting both the upscaling of REaCH training and subsequently the delivery of safe and trustworthy remote health care. Conclusions: The REaCH training program is feasible, acceptable, and effective in changing trainees’ behavior. However, government and organizational support is required to facilitate the expansion of the program and remote consulting in Tanzania and other low-resource settings. 
%M 35507772
%R 10.2196/32964
%U https://formative.jmir.org/2022/6/e32964
%U https://doi.org/10.2196/32964
%U http://www.ncbi.nlm.nih.gov/pubmed/35507772

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e31069
%T Viewing Mobile Health Technology Design Through the Lens of Amplification Theory
%A Merid,Beza
%A Robles,Maria Cielito
%A Nallamothu,Brahmajee K
%A Newman,Mark W
%A Skolarus,Lesli E
%+ School for the Future of Innovation in Society, Arizona State University, 1120 South Cady Mall, Tempe, AZ, 85281, United States, 1 (480) 727 8787, Beza.Merid@asu.edu
%K mHealth
%K digital health
%K cardiovascular disease
%K high blood pressure
%K structural barriers to health
%K racial health disparities
%K Amplification Theory of Technology
%D 2022

%7 10.6.2022
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Digital health interventions designed to promote health equity can be valuable tools in the delivery of health care to hardly served patient populations. But if the design of these technologies and the interventions in which they are deployed do not address the myriad structural barriers to care that minoritized patients, patients in rural areas, and patients who have trouble paying for care often face, their impact may be limited. Drawing on our mobile health (mHealth) research in the arena of cardiovascular care and blood pressure management, this viewpoint argues that health care providers and researchers should tend to structural barriers to care as a part of their digital health intervention design. Our 3-step predesign framework, informed by the Amplification Theory of Technology, offers a model that interventionists can follow to address these concerns.
%M 35687411
%R 10.2196/31069
%U https://mhealth.jmir.org/2022/6/e31069
%U https://doi.org/10.2196/31069
%U http://www.ncbi.nlm.nih.gov/pubmed/35687411

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 6
%P e37084
%T The First National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China: Protocol for the Design, Development, and Evaluation of a WeChat Applet
%A Yu,Hong
%A Tan,Lingcan
%A Teng,Yi
%A Xu,Zhao
%A Xiao,Kun
%A Yin,Jin
%A Zuo,Yunxia
%A Zhu,Tao
%A Deng,Xiaoqian
%+ Department of Anesthesiology, Sichuan University West China Hospital, No 37 Guoxue Alley, Chengdu, 610041, China, 86 13880408185, d_xiaoqian@163.com
%K malignant hyperthermia
%K hyperthermia
%K anesthetic
%K anesthesia
%K anesthesiology
%K anesthesiologist
%K mHealth
%K mobile health
%K health app
%K evaluation
%K user experience
%K perception
%K development
%K uni-app
%K digital health
%K national remote emergency system
%K WeChat
%K emergency
%K WeChat applet
%K dantrolene
%K China
%K Chinese
%K applet
%K messaging app
%K calling app
%K diagnosis
%K diagnostic service
%D 2022

%7 10.6.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Malignant hyperthermia (MH) is a rare life-threatening anesthetic emergency. With respect to the high fatality rate, difficulty in early recognition, and the lack of disease-specific drug (ie, dantrolene) in China, more effort is needed to strengthen early diagnosis and effective treatment of MH emergencies. Nowadays, mobile health (mHealth) apps are changing the way of medical practice; they can serve as an accessible tool to help anesthesiologists deal with MH crises. However, no related mHealth-based emergency system is available currently. Objective: The aim of this study is to outline the protocol for the development of a WeChat applet used to design a National Remote Emergency System for Malignant Hyperthermia (MH-NRES) in China, as well as the protocol for the evaluation of the user experience and perception of the system. Methods: The system adopts the client-server architecture, with a custom user interface operating as clients and the back-end system operating as the server. The client-side software was developed using uni-app technology with Vue.js-based framework, which consists of 6 modules: Quick Diagnosis, Dantrolene Mobilization, Instruction on Dantrolene Use, MH Treatment, Recovery Period Treatment, and DNA Test and Biopsy. The back-end system was developed based on the Spring framework. The system will be evaluated by administrating a modified user version of the Mobile App Rating Scale. Pilot testing will be conducted in Sichuan Province, China, and a subsequent evaluation on a national scale is planned. Results: The theoretical framework design of this system was completed in August 2021. The development of the system was completed in February 2022, and the refinement is currently ongoing. Pilot testing after the implementation of the system in Sichuan Province is planned to take 2 months, and the subsequent evaluation on a national scale is planned to take 2 months. Conclusions: We have described a novel approach using the WeChat applet to develop the MH-NRES. Findings from the usability testing process in the current study may lead to refinements and is expected to suggest that this system is both feasible and welcomed by anesthesiologists. Depending on the availability of research funding, this system will be extended nationally across China. International Registered Report Identifier (IRRID): PRR1-10.2196/37084 
%M 35687418
%R 10.2196/37084
%U https://www.researchprotocols.org/2022/6/e37084
%U https://doi.org/10.2196/37084
%U http://www.ncbi.nlm.nih.gov/pubmed/35687418

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e35155
%T The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial
%A Kateera,Fredrick
%A Riviello,Robert
%A Goodman,Andrea
%A Nkurunziza,Theoneste
%A Cherian,Teena
%A Bikorimana,Laban
%A Nkurunziza,Jonathan
%A Nahimana,Evrard
%A Habiyakare,Caste
%A Ntakiyiruta,Georges
%A Matousek,Alexi
%A Gaju,Erick
%A Gruendl,Magdalena
%A Powell,Brittany
%A Sonderman,Kristin
%A Koch,Rachel
%A Hedt-Gauthier,Bethany
%+ Center for Surgery and Public Health, Brigham and Women's Hospital, One Brigham Circle, 1620 Tremont St., Suite 2-016, Boston, MA, 02120, United States, 1 6177327715, rriviello@bwh.harvard.edu
%K obstetric surgery
%K community health workers
%K mobile health
%K surgical site infections
%K c-section
%K infection
%K community health
%K Rwanda
%D 2022

%7 8.6.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings. Objective: This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district. Methods: A total of 1025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7%), (2) phone call intervention (n=334, 32.6%), and (3) standard of care (n=356, 34.7%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care. Results: The majority of women in Arm 1 (n=295, 88.1%) and Arm 2 (n=226, 67.7%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7%, Arm 2: 98.4%, and Arm 3: 99.7%, respectively). Conclusions: Home-based post–c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy. Trial Registration: ClinicalTrials.gov NCT03311399; https://clinicaltrials.gov/ct2/show/NCT03311399 
%M 35675108
%R 10.2196/35155
%U https://mhealth.jmir.org/2022/6/e35155
%U https://doi.org/10.2196/35155
%U http://www.ncbi.nlm.nih.gov/pubmed/35675108

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 6
%P e28885
%T Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study
%A Stocks,Jacob
%A Ibrahim,Saduma
%A Park,Lawrence
%A Huchko,Megan
%+ Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 681 7760, jacob_stocks@med.unc.edu
%K cell phone
%K mobile health
%K mHealth
%K cervical cancer screening
%K Kenya
%K human papillomavirus
%K HPV testing
%D 2022

%7 7.6.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective: This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message–guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods: This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)–based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results: Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV–positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions: Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process. 
%M 35671089
%R 10.2196/28885
%U https://publichealth.jmir.org/2022/6/e28885
%U https://doi.org/10.2196/28885
%U http://www.ncbi.nlm.nih.gov/pubmed/35671089

%0 Journal Article
        
%@ 2369-3762
%I JMIR Publications
%V 8
%N 2
%P e32614
%T Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review
%A Guillaume,Dominique
%A Troncoso,Erica
%A Duroseau,Brenice
%A Bluestone,Julia
%A Fullerton,Judith
%+ Jhpiego, 1615 Thames St # 200, Baltimore, MD, 21231, United States, 1 410 537 1800, dominique.guillaume@jhpiego.org
%K digital learning
%K continuing medical education
%K mHealth
%K peer learning
%K mentorship
%K health systems
%K global health
%K mobile phone
%D 2022

%7 7.6.2022
%9 Review
%J JMIR Med Educ
%G English
                
%X Background: Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs. Objective: The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning. Methods: A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes. Results: A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students. Conclusions: The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital. 
%M 35671080
%R 10.2196/32614
%U https://mededu.jmir.org/2022/2/e32614
%U https://doi.org/10.2196/32614
%U http://www.ncbi.nlm.nih.gov/pubmed/35671080

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 7
%N 2
%P e23641
%T Technological Proficiencies, Engagement, and Practical Considerations for mHealth Programs at an Urban Safety-Net Hospital Emergency Departments: Data Analysis
%A Treacy-Abarca,Sean
%A Mercado,Janisse
%A Serrano,Jorge
%A Gonzalez,Jennifer
%A Menchine,Michael
%A Arora,Sanjay
%A Wu,Shinyi
%A Burner,Elizabeth
%+ David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 3108256373, sean.e.treacy@gmail.com
%K mHealth
%K engagement
%K practical considerations
%K safety-net hospital
%K emergency department
%K minority health
%K low income
%D 2022

%7 6.6.2022
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: Safety-net emergency departments often serve as the primary entry point for medical care for low income predominantly minority patient populations. Herein, we sought to provide insight into the feasibility, technological proficiencies, engagement characteristics, and practical considerations for a mHealth intervention at a safety-net emergency department. Objective: We aimed to analyze patient technological proficiency to understand the feasibility of and draw practical considerations for mobile phone technology (mHealth) solutions for patients with chronic disease served by safety-net emergency departments. Methods: We analyzed data from a previous diabetes randomized clinical mHealth trial for a diabetes social support intervention. Patients from a safety-net emergency department with preexisting diabetes who used SMS text messages, owned a mobile phone, and with hemoglobin A1c levels >8.5% were enrolled. A text message–based mHealth program to improve disease self-management was provided to all patients. Supporters of patients were randomized to receive a mailed copy or mHealth-based curriculum designed to improve diabetes support. Among enrolled patients, we surveyed mobile technological capacity and frequency of use. We performed latent class analysis to identify classes of patients by level of technological proficiency and compared demographic characteristics between the latent classes to identify demographic subgroups that may require more training or tailoring of the mHealth approach. Study engagement between classes was assessed by comparing the mean number of text messages exchanged, loss to follow-up, and early termination. Results: Of 1876 patients who were approached, 44.2% (n=829) of patients had a stable mobile phone and were able to use text messages. Among them 166 met the trial inclusion and enrolled, 90% (149/166) of the cohort were ethnically diverse. Significant variance was found in technology capacity and frequency of use. Our latent class analysis classified 75% (124/166) of patients as highly technologically proficient and 25% (42/166) patients as minimally technologically proficient. Age (P<.001) and level of education (P<.001) were associated with class membership. Highly technologically proficient patients were younger and had higher levels of education (45.74 years old; high school or more: 90%) than minimally technologically proficient patients (53.64 years old; high school or more: 18%). Highly technologically proficient participants exchanged a mean of 40 text messages with the system coordinators compared to a mean of 10 text messages by minimally technologically proficient patients (P<.001). Conclusions: This study found that nearly half of the patients screened at the safety-net emergency department were equipped for an SMS text message–based mHealth intervention. In the small sample of patients who were enrolled, the majority were classified as highly technologically proficient. These highly proficient patients had greater study engagement. mHealth use in emergency departments may be an opportunity to improve health of ethnically diverse populations by pairing sophisticated chronic disease self-management program with SMS text message–based and traditional in-person interventions to reach patients through the method that is most familiar and comfortable. International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.03.003 
%M 35666555
%R 10.2196/23641
%U https://diabetes.jmir.org/2022/2/e23641
%U https://doi.org/10.2196/23641
%U http://www.ncbi.nlm.nih.gov/pubmed/35666555

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 6
%P e30960
%T Impact of the Moderating Effect of National Culture on Adoption Intention in Wearable Health Care Devices: Meta-analysis
%A Zhang,Zhenming
%A Xia,Enjun
%A Huang,Jieping
%+ School of Management and Economics, Beijing Institute of Technology, 5 South Zhongguancun Street, Haidian District, Beijing, 100081, China, 86 139 1085 0628, cindy@bit.edu.cn
%K wearable health care devices
%K national culture
%K moderating effect
%K meta-analysis
%D 2022

%7 3.6.2022
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Wearable health care devices have not yet been commercialized on a large scale. Additionally, people in different countries have different utilization rates. Therefore, more in-depth studies on the moderating effect of national culture on adoption intention in wearable health care devices are necessary. Objective: This study aims to explore the summary results of the relationships between perceived usefulness and perceived ease of use with adoption intention in wearable health care devices and the impact of the moderating effect of national culture on these two relationships. Methods: We searched for studies published before September 2021 in the Web of Science, EBSCO, Engineering Village, China National Knowledge Infrastructure, IEEE Xplore, and Wiley Online Library databases. CMA (version 2.0, Biostat Inc) software was used to perform the meta-analysis. We conducted publication bias and heterogeneity tests on the data. The random-effects model was used to estimate the main effect size, and a sensitivity analysis was conducted. A meta-regression analysis was used to test the moderating effect of national culture. Results: This meta-analysis included 20 publications with a total of 6128 participants. Perceived usefulness (r=0.612, P<.001) and perceived ease of use (r=0.462, P<.001) positively affect adoption intention. The relationship between perceived usefulness and adoption intention is positively moderated by individualism/collectivism (β=.003, P<.001), masculinity/femininity (β=.008, P<.001) and indulgence/restraint (β=.005, P<.001), and negatively moderated by uncertainty avoidance (β=-.005, P<.001). The relationship between perceived ease of use and adoption intention is positively moderated by individualism/collectivism (β=.003, P<.001), masculinity/femininity (β=.006, P<.001) and indulgence/restraint (β=.009, P<.001), and negatively moderated by uncertainty avoidance (β=-.004, P<.001). Conclusions: This meta-analysis provided comprehensive evidence on the positive relationship between perceived usefulness and perceived ease of use with adoption intention and the moderating effect of national culture on these two relationships. Regarding the moderating effect, perceived usefulness and perceived ease of use have a greater impact on adoption intention for people in individualistic, masculine, low uncertainty avoidance, and indulgence cultures, respectively. 
%M 35657654
%R 10.2196/30960
%U https://mhealth.jmir.org/2022/6/e30960
%U https://doi.org/10.2196/30960
%U http://www.ncbi.nlm.nih.gov/pubmed/35657654

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 11
%N 1
%P e35062
%T Ethical, Legal, and Sociocultural Issues in the Use of Mobile Technologies and Call Detail Records Data for Public Health in the East African Region: Scoping Review
%A Sekandi,Juliet Nabbuye
%A Murray,Kenya
%A Berryman,Corinne
%A Davis-Olwell,Paula
%A Hurst,Caroline
%A Kakaire,Robert
%A Kiwanuka,Noah
%A Whalen,Christopher C
%A Mwaka,Erisa Sabakaki
%+ Global Health Institute, College of Public Health, University of Georgia, Wright Hall, Room 227B, 100 Foster Rd, Athens, GA, 30602, United States, 1 706 542 5257, jsekandi@uga.edu
%K mobile health
%K public health
%K ethics
%K privacy
%K call detail records
%K East Africa
%K Africa
%K mobile apps
%K mHealth
%D 2022

%7 2.6.2022
%9 Review
%J Interact J Med Res
%G English
                
%X Background: The exponential scale and pace of real-time data generated from mobile phones present opportunities for new insights and challenges across multiple sectors, including health care delivery and public health research. However, little attention has been given to the new ethical, social, and legal concerns related to using these mobile technologies and the data they generate in Africa. Objective: The objective of this scoping review was to explore the ethical and related concerns that arise from the use of data from call detail records and mobile technology interventions for public health in the context of East Africa. Methods: We searched the PubMed database for published studies describing ethical challenges while using mobile technologies and related data in public health research between 2000 and 2020. A predefined search strategy was used as inclusion criteria with search terms such as “East Africa,” “mHealth,” “mobile phone data,” “public health,” “ethics,” or “privacy.” We screened studies using prespecified eligibility criteria through a two-stage process by two independent reviewers. Studies were included if they were (1) related to mobile technology use and health, (2) published in English from 2000 to 2020, (3) available in full text, and (4) conducted in the East African region. We excluded articles that (1) were conference proceedings, (2) studies presenting an abstract only, (3) systematic and literature reviews, (4) research protocols, and (5) reports of mobile technology in animal subjects. We followed the five stages of a published framework for scoping reviews recommended by Arksey and O’Malley. Data extracted included title, publication year, target population, geographic region, setting, and relevance to mobile health (mHealth) and ethics. Additionally, we used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews checklist to guide the presentation of this scoping review. The rationale for focusing on the five countries in East Africa was their geographic proximity, which lends itself to similarities in technology infrastructure development. Results: Of the 94 studies identified from PubMed, 33 met the review inclusion criteria for the final scoping review. The 33 articles retained in the final scoping review represent studies conducted in three out of five East African countries: 14 (42%) from Uganda, 13 (39%) from Kenya, and 5 (16%) from Tanzania. Three main categories of concerns related to the use of mHealth technologies and mobile phone data can be conceptualized as (1) ethical issues (adequate informed consent, privacy and confidentiality, data security and protection), (2) sociocultural issues, and (3) regulatory/legal issues. Conclusions: This scoping review identified major cross-cutting ethical, regulatory, and sociocultural concerns related to using data from mobile technologies in the East African region. A comprehensive framework that accounts for the critical concerns raised would be valuable for guiding the safe use of mobile technology data for public health research purposes. 
%M 35533323
%R 10.2196/35062
%U https://www.i-jmr.org/2022/1/e35062
%U https://doi.org/10.2196/35062
%U http://www.ncbi.nlm.nih.gov/pubmed/35533323

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 5
%P e37356
%T Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review
%A Phoo,Nang Nge Nge
%A Lobo,Roanna
%A Vujcich,Daniel
%A Reid,Alison
%+ School of Population Health, Curtin University, Kent Street, Bentley WA, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au
%K ACASI
%K survey mode
%K sexual behaviors
%K HIV
%K STI
%K hepatitis
%K blood-borne virus
%K Asia
%K sub-Saharan Africa
%K review
%D 2022

%7 31.5.2022
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are  regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as “forced sex,” “multiple partners,” “transactional sex,” and “ever had sex,” as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. 
%M 35639465
%R 10.2196/37356
%U https://www.jmir.org/2022/5/e37356
%U https://doi.org/10.2196/37356
%U http://www.ncbi.nlm.nih.gov/pubmed/35639465

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e34279
%T Application of Spatial Risk Assessment Integrated With a Mobile App in Fighting Against the Introduction of African Swine Fever in Pig Farms in Thailand: Development Study
%A Thanapongtharm,Weerapong
%A Wongphruksasoong,Vilaiporn
%A Sangrat,Waratida
%A Thongsrimoung,Kittin
%A Ratanavanichrojn,Nattavut
%A Kasemsuwan,Suwicha
%A Khamsiriwatchara,Amnat
%A Kaewkungwal,Jaranit
%A Leelahapongsathon,Kansuda
%+ Faculty of Veterinary Medicine, Kasetsart University, Malaiman Rd, Kamphaeng Saen, Nakhon Pathom, 73140, Thailand, 66 34351901, fvetkul@ku.ac.th
%K African swine fever
%K multi-criteria decision analysis
%K risk-based surveillance
%K risk assessment
%K spatial analysis
%D 2022

%7 31.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: African swine fever (ASF), a highly contagious disease affecting both domestic and wild pigs, has been having a serious impact on the swine industry worldwide. This important transboundary animal disease can be spread by animals and ticks via direct transmission and by contaminated feed and fomites via indirect transmission because of the high environmental resistance of the ASF virus. Thus, the prevention of the introduction of ASF to areas free of ASF is essential. After an outbreak was reported in China, intensive import policies and biosecurity measures were implemented to prevent the introduction of ASF to pig farms in Thailand. Objective: Enhancing prevention and control, this study aims to identify the potential areas for ASF introduction and transmission in Thailand, develop a tool for farm assessment of ASF risk introduction focusing on smallholders, and develop a spatial analysis tool that is easily used by local officers for disease prevention and control planning. Methods: We applied a multi-criteria decision analysis approach with spatial and farm assessment and integrated the outputs with the necessary spatial layers to develop a spatial analysis on a web-based platform. Results: The map that referred to potential areas for ASF introduction and transmission was derived from 6 spatial risk factors; namely, the distance to the port, which had the highest relative importance, followed by the distance to the border, the number of pig farms using swill feeding, the density of small pig farms (<50 heads), the number of pigs moving in the area, and the distance to the slaughterhouse. The possible transmission areas were divided into 5 levels (very low, low, medium, high, and very high) at the subdistrict level, with 27 subdistricts in 10 provinces having very high suitability and 560 subdistricts in 34 provinces having high suitability. At the farm level, 17 biosecurity practices considered as useful and practical for smallholders were selected and developed on a mobile app platform. The outputs from the previous steps integrated with necessary geographic information system layers were added to a spatial analysis web-based platform. Conclusions: The tools developed in this study have been complemented with other strategies to fight against the introduction of ASF to pig farms in the country. The areas showing high and very high risk for disease introduction and transmission were applied for spatial information planning, for example, intensive surveillance, strict animal movement, and public awareness. In addition, farms with low biosecurity were improved in these areas, and the risk assessment developed on a mobile app in this study helped enhance this matter. The spatial analysis on a web-based platform helped facilitate disease prevention planning for the authorities. 
%M 35639455
%R 10.2196/34279
%U https://formative.jmir.org/2022/5/e34279/
%U https://doi.org/10.2196/34279
%U http://www.ncbi.nlm.nih.gov/pubmed/35639455

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 5
%P e37659
%T Optimizing an mHealth Intervention to Improve Uptake and Adherence to HIV Pre-exposure Prophylaxis in Young Transgender Women: Protocol for a Multi-Phase Trial
%A MacDonell,Karen Kolmodin
%A Wang,Bo
%A Phanuphak,Nittaya
%A Janamnuaysook,Rena
%A Srimanus,Peevara
%A Rongkavilit,Chokechai
%A Naar,Sylvie
%+ Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, iBio 6135 Woodward Ave, Detroit, MI, 48202, United States, 1 3135776996, karen.macdonell@wayne.edu
%K transgender women
%K PrEP
%K HIV prevention
%K mHealth
%K motivational interviewing
%K Thailand
%K mobile phone
%D 2022

%7 19.5.2022
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Vulnerable adolescents and emerging adults (aged 18-29 years), particularly young transgender women, are among the fastest-growing HIV positive populations worldwide. Thailand has the highest adult HIV seroprevalence in Asia, with a rate of infection among this population of 18%. Widespread technology offers opportunities for innovative mobile health (mHealth) interventions. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for at-risk individuals. PrEP is highly effective when taken as prescribed, but uptake and adherence have been low, with high discontinuation rates among youth. Objective: We propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage. We will adapt an existing 2-session, technology-delivered, motivational interviewing-based intervention to focus on PrEP use in transgender women in Thailand. We call this the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team. The new version of the app is called Enhanced YaCool, and it enables self-management of gender and sexual health (including PrEP). Our primary aim is to develop and assess the preliminary efficacy of this mHealth intervention. Methods: We will utilize a multiphase optimization strategy (MOST) to identify the most effective intervention component or combination of components to improve PrEP usage in Thai transgender women. The study includes two phases: phase I (R21) includes qualitative interviews with key stakeholders to explore barriers and facilitators of PrEP usage through thematic analysis to inform intervention adaptation. Following this, we will adapt and beta-test MES-PrEP and Enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women. In phase II (R33), we will conduct a MOST design-based trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and Enhanced YaCool. Eighty HIV-negative participants who are currently taking PrEP and 80 participants who are not will be randomized to four conditions: (1) standard PrEP counseling (the control condition); (2) MES-PrEP and standard PrEP counseling; (3) Enhanced YaCool and standard PrEP counseling; and (4) MES-PrEP, Enhanced YaCool, and standard PrEP counseling. Feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of participants who initiate PrEP and their level of adherence to PrEP. Assessments will be at baseline and 1, 3, 6, 9, and 12 months postintervention. Biomarkers of adherence to PrEP, HIV, and other sexually transmitted infections will be collected. Results: Upon project completion, we will have an optimized mHealth intervention to support the use of PrEP by transgender women that will be ready for testing in a larger efficacy trial. Conclusions: Even though transgender women in Thailand face increasing risks of HIV, few interventions have targeted them. Effective developmentally and culturally tailored interventions are needed to prevent HIV transmission in this high-risk population. Trial Registration: ClinicalTrials.gov NCT05262426; https://clinicaltrials.gov/ct2/show/NCT05262426 International Registered Report Identifier (IRRID): PRR1-10.2196/37659 
%M 35587370
%R 10.2196/37659
%U https://www.researchprotocols.org/2022/5/e37659
%U https://doi.org/10.2196/37659
%U http://www.ncbi.nlm.nih.gov/pubmed/35587370

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e37124
%T The Acceptability of Adherence Support via Mobile Phones for Antituberculosis Treatment in South India: Exploratory Study
%A Jose,Nisha K
%A Vaz,Clint
%A Chai,Peter R
%A Rodrigues,Rashmi
%+ Non Communicable Diseases Division, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India, 91 9717660464, cathnisha@gmail.com
%K adherence
%K tuberculosis
%K antitubercular therapy
%K mHealth
%K mobile health
%K digital health
%K South India
%K technology acceptance
%K health intervention
%D 2022

%7 13.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: India has the greatest burden of tuberculosis (TB). However, over 15% of the people on antitubercular therapy (ATT) in India are nonadherent. Several adherence monitoring techniques deployed in India to enhance ATT adherence have had modest effects. Increased adoption of mobile phones and other technologies pose potential solutions to measuring and intervening in ATT adherence. Several technology-based interventions around ATT adherence have been demonstrated in other countries. Objective: The objective of our study was to understand the acceptance of mobile phone adherence supports for ATT using self-administered quantitative measures among patients with TB in South India. Methods: This exploratory study was conducted at a TB treatment center (TTC) at a tertiary care center in Thrissur District, Kerala, India. We recruited 100 patients with TB on ATT using convenience sampling after obtaining written informed consent. Trained study staff administered the questionnaire in Malayalam, commonly spoken in Kerala, India. We used frequency, mean, median, and SD or IQR to describe the data. Results: Of the 100 participants diagnosed with TB on ATT, 90% used mobile phones routinely, and 84% owned a mobile phone. Ninety-five percent of participants knew how to use the calling function, while 65% of them did not know how to use the SMS function on their mobile phone. Overall, 89% of the participants did not consider mobile phone–based ATT adherence interventions an intrusion in their privacy, and 93% did not fear stigma if the adherence reminder was received by someone else. Most (95%) of the study participants preferred mobile phone reminders instead of directly observed treatment, short-course. Voice calls (n=80, 80%) were the more preferred reminder modality than SMS reminders (n=5, 5%). Conclusions: Mobile phones are likely an acceptable platform to deliver ATT adherence interventions among individuals with TB in South India. Preference of voice call reminders may inform the architecture of future adherence interventions surrounding ATT in South India. 
%M 35560021
%R 10.2196/37124
%U https://formative.jmir.org/2022/5/e37124
%U https://doi.org/10.2196/37124
%U http://www.ncbi.nlm.nih.gov/pubmed/35560021

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e34852
%T Access to and Use of Mobile Phone by Postpartum, Married Women in Punjab, India: Secondary Analysis of mHealth Intervention Pilot Data
%A Pendse,Ruchita S
%A El Ayadi,Alison M
%A Sharma,Preetika
%A Ahuja,Alka
%A Hosapatna Basavarajappa,Darshan
%A Duggal,Mona
%A Kankaria,Ankita
%A Singh,Pushpendra
%A Kumar,Vijay
%A Bagga,Rashmi
%A Diamond-Smith,Nadia G
%+ Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St 2nd floor, San Francisco, CA, 94158, United States, 1 4154762300, nadia.diamond-smith@ucsf.edu
%K pregnancy
%K mothers
%K postpartum period
%K postnatal care
%K mobile phone use
%K mHealth
%K mobile health
%K digital health
%K telemedicine
%K health education
%K sex factors
%K gender
%K India
%K South Asia
%D 2022

%7 12.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: As mobile phone uptake in India continues to grow, there is also continued interest in mobile platform–based interventions for health education. There is a significant gender gap in mobile phone access—women’s access to mobile phones is constrained by economic and social barriers. Pregnancy and postpartum care is one of many targets for mobile health (mHealth) interventions that particularly rely upon women’s access to and facility with mobile phone use. Objective: We aimed to describe the dynamics and patterns of married pregnant and postpartum women’s mobile phone access and use (among both phone owners and nonowners) who participated in an mHealth postpartum care intervention and to identify potential barriers to their participation in mobile platform–based interventions. Methods: A secondary analysis was performed on mixed methods data obtained for a pilot mHealth intervention for postpartum care of mothers in rural Punjab from July 2020 to February 2021. Two formative sources included exploratory in-depth interviews among postpartum women (n=20; 1-3 months postpartum) and quantitative maternal health survey among women who were pregnant or who had recently given birth (n=102). We also utilized mixed methods intervention assessment data from early postpartum women who participated in the pilot intervention (n=29), including intervention moderator perspectives. Qualitative and quantitative analyses were performed, and pertinent findings were grouped thematically. Results: The majority of women owned a phone (maternal health survey: 75/102, 74%; demographic survey: 17/29, 59%), though approximately half (53/102, 52%) still reported sharing phones with other family members. Sharing a phone with female family members typically allowed for better access than sharing with male family members. Some households had strict preferences against daughters-in-law having phones, or otherwise significantly restricted women’s phone access. Others reported concerns about phone use–related health hazards  for mother and infant during the pregnancy or postpartum period. Conclusions: These findings suggest nuance regarding what is meant by women’s phone ownership and access—there were numerous additional constraints on women’s use of phones, particularly during pregnancy and the postpartum period. Future research and mHealth interventions should probe these domains to better understand the dynamics governing women’s access, use, and fluency with mobile phones to optimally design mHealth interventions. 
%M 35551059
%R 10.2196/34852
%U https://formative.jmir.org/2022/5/e34852
%U https://doi.org/10.2196/34852
%U http://www.ncbi.nlm.nih.gov/pubmed/35551059

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 5
%P e34041
%T An Evidence-Based HIV Risk–Reduction Intervention for Young African American Women in the US South Using mHealth: Adaptation and Development Study
%A Watkins,Rebecca L
%A Browne,Felicia A
%A Kizakevich,Paul N
%A Howard,Brittni N
%A Turner,Leslie B
%A Eckhoff,Randall
%A Wechsberg,Wendee M
%+ RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 541 6596, fbrowne@rti.org
%K substance use
%K prevention
%K e-learning
%K adaptation
%K mobile apps
%K health risk behaviors
%K self-directed learning
%K HIV
%K women
%K young women
%K violence
%K mHealth app
%K gamification
%K mobile phone
%D 2022

%7 9.5.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Young African American women have higher rates of sexually transmitted infections, including HIV, than those of young women of other racial and ethnic groups. Gender-, culture-, and age-specific interventions are needed to end the HIV epidemic. The Women’s CoOp (WC) is an HIV risk–reduction intervention that is proven to be efficacious in various face-to-face formats. Objective: This study aims to adapt the delivery method of an evidence-based intervention, the WC, from an in-person format to a self-guided mobile health (mHealth) format while ensuring that core elements are maintained for intervention comparability and fidelity. Methods: Several adaptation phases were conducted by using the Personal Health Informatics and Intervention Toolkit (PHIT) as a guiding point to create the mobile app version of the WC. Throughout 5 phases, we established the implementation groundwork for the app; conducted formative research activities to test the initial draft of the app and obtain feedback; applied the PHIT toolkit programming structure to produce the mHealth version of the WC intervention; conducted usability testing and pretesting with interested parties, followed by in-house testing by WC interventionists and PHIT developers; and deployed the app to tablets and distributed it to study participants. The app underwent regular maintenance updates during the study. Results: The team converted the seven elements of the WC as accurately as possible for comparability to determine efficacy in a mobile app format while changing little about the basic delivery methods. For instance, cue card presentations of the materials delivered by the intervention staff were presented within the app but with voice-over narration and in a self-guided format rather than being led by a staff member. Other aspects of the intervention did not lend themselves to such straightforward adaptation, such as hands-on condom proficiency practice and one-on-one goal-setting activities. In these cases, the subject matter experts and app developers worked together to find comparable analogs to be used within the app. Once developed, tested, and finalized, the mHealth WC app was deployed into local health departments as part of a randomized trial. Conclusions: This systematic adaptation process created an accurate mHealth equivalent of an existing, in-person behavioral health intervention. Although participants’ reception of the app during the formative developmental phase was overall positive, maintaining fidelity to the in-person delivery compromised the natural capabilities of a mobile app, such as further gamification, different types of interactivity, and integrated notifications and messaging, which could be helpful for participants’ adherence to the intervention schedule. Given the development and implementation of the app, the next step is to examine the impact of the app and its efficacy in HIV and substance use risk-reduction. 
%M 35532978
%R 10.2196/34041
%U https://formative.jmir.org/2022/5/e34041
%U https://doi.org/10.2196/34041
%U http://www.ncbi.nlm.nih.gov/pubmed/35532978

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 10
%N 5
%P e32305
%T User Perceptions and Use of an Enhanced Electronic Health Record in Rwanda With and Without Clinical Alerts: Cross-sectional Survey
%A Fraser,Hamish S F
%A Mugisha,Michael
%A Remera,Eric
%A Ngenzi,Joseph Lune
%A Richards,Janise
%A Santas,Xenophon
%A Naidoo,Wayne
%A Seebregts,Christopher
%A Condo,Jeanine
%A Umubyeyi,Aline
%+ Brown Center for Biomedical Informatics, Brown University, 233 Richmond street, Providence, RI, 02912, United States, 1 401 863 1815, hamish_fraser@brown.edu
%K electronic health record
%K eHealth
%K HIV/AIDS
%K survey
%K Rwanda
%K implementation science
%D 2022

%7 3.5.2022
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Electronic health records (EHRs) have been implemented in many low-resource settings but lack strong evidence for usability, use, user confidence, scalability, and sustainability. Objective: This study aimed to evaluate staff use and perceptions of an EHR widely used for HIV care in >300 health facilities in Rwanda, providing evidence on factors influencing current performance, scalability, and sustainability. Methods: A randomized, cross-sectional, structured interview survey of health center staff was designed to assess functionality, use, and attitudes toward the EHR and clinical alerts. This study used the associated randomized clinical trial study sample (56/112, 50% sites received an enhanced EHR), pulling 27 (50%) sites from each group. Free-text comments were analyzed thematically using inductive coding. Results: Of the 100 participants, 90 (90% response rate) were interviewed at 54 health centers: 44 (49%) participants were clinical and 46 (51%) were technical. The EHR top uses were to access client data easily or quickly (62/90, 69%), update patient records (56/89, 63%), create new patient records (49/88, 56%), generate various reports (38/85, 45%), and review previous records (43/89, 48%). In addition, >90% (81/90) of respondents agreed that the EHR made it easier to make informed decisions, was worth using, and has improved patient information quality. Regarding availability, (66/88) 75% said they could always or almost always count on the EHR being available, whereas (6/88) 7% said never/almost never. In intervention sites, staff were significantly more likely to update existing records (P=.04), generate summaries before (P<.001) or during visits (P=.01), and agree that “the EHR provides useful alerts, and reminders” (P<.01). Conclusions: Most users perceived the EHR as well accepted, appropriate, and effective for use in low-resource settings despite infrastructure limitation in 25% (22/88) of the sites. The implementation of EHR enhancements can improve the perceived usefulness and use of key functions. Successful scale-up and use of EHRs in small health facilities could improve clinical documentation, care, reporting, and disease surveillance in low- and middle-income countries. 
%M 35503526
%R 10.2196/32305
%U https://medinform.jmir.org/2022/5/e32305
%U https://doi.org/10.2196/32305
%U http://www.ncbi.nlm.nih.gov/pubmed/35503526

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 4
%P e34061
%T Effects of mHealth Interventions on Improving Antenatal Care Visits and Skilled Delivery Care in Low- and Middle-Income Countries: Systematic Review and Meta-analysis
%A Rahman,Md Obaidur
%A Yamaji,Noyuri
%A Nagamatsu,Yasuko
%A Ota,Erika
%+ Department of Global Health Nursing, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 3543 6391 ext 4990, obaidur006@gmail.com
%K mobile health
%K ANC
%K skilled delivery care
%K LMICs
%K systematic review and meta-analysis
%D 2022

%7 22.4.2022
%9 Review
%J J Med Internet Res
%G English
                
%X Background: The poor coverage of essential maternal services, such as antenatal care (ANC) and skilled delivery care utilization, accounts for higher maternal and infant mortality in low- and middle-income countries (LMICs). Although mobile health (mHealth) interventions could potentially improve the service utilization in resource-limited settings, their effectiveness remains unclear. Objective: This review aimed to summarize the effect of mHealth interventions on improving the uptake of ANC visits, skilled birth attendance at the time of delivery, and facility delivery among pregnant women in LMICs. Methods: We conducted a comprehensive search on 9 electronic databases and other resources from inception to October 2020. We included individual randomized controlled trials and cluster randomized controlled trials that assessed the effectiveness of mHealth interventions for improving perinatal health care utilization among healthy pregnant women in LMICs. We performed a random-effects meta-analysis and estimated the pooled effect size by using risk ratios (RRs) with 95% CIs. In addition, 2 reviewers independently assessed the risk of bias of the included studies by using the Cochrane risk of bias tool and the certainty of the evidence by using the Grading of Recommendation, Assessment, Development and Evaluation approach. Results: A total of 9 studies (10 articles) that randomized 10,348 pregnant women (n=6254, 60.44% in the intervention group; n=4094, 39.56% in the control group) were included in this synthesis. The pooled estimates showed a positive effect of mHealth interventions on improving 4 or more ANC visit utilizations among pregnant women in LMICs, irrespective of the direction of interventions (1-way communications: RR 2.14, 95% CI 1.76-2.60, I2=36%, 2 studies, moderate certainty; 2-way communications: RR 1.17, 95% CI 1.08-1.27, I2=59%, 3 studies, low certainty). Only 2-way mHealth interventions were effective in improving the use of skilled birth attendance during delivery (RR 1.23, 95% CI 1.14-1.33, I2=0%, 2 studies, moderate certainty), but the effects were unclear for 1-way mHealth interventions (RR 1.04, 95% CI 0.97-1.10, I2=73%, 3 studies, very low certainty) when compared with standard care. For facility delivery, the interventions were effective in settings where fewer pregnant women used facility delivery (RR 1.68, 95% CI 1.30-2.19, I2=36%, 2 studies, moderate certainty); however, the effects were unclear in settings where most pregnant women already used facility delivery (RR 1.01, 95% CI 0.97-1.04, I2=0%, 1 study, low certainty). Conclusions: mHealth interventions may contribute to improving ANC and skilled delivery care utilization among pregnant women in LMICs. However, more studies are required to improve their reproducibility and efficiency or strengthen the evidence of different forms of mHealth interventions because of the considerable heterogeneity observed in the meta-analyses. Trial Registration: PROSPERO CRD42020210813; https://tinyurl.com/2n7ny9a7 
%M 35451987
%R 10.2196/34061
%U https://www.jmir.org/2022/4/e34061
%U https://doi.org/10.2196/34061
%U http://www.ncbi.nlm.nih.gov/pubmed/35451987

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 4
%P e25561
%T A Mobile Phone App to Support Adherence to Daily HIV Pre-exposure Prophylaxis Engagement Among Young Men Who Have Sex With Men and Transgender Women Aged 15 to 19 Years in Thailand: Pilot Randomized Controlled Trial
%A Kawichai,Surinda
%A Songtaweesin,Wipaporn Natalie
%A Wongharn,Prissana
%A Phanuphak,Nittaya
%A Cressey,Tim R
%A Moonwong,Juthamanee
%A Vasinonta,Anuchit
%A Saisaengjan,Chutima
%A Chinbunchorn,Tanat
%A Puthanakit,Thanyawee
%+ Center of Excellence in Transgender Health, Chulalongkorn University, King Chulalongkorn Memorial Hospital, 1873 Rama 4 Rd, Patumwan, Bangkok, 10330, Thailand, 66 22564930, wipaporn.n@chula.ac.th
%K mHealth
%K PrEP adherence
%K adolescents
%K men who have sex with men
%K transgender women
%K mobile phone
%D 2022

%7 21.4.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Widespread smartphone use provides opportunities for mobile health HIV prevention strategies among at-risk populations. Objective: This study aims to investigate engagement in a theory-based (information–motivation–behavioral skills model) mobile phone app developed to support HIV pre-exposure prophylaxis (PrEP) adherence among Thai young men who have sex with men (YMSM) and young transgender women (YTGW) in Bangkok, Thailand. Methods: A randomized controlled trial was conducted among HIV-negative YMSM and YTGW aged 15-19 years initiating daily oral PrEP. Participants were randomized to receive either youth-friendly PrEP services (YFS) for 6 months, including monthly contact with site staff (clinic visits or telephone follow-up) and staff consultation access, or YFS plus use of a PrEP adherence support app (YFS+APP). The target population focus group discussion findings and the information–motivation–behavioral skills model informed app development. App features were based on the 3Rs—risk assessment of self-HIV acquisition risk, reminders to take PrEP, and rewards as redeemable points. Dried blood spots quantifying of tenofovir diphosphate were collected at months 3 and 6 to assess PrEP adherence. Tenofovir diphosphate ≥350-699 fmol/punch was classified as fair adherence and ≥700 fmol/punch as good adherence. Data analysis on app use paradata and exit interviews were conducted on the YFS+APP arm after 6 months of follow-up. Results: Between March 2018 and June 2019, 200 participants with a median age of 18 (IQR 17-19) years were enrolled. Overall, 74% (148/200) were YMSM; 87% (87/100) of participants who received YFS+APP logged in to the app and performed weekly HIV acquisition risk assessments (log-in and risk assessment [LRA]). The median duration between the first and last log-in was 3.5 (IQR 1.6-5.6) months, with a median frequency of 6 LRAs (IQR 2-10). Moreover, 22% (22/100) of the participants in the YFS+APP arm were frequent users (LRA≥10) during the 6-month follow-up period. YMSM were 9.3 (95% CI 1.2-74.3) times more likely to be frequent app users than YTGW (P=.04). Frequent app users had higher proportions (12%-16%) of PrEP adherence at both months 3 and 6 compared with infrequent users (LRA<10) and the YFS arm, although this did not reach statistical significance. Of the 100 participants in the YFS+APP arm, 23 (23%) were interviewed. The risk assessment function is perceived as the most useful app feature. Further aesthetic adaptations and a more comprehensive rewards system were suggested by the interviewees. Conclusions: Higher rates of PrEP adherence among frequent app users were observed; however, this was not statistically significant. A short app use duration of 3 months suggests that they may be useful in establishing habits in taking daily PrEP, but not long-term adherence. Further studies on the specific mechanisms of mobile phone apps that influence health behaviors are needed. Trial Registration: ClinicalTrials.gov NCT03778892; https://clinicaltrials.gov/ct2/show/NCT03778892 
%M 35451976
%R 10.2196/25561
%U https://mhealth.jmir.org/2022/4/e25561
%U https://doi.org/10.2196/25561
%U http://www.ncbi.nlm.nih.gov/pubmed/35451976

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 4
%P e34035
%T Developing a Technology Acceptability and Usage Survey (TAUS) for mHealth Intervention Planning and Evaluation in Nigeria: Pilot Study
%A Lynch,Kathleen A
%A Atkinson,Thomas M
%A Omisore,Adeleye D
%A Famurewa,Olusola
%A Olasehinde,Olalekan
%A Odujoko,Oluwole
%A Alatise,Olusegun I
%A Egberongbe,Adedeji
%A Kingham,T Peter
%A Morris,Elizabeth A
%A Sutton,Elizabeth
%+ Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Suite 727, New York, NY, 10065, United States, 1 646 888 5455, suttone@mskcc.org
%K measure development
%K survey methods
%K technology acceptability and use
%K global health
%K mHealth
%K Nigeria
%D 2022

%7 20.4.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Technology acceptability and usage surveys (TAUS) are brief questionnaires that measure technology comfort, typical daily use, and access in a population. However, current measures are not adapted to low- and middle-income country (LMIC) contexts. Objective: The objective of this pilot study was to develop a TAUS that could be used to inform the implementation of a mobile health (mHealth) intervention in Nigeria. Methods: A literature review of validated technology comfort and usage scales was conducted to identify candidate items. The draft measure was reviewed for face validity by an expert panel comprised of clinicians and researchers with cultural, methodological, and clinical expertise. The measure was piloted by radiologists at an oncology symposium in Nigeria. Results: After expert review, the final measure included 18 items organized into 3 domains: (1) comfort with using mobile applications, (2) reliability of internet or electricity, and (3) attitudes toward using computers or mobile applications in clinical practice. The pilot sample (n=16) reported high levels of comfort and acceptability toward using mHealth applications in the clinical setting but faced numerous infrastructure challenges. Conclusions: Pilot results indicate that the TAUS may be a feasible and appropriate measure for assessing technology usage and acceptability in LMIC clinical contexts. Dedicating a domain to technology infrastructure and access yielded valuable insights for program implementation. 
%M 35442204
%R 10.2196/34035
%U https://formative.jmir.org/2022/4/e34035
%U https://doi.org/10.2196/34035
%U http://www.ncbi.nlm.nih.gov/pubmed/35442204

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 4
%P e31233
%T An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial
%A Macharia,Paul
%A Pérez-Navarro,Antoni
%A Sambai,Betsy
%A Inwani,Irene
%A Kinuthia,John
%A Nduati,Ruth
%A Carrion,Carme
%+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 619963691, paulmachariah@gmail.com
%K adolescents
%K sexual reproductive health
%K mobile phones
%K randomized controlled trial
%D 2022

%7 15.4.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions. Objective: This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH. Methods: A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information. Results: During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses. Conclusions: Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information. Trial Registration: Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623 
%M 35436230
%R 10.2196/31233
%U https://mhealth.jmir.org/2022/4/e31233
%U https://doi.org/10.2196/31233
%U http://www.ncbi.nlm.nih.gov/pubmed/35436230

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 9
%N 1
%P e33325
%T Designing a Novel Clinician Decision Support Tool for the Management of Acute Diarrhea in Bangladesh: Formative Qualitative Study
%A Rosen,Rochelle K
%A Garbern,Stephanie C
%A Gainey,Monique
%A Lantini,Ryan
%A Nasrin,Sabiha
%A Nelson,Eric J
%A Elshabassi,Nour
%A Alam,Nur H
%A Sultana,Sufia
%A Hasnin,Tahmida
%A Qu,Kexin
%A Schmid,Christopher H
%A Levine,Adam C
%+ Center for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit St, Coro Building Suite 134, Providence, RI, 02906, United States, 1 401 793 8182, rrosen@lifespan.org
%K clinical decision support tools
%K diarrhea management
%K focus group
%K formative qualitative research
%K low- and middle-income countries
%K mobile phone
%D 2022

%7 25.3.2022
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: The availability of mobile clinical decision support (CDS) tools has grown substantially with the increased prevalence of smartphone devices and apps. Although health care providers express interest in integrating mobile health (mHealth) technologies into their clinical settings, concerns have been raised, including perceived disagreements between information provided by mobile CDS tools and standard guidelines. Despite their potential to transform health care delivery, there remains limited literature on the provider’s perspective on the clinical utility of mobile CDS tools for improving patient outcomes, especially in low- and middle-income countries. Objective: This study aims to describe providers’ perceptions about the utility of a mobile CDS tool accessed via a smartphone app for diarrhea management in Bangladesh. In addition, feedback was collected on the preliminary components of the mobile CDS tool to address clinicians’ concerns and incorporate their preferences. Methods: From November to December 2020, qualitative data were gathered through 8 web-based focus group discussions with physicians and nurses from 3 Bangladeshi hospitals. Each discussion was conducted in the local language—Bangla—and audio recorded for transcription and translation by the local research team. Transcripts and codes were entered into NVivo (version 12; QSR International), and applied thematic analysis was used to identify themes that explore the clinical utility of an mHealth app for assessing dehydration severity in patients with acute diarrhea. Summaries of concepts and themes were generated from reviews of the aggregated coded data; thematic memos were written and used for the final analysis. Results: Of the 27 focus group participants, 14 (52%) were nurses and 13 (48%) were physicians; 15 (56%) worked at a diarrhea specialty hospital and 12 (44%) worked in government district or subdistrict hospitals. Participants’ experience in their current position ranged from 2 to 14 years, with an average of 10.3 (SD 9.0) years. Key themes from the qualitative data analysis included current experience with CDS, overall perception of the app’s utility and its potential role in clinical care, barriers to and facilitators of app use, considerations of overtreatment and undertreatment, and guidelines for the app’s clinical recommendations. Participants felt that the tool would initially take time to use, but once learned, it could be useful during epidemic cholera. Some felt that clinical experience remains an important part of treatment that can be supplemented, but not replaced, by a CDS tool. In addition, diagnostic information, including mid-upper arm circumference and blood pressure, might not be available to directly inform programming decisions. Conclusions: Participants were positive about the mHealth app and its potential to inform diarrhea management. They provided detailed feedback, which developers used to revise the mobile CDS tool. These formative qualitative data provided timely and relevant feedback to improve the utility of a CDS tool for diarrhea treatment in Bangladesh. 
%M 35333190
%R 10.2196/33325
%U https://humanfactors.jmir.org/2022/1/e33325
%U https://doi.org/10.2196/33325
%U http://www.ncbi.nlm.nih.gov/pubmed/35333190

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 3
%P e22544
%T Leveraging Polio Geographic Information System Platforms in the African Region for Mitigating COVID-19 Contact Tracing and Surveillance Challenges: Viewpoint
%A Akpan,Godwin Ubong
%A Bello,Isah Mohammed
%A Touray,Kebba
%A Ngofa,Reuben
%A Oyaole,Daniel Rasheed
%A Maleghemi,Sylvester
%A Babona,Marie
%A Chikwanda,Chanda
%A Poy,Alain
%A Mboussou,Franck
%A Ogundiran,Opeayo
%A Impouma,Benido
%A Mihigo,Richard
%A Yao,Nda Konan Michel
%A Ticha,Johnson Muluh
%A Tuma,Jude
%A A Mohamed,Hani Farouk
%A Kanmodi,Kehinde
%A Ejiofor,Nonso Ephraim
%A Kipterer,John Kapoi
%A Manengu,Casimir
%A Kasolo,Francis
%A Seaman,Vincent
%A Mkanda,Pascal
%+ Regional Office of Africa, World Health Organization, World Health Organization,Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int
%K contact tracing
%K GIS
%K COVID-19
%K surveillance
%D 2022

%7 17.3.2022
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The ongoing COVID-19 pandemic in Africa is an urgent public health crisis. Estimated models projected over 150,000 deaths and 4,600,000 hospitalizations in the first year of the disease in the absence of adequate interventions. Therefore, electronic contact tracing and surveillance have critical roles in decreasing COVID-19 transmission; yet, if not conducted properly, these methods can rapidly become a bottleneck for synchronized data collection, case detection, and case management. While the continent is currently reporting relatively low COVID-19 cases, digitized contact tracing mechanisms and surveillance reporting  are necessary for standardizing real-time reporting of new chains of infection in order to quickly reverse growing trends and halt the pandemic. Objective: This paper aims to describe a COVID-19 contact tracing smartphone app that includes health facility surveillance with a real-time visualization platform. The app was developed by the AFRO (African Regional Office) GIS (geographic information system) Center, in collaboration with the World Health Organization (WHO) emergency preparedness and response team. The app was developed through the expertise and experience gained from numerous digital apps that had been developed for polio surveillance and immunization  via the WHO’s polio program in the African region. Methods: We repurposed the GIS infrastructures of the polio program and the database structure that relies on mobile data collection that is built on the Open Data Kit. We harnessed the technology for visualization of real-time COVID-19 data using dynamic dashboards built on Power BI, ArcGIS Online, and Tableau. The contact tracing app was developed with the pragmatic considerations of COVID-19 peculiarities. The app underwent testing by field surveillance colleagues to meet the requirements of linking contacts to cases and monitoring chains of transmission. The health facility surveillance app was developed from the knowledge and assessment of models of surveillance at the health facility level for other diseases of public health importance. The  Integrated Supportive Supervision app was added as an appendage to the pre-existing paper-based surveillance form. These two mobile apps collected information on cases and contact tracing, alongside alert information on COVID-19 reports at the health facility level; the information was linked to visualization platforms in order to  enable actionable insights. Results: The contact tracing app and platform were piloted between April and June 2020; they were then put to use in Zimbabwe, Benin, Cameroon, Uganda, Nigeria, and South Sudan, and their use has generated some palpable successes with respect to COVID-19 surveillance. However, the COVID-19 health facility–based surveillance app has been used more extensively, as it has been used in 27 countries in the region. Conclusions: In light of the above information, this paper was written to give an overview of the app and visualization platform development, app and platform deployment, ease of replicability, and preliminary outcome evaluation of their use in the field.  From a regional perspective, integration of contact tracing and surveillance data into one platform provides the AFRO with a more accurate method of monitoring countries’ efforts in their response to COVID-19, while guiding public health decisions and the assessment of risk of COVID-19. 
%M 34854813
%R 10.2196/22544
%U https://mhealth.jmir.org/2022/3/e22544
%U https://doi.org/10.2196/22544
%U http://www.ncbi.nlm.nih.gov/pubmed/34854813

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 3
%P e29407
%T Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study
%A Miyashita,Ayano
%A Nakamura,Keiko
%A Ohnishi,Mayumi
%A Bintabara,Deogratius
%A Shayo,Festo K
%A Maro,Isaac I
%A Sato,Hideko
%A Seino,Kaoruko
%A Kibusi,Stephen
%+ Department of Global Health Entrepreneurship, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan, 81 3 5803 4048, nakamura.ith@tmd.ac.jp
%K noncommunicable disease
%K community health workers
%K Tanzania
%K communication
%K rural
%K community
%K trust
%K disease
%K acceptability
%K usability
%K text message
%K SMS
%K mobile phone
%K implementation
%D 2022

%7 17.3.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. Objective: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. Methods: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. Results: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. Conclusions: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area. 
%M 35297772
%R 10.2196/29407
%U https://mhealth.jmir.org/2022/3/e29407
%U https://doi.org/10.2196/29407
%U http://www.ncbi.nlm.nih.gov/pubmed/35297772

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 3
%P e36026
%T HIV Surveillance and Research for Migrant Populations: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia
%A Wirtz,Andrea L
%A Page,Kathleen R
%A Stevenson,Megan
%A Guillén,José Rafael
%A Ortíz,Jennifer
%A López,Jhon Jairo
%A Ramírez,Jhon Fredy
%A Quijano,Cindy
%A Vela,Alejandra
%A Moreno,Yessenia
%A Rigual,Francisco
%A Case,James
%A Hakim,Avi J
%A Hladik,Wolfgang
%A Spiegel,Paul B
%+ Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4109292881, awirtz1@jhu.edu
%K HIV
%K epidemiology
%K migrant
%K Venezuela
%K Colombia
%K respondent-driven sampling
%K case finding
%K HIV treatment
%K HIV surveillance
%K research
%D 2022

%7 8.3.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming. Objective: We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia. Methods: Respondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia. Results: Data collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022. Conclusions: Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming. International Registered Report Identifier (IRRID): DERR1-10.2196/36026 
%M 35258458
%R 10.2196/36026
%U https://www.researchprotocols.org/2022/3/e36026
%U https://doi.org/10.2196/36026
%U http://www.ncbi.nlm.nih.gov/pubmed/35258458

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 3
%P e35117
%T The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19
%A Mudhune,Victor
%A Sabben,Gaëlle
%A Ondenge,Ken
%A Mbeda,Calvin
%A Morales,Marissa
%A Lyles,Robert H
%A Arego,Judith
%A Ndivo,Richard
%A Bednarczyk,Robert A
%A Komro,Kelli
%A Winskell,Kate
%+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 7275286, swinske@emory.edu
%K HIV
%K young Africans
%K adolescent
%K Kenya
%K serious game
%K game for health
%K randomized controlled trial
%K mHealth
%K prevention
%K smartphone
%K teenager
%K young adult
%K Africa
%K gaming
%K COVID-19
%K efficacy
%D 2022

%7 3.3.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. Objective: The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. Methods: Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. Results: Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. Conclusions: This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. Trial Registration: ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667 International Registered Report Identifier (IRRID): DERR1-10.2196/35117 
%M 35030090
%R 10.2196/35117
%U https://www.researchprotocols.org/2022/3/e35117
%U https://doi.org/10.2196/35117
%U http://www.ncbi.nlm.nih.gov/pubmed/35030090

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 3
%P e32213
%T Tracking Demographic Movements and Immunization Status to Improve Children’s Access to Immunization: Field-Based Randomized Controlled Trial
%A Ateudjieu,Jérôme
%A Tchio-Nighie,Ketina Hirma
%A Goura,André Pascal
%A Ndinakie,Martin Yakum
%A Dieffi Tchifou,Miltiade
%A Amada,Lapia
%A Tsafack,Marcelin
%A Kiadjieu Dieumo,Frank Forex
%A Guenou,Etienne
%A Nangue,Charlette
%A Kenfack,Bruno
%+ Department of Health Research, Meilleur Accès Aux Soins de Santé (M.A.SANTE), Avenue De Mvolye (Street 7.331) Biyem-assi Lac – Buildings 1416 and 1410, Yaounde, P.O. Box: 33490, Cameroon, 237 222 311 647, ktchio@masante-cam.org
%K immunization status
%K coverage
%K completeness
%K timeliness
%K EPI vaccines
%K children under five
%K Foumban
%K Cameroon
%K mobile phone
%D 2022

%7 1.3.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Countries’ Expanded Program on Immunization (EPI) contribute to the reduction of mortality and morbidity, but access to these vaccines remains limited in most low-income countries. Objective: We aim to assess whether involving community volunteers (CVs) to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions can improve children’s vaccination timeliness, completeness, and coverage. Methods: This was a field-based randomized controlled trial and communities of the Foumban health district in West Cameroon were allocated to intervention or control groups. In the intervention group, a CV per community was trained to visit households monthly for a year to assess and record in a register, details of EPI-targeted children, their demographic movements and immunization status. The scanned recorded pages were sent to the health center immunization team through WhatsApp and used to organize monthly community catch-up immunization sessions. In the control group, EPI vaccination sessions were routinely conducted. Surveys were conducted at 6 and 12 months from the beginning of the intervention in both study groups to assess and compare immunization timeliness, coverage, and completeness. Results: Overall, 30 buildings per cluster were surveyed at midline and endline. Of the 633 and 729 visited households in the intervention group at midline and endline, 630 (99.5%) and 718 (98.4%), respectively, consented to participate. In the control group, 507 and 651 households were visited and 505 (99.6%) and 636 (97.7%), respectively, consented to participate. At 12 months intervention, the month one timeliness of bacille Calmette–Guerin (BCG) vaccine did not increase in the intervention group compared with the control group for the age groups 0-11 months (adjusted odds ratio [aOR] 1.1, 95% CI 0.7-1.8) and 0-59 months (aOR 1.1, 95% CI 0.9-1.4), and significantly increased for the first-year BCG vaccine administration for the age group 0-23 months (aOR 1.5, 95% CI 1.1-2.2). The coverage of diphtheria-pertussis-tetanus and hepatitis B+Hemophilus influenzae type B (DPT-Hi +Hb) dose 3 (aOR 2.0, 95% CI 1.5-2.7) and of DPT-Hi+Hb dose 1 (aOR 1.8, 95% CI 1.4-2.4) vaccines increased significantly in the intervention group compared with the control group in the age groups 12-59 months and 12-23 months, respectively. Specific (DPT-Hi+Hb dose 1 to DPT-Hi+Hb dose 3: aOR 1.9, 95% CI 1.4-2.6) and general (BCG to measles: aOR 1.5, 95% CI 1.1-2.1) vaccine completeness increased significantly in the intervention group compared with the control group. Conclusions: Findings support that involving CVs to track children’s vaccination status and demographic movements and using recorded data to plan catch-up immunization sessions improve children’s vaccination timeliness, completeness, and coverage. This strategy should be adopted to improve access to vaccination for EPI target populations and the consistency verified in other contexts. Trial Registration: Pan African Clinical Trials Registry PACTR201808527428720; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3548 
%M 35230249
%R 10.2196/32213
%U https://publichealth.jmir.org/2022/3/e32213
%U https://doi.org/10.2196/32213
%U http://www.ncbi.nlm.nih.gov/pubmed/35230249

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 2
%P e32428
%T Understanding the Needs of a Mobile Phone–Based Telemonitoring Program for Pregnant Women at High Risk for Pre-Eclampsia: Interpretive Qualitative Description Study
%A Feroz,Anam Shahil
%A De Vera,Kristina
%A D Bragagnolo,Nadia
%A Saleem,Sarah
%A Bhutta,Zulfiqar
%A Seto,Emily
%+ Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 6478676702, anam.shahil@mail.utoronto.ca
%K telemonitoring
%K pre-eclampsia
%K qualitative study
%K Pakistan
%K pregnant women at high risk
%K low- to middle-income country
%K pregnant
%K pregnancy
%K women
%K mobile phone
%D 2022

%7 24.2.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Lack of early risk detection, diagnosis, and treatment of pregnant women at high risk for pre-eclampsia can result in high maternal mortality and morbidity not only in Pakistan but also in other low- to middle-income countries (LMICs). A potential tool for supporting pregnant women at high risk for pre-eclampsia for early detection is telemonitoring (TM). However, there is a limited body of evidence on end-user needs and preferences to inform the design of the TM programs for pregnant women at high risk for pre-eclampsia, specifically in LMICs such as Pakistan. Objective: This study aims to explore the needs of TM for pregnant women at high risk for pre-eclampsia in Karachi, Pakistan, to inform a potential future feasibility trial of a mobile phone–based TM program. Methods: An interpretive qualitative description approach was used to conduct and analyze 36 semistructured interviews with 15 (42%) pregnant women and 21 (58%) key informants, including clinicians; nurses; maternal, neonatal, and child health specialists; and digital health experts to explore the perspectives, needs, and preferences of a mobile phone–based TM program to support pregnant women at high risk for pre-eclampsia. Pregnant women were identified through heterogeneous sampling, whereas key informants were selected through purposive sampling. The interview transcripts were analyzed using a conventional content analysis technique. Results: The following four themes emerged from the analysis of the transcripts: poor use of antenatal care during pregnancy, the value of a TM program in high-risk pregnancy, barriers influencing the adoption of TM programs and potential strategies, and considerations for implementing TM programs. The pregnant women and health care providers were willing to use a TM program as they perceived many benefits, including early identification of pregnancy complications, prompt treatment, convenience, cost-effectiveness, increased sense of empowerment for one’s health care, improved care continuity, and reduced clinical workload. However, some providers and pregnant women mentioned some concerns regarding the adoption of a TM program, including malfunctioning and safety concerns, potential inaccuracy of blood pressure machines, increased clinical workload, and resistance to learning new technology. Our study recommends building the capacity of patients and providers on TM program use, sensitizing the community and family members on the usefulness of the TM program, using an approach incorporating user-centered design and phased implementation to determine the clinical workload and whether additional staff for the TM program is required, and ensuring greater levels of co-design and the engagement of consumer representatives. Conclusions: Our findings highlight the perceived feasibility of a mobile phone–based TM program for pregnant women at high risk for pre-eclampsia and provide insights that can be directly used for the design of future TM programs with the aim of reducing mortality and morbidity from pre-eclampsia and eclampsia in LMICs. 
%M 35200152
%R 10.2196/32428
%U https://formative.jmir.org/2022/2/e32428
%U https://doi.org/10.2196/32428
%U http://www.ncbi.nlm.nih.gov/pubmed/35200152

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 2
%P e27501
%T Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study
%A Stocks,Jacob
%A Choi,Yujung
%A Ibrahim,Saduma
%A Huchko,Megan
%+ Center for Global Reproductive Health, Duke Global Health Institute, 310 Trent Drive, Durham, NC, 27710, United States, 1 919 681 7760, jacob_stocks@med.unc.edu
%K mHealth
%K cervical cancer screening
%K Kenya
%K HPV testing
%K user-testing
%K community health volunteers
%K mobile phone
%D 2022

%7 24.2.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)–based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. Objective: The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. Methods: A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. Results: A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada’s impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. Conclusions: Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs. 
%M 35200151
%R 10.2196/27501
%U https://formative.jmir.org/2022/2/e27501
%U https://doi.org/10.2196/27501
%U http://www.ncbi.nlm.nih.gov/pubmed/35200151

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 2
%P e28342
%T Determining Priorities in the Aboriginal and Islander Mental Health Initiative for Youth App Second Phase Participatory Design Project: Qualitative Study and Narrative Literature Review
%A Povey,Josie
%A Sweet,Michelle
%A Nagel,Tricia
%A Lowell,Anne
%A Shand,Fiona
%A Vigona,Jahdai
%A Dingwall,Kylie M
%+ Menzies School of Health Research, Charles Darwin University, Red 9 CDU Campus, Casuarina, 0820, Australia, 61 8 8946 8487, josie.povey@menzies.edu.au
%K Aboriginal and Torres Strait Islander
%K young people
%K digital mental health
%K app
%K participatory design
%K decision-making
%K mobile phone
%D 2022

%7 18.2.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Digital mental health tools can promote access to culturally safe early intervention mental health services for Aboriginal and Torres Strait Islander young people. Participatory design methodology facilitates user engagement in the co-design of digital resources. However, several challenges have been identified that limit the methodological rigor of this approach. Objective: This paper aims to present an in-depth account of the second phase of participatory design in the development of the Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app. Methods: A first idea storyboard, generated from a formative phase of the AIMhi-Y project, was refined through a series of youth co-design workshops and meetings. A narrative review of the literature, 6 service provider interviews, and engagement with an expert reference group also informed the design process. Generative design activities, storyboarding, discussions, and voting strategies were used. Results: The participatory design process identified the app features preferred by young people and service providers and assessed their alignment with current recommendations from the scientific literature. Findings from the co-design process are presented across 9 app characteristic domains. Integration of findings into app design proved complex. Although most preferred features identified by young people were included to some degree, other inclusions were restricted by budget, time, and the need to integrate best practice recommendations. A process of prioritization was required. Conclusions: Participatory design is often cited in the development of digital mental health resources; however, methods are diverse and often lack detailed descriptions. This study reports the outcomes and strategies used to determine priorities in the second phase of the development of the AIMhi-Y app. We provide an example and the key learnings to inform others seeking to use participatory design with a similar cohort. 
%M 35179498
%R 10.2196/28342
%U https://formative.jmir.org/2022/2/e28342
%U https://doi.org/10.2196/28342
%U http://www.ncbi.nlm.nih.gov/pubmed/35179498

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 10
%N 2
%P e30040
%T Electricity, Computing Hardware, and Internet Infrastructures in Health Facilities in Sierra Leone: Field Mapping Study
%A Chukwu,Emeka
%A Garg,Lalit
%A Foday,Edward
%A Konomanyi,Abdul
%A Wright,Royston
%A Smart,Francis
%+ Department of Computer Information Systems, Faculty of Information Communications Technology, University of Malta, Tal-Qroqq, Msida, 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com
%K digital health
%K mHealth
%K eHealth infrastructure
%K health ICT
%K SpaceX
%K connectivity
%K Sierra Leone
%K rural-urban divide
%K rural areas
%K internet
%D 2022

%7 3.2.2022
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Years of health information system investment in many countries have facilitated service delivery, surveillance, reporting, and monitoring. Electricity, computing hardware, and internet networks are vital for health facility–based information systems. Availability of these infrastructures at health facilities is crucial for achieving national digital health visions. Objective: The aim of this study was to gain insight into the state of computing hardware, electricity, and connectivity infrastructure at health facilities in Sierra Leone using a representative sample. Methods: Stratified sampling of 72 (out of 1284) health facilities distributed in all districts of Sierra Leone was performed, factoring in the rural-urban divide, digital health activity, health facility type, and health facility ownership. Enumerators visited each health facility over a 2-week period. Results: Among the 72 surveyed health facilities, 59 (82%) do not have institutionally provided internet. Among the 15 Maternal and Child Health Posts, as a type of primary health care unit (PHU), 9 (60%) use solar energy as their only electricity source and the other 6 (40%) have no electricity source. Similarly, among the 13 hospitals, 5 (38%) use a generator as a primary electricity source. All hospitals have at least one functional computer, although only 7 of the 13 hospitals have four or more functional computers. Similarly, only 2 of the 59 (3%) PHUs have one computer each, and 37 (63%) of the PHUs have one tablet device each. We consider this health care computing infrastructure mapping to be representative with a 95% confidence level within an 11% margin of error. Two-thirds of the PHUs have only alternate solar electricity, only 10 of the 72 surveyed health facilities have functional official internet, and most use suboptimal computing hardware. Overall, 43% of the surveyed health facilities believe that inadequate electricity is the biggest threat to digitization. Similarly, 16 (22%) of the 72 respondents stated that device theft is a primary hindrance to digitization. Conclusions: Electricity provision for off-electricity-grid health facilities using alternative and renewable energy sources is emerging. The current trend where GSM (Global System for Mobile Communication) service providers provide the internet to all health facilities may change to other promising alternatives. This study provides evidence of the critical infrastructure gaps in health facilities in Sierra Leone. 
%M 35113026
%R 10.2196/30040
%U https://medinform.jmir.org/2022/2/e30040
%U https://doi.org/10.2196/30040
%U http://www.ncbi.nlm.nih.gov/pubmed/35113026

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 6
%N 2
%P e26033
%T Implementation of an mHealth App to Promote Engagement During HIV Care and Viral Load Suppression in Johannesburg, South Africa (iThemba Life): Pilot Technical Feasibility and Acceptability Study
%A Lalla-Edward,Samanta Tresha
%A Mashabane,Nonkululeko
%A Stewart-Isherwood,Lynsey
%A Scott,Lesley
%A Fyvie,Kyle
%A Duncan,Dana
%A Haile,Betiel
%A Chugh,Kamal
%A Zhou,Yiyong
%A Reimers,Jacob
%A Pan,Matteus
%A Venkatraman,Maya
%A Stevens,Wendy
%+ Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Sunnyside Office Park, 32 Princess of Wales Terrace, Parktown, 2193, South Africa, 27 0826172490, slallaedward@ezintsha.org
%K HIV
%K virological suppression
%K mHealth
%K digital health
%K South Africa
%K patient-centric
%K disease management
%K mobile phone
%D 2022

%7 2.2.2022
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: South Africa has the largest HIV treatment program worldwide. Retention in care and medication adherence remain problematic necessitating innovative solutions for improving HIV care. The increasing availability and use of mobile technology can support positive clinical outcomes for persons living with HIV. iThemba Life is a mobile health app designed with input from South African health professionals and patients, promoting engagement with HIV care through access to medical results. Objective: This study aimed to test the feasibility and acceptability of receiving HIV viral load (VL) results through the app and compare the time to HIV VL result return for study participants before and after app use. Methods: Using convenience sampling, adults having routine VL phlebotomy were recruited from 2 Johannesburg health facilities. After signed consent, the app was downloaded on their Android smartphones, phlebotomy was performed, and the sample barcode was scanned through their phone to link the sample and app. Participants received a notification of the result availability and logged into the app to view results, their explanation and recommended action. Results: Overall, 750 people were screened to enroll 500 participants. Of 750, 113 (15.1%) failed eligibility screening. 21.5% (137/637) had smartphone technical limitations preventing enrollment. Results were released to 92.2% (461/500) of participants’ phones. App technical issues and laboratory operational issues limited the number of released results. Approximately 78.1% (360/461) results were viewed in the app. Median time from notification of availability to result viewed being 15.5 hours (0.6; range 0-150 days). Turnaround time from phlebotomy to the result being received was 6 (range 1-167) days for users versus 56 days (range 10-430 days; P<.001) before app use. Overall, 4% (20/500) of participants received unsuppressed results (VL>1000 copies/mL). Turnaround time for unsuppressed results was 7 days for participants versus 37.5 days before app use (P<.001). The difference before and after app use in the suppressed and unsuppressed users for time from sample collection to result delivery was statistically significant. Of 20 participants, 12 (60%) returned for a confirmatory VL during the study period. The time from an unsuppressed VL to a confirmatory VL was 106 days for app users versus 203 days before app use (P<.001). Overall, 52.4% (262/500) of participants completed an exit survey; 23.2% (58/250) reported challenges in viewing their VL results. Moreover, 58% (35/60) reported that they overcame challenges with technical assistance from others, and 97.3% (255/262) wanted to continue using the app for VL results. Conclusions: Using iThemba Life for VL results was well-received despite limited smartphone access for some participants. App users received results 10 times sooner than before the app and 5 times sooner if their VL >1000 copies/mL. This increased notification speed led to participants wanting to continue using iThemba Life. 
%M 35107427
%R 10.2196/26033
%U https://formative.jmir.org/2022/2/e26033
%U https://doi.org/10.2196/26033
%U http://www.ncbi.nlm.nih.gov/pubmed/35107427

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 1
%P e33596
%T A Novel, Scalable Social Media–Based Intervention (“Warna-Warni Waktu”) to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial
%A Garbett,Kirsty May
%A Craddock,Nadia
%A Haywood,Sharon
%A Nasution,Kholisah
%A White,Paul
%A Saraswati,L Ayu
%A Medise,Bernie Endyarni
%A ,
%A ,
%A Diedrichs,Phillippa C
%A Williamson,Heidi
%+ Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 1173282911, Kirsty.garbett@uwe.ac.uk
%K body image
%K body dissatisfaction
%K Indonesia
%K adolescent
%K mental health
%K randomized controlled trial
%K study protocol
%K eHealth intervention
%K Southeast Asia
%K young adult
%K teenager
%K women
%K social media
%K intervention
%K image
%K protocol
%K mood
%K satisfaction
%D 2022

%7 28.1.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population. Objective: This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years. Methods: The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level. Results: Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022. Conclusions: This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube. Trial Registration: ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213 International Registered Report Identifier (IRRID): PRR1-10.2196/33596 
%M 35089154
%R 10.2196/33596
%U https://www.researchprotocols.org/2022/1/e33596
%U https://doi.org/10.2196/33596
%U http://www.ncbi.nlm.nih.gov/pubmed/35089154

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 1
%P e22093
%T The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review
%A Sowon,Karen
%A Maliwichi,Priscilla
%A Chigona,Wallace
%+ University of Cape Town, Department of Information Systems, University of Cape Town, Cape Town, 7700, South Africa, 27 651932568, swnkar004@myuct.ac.za
%K human-technology interaction
%K maternal health
%K mHealth
%K mobile phone
%K utilization
%K Kenya
%D 2022

%7 27.1.2022
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective: This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods: Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results: A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions: In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness. 
%M 35084356
%R 10.2196/22093
%U https://mhealth.jmir.org/2022/1/e22093
%U https://doi.org/10.2196/22093
%U http://www.ncbi.nlm.nih.gov/pubmed/35084356

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 8
%N 1
%P e32455
%T Added Value of Electronic Immunization Registries in Low- and Middle-Income Countries: Observational Case Study in Tanzania
%A Secor,Andrew M
%A Mtenga,Hassan
%A Richard,John
%A Bulula,Ngwegwe
%A Ferriss,Ellen
%A Rathod,Mansi
%A Ryman,Tove K
%A Werner,Laurie
%A Carnahan,Emily
%+ PATH, 2201 Westlake Avenue, Seattle, WA, , United States, 1 206 285 3500, ecarnahan@path.org
%K immunization
%K immunization information system
%K electronic immunization registry
%K digital health
%K eHealth
%D 2022

%7 21.1.2022
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: There is growing interest and investment in electronic immunization registries (EIRs) in low- and middle-income countries. EIRs provide ready access to patient- and aggregate-level service delivery data that can be used to improve patient care, identify spatiotemporal trends in vaccination coverage and dropout, inform resource allocation and program operations, and target quality improvement measures. The Government of Tanzania introduced the Tanzania Immunization Registry (TImR) in 2017, and the system has since been rolled out in 3736 facilities in 15 regions. Objective: The aims of this study are to conceptualize the additional ways in which EIRs can add value to immunization programs (beyond measuring vaccine coverage) and assess the potential value-add using EIR data from Tanzania as a case study. Methods: This study comprised 2 sequential phases. First, a comprehensive list of ways EIRs can potentially add value to immunization programs was developed through stakeholder interviews. Second, the added value was evaluated using descriptive and regression analyses of TImR data for a prioritized subset of program needs. Results: The analysis areas prioritized through stakeholder interviews were population movement, missed opportunities for vaccination (MOVs), continuum of care, and continuous quality improvement. The included TImR data comprised 958,870 visits for 559,542 patients from 2359 health facilities. Our analyses revealed that few patients sought care outside their assigned facility (44,733/810,568, 5.52% of applicable visits); however, this varied by region; facility urbanicity, type, ownership, patient volume, and duration of TImR system use; density of facilities in the immediate area; and patient age. Analyses further showed that MOVs were highest among children aged <12 months (215,576/831,018, 25.94% of visits included an MOV and were applicable visits); however, there were few significant differences based on other individual or facility characteristics. Nearly half (133,337/294,464, 45.28%) of the children aged 12 to 35 months were fully vaccinated or had received all doses except measles-containing vaccine–1 of the 14-dose under-12-month schedule (ie, through measles-containing vaccine–1), and facility and patient characteristics associated with dropout varied by vaccine. The continuous quality improvement analysis showed that most quality issues (eg, MOVs) were concentrated in <10% of facilities, indicating the potential for EIRs to target quality improvement efforts. Conclusions: EIRs have the potential to add value to immunization stakeholders at all levels of the health system. Individual-level electronic data can enable new analyses to understand service delivery or care-seeking patterns, potential risk factors for underimmunization, and where challenges occur. However, to achieve this potential, country programs need to leverage and strengthen the capacity to collect, analyze, interpret, and act on the data. As EIRs are introduced and scaled in low- and middle-income countries, implementers and researchers should continue to share real-world examples and build an evidence base for how EIRs can add value to immunization programs, particularly for innovative uses. 
%M 35060919
%R 10.2196/32455
%U https://publichealth.jmir.org/2022/1/e32455
%U https://doi.org/10.2196/32455
%U http://www.ncbi.nlm.nih.gov/pubmed/35060919

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 11
%N 1
%P e35455
%T Mobile Phone–Based Intervention Among Adolescents Living With Perinatally Acquired HIV Transitioning from Pediatric to Adult Care: Protocol for the Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA) Study
%A Zanoni,Brian C
%A Archary,Moherndran
%A Sibaya,Thobekile
%A Goldstein,Madeleine
%A Bergam,Scarlett
%A Denton,David
%A Cordero,Vincente
%A Peng,Cynthia
%A Psaros,Christina
%A Marconi,Vincent C
%A Haberer,Jessica E
%+ School of Medicine, Emory University, 2014 Upper Gate Drive, 5th floor, Atlanta, GA, 30322, United States, 1 404 727 0284, bzanoni@emory.edu
%K adolescent
%K mHealth
%K South Africa
%K HIV
%K Social media
%K InTSHA
%K protocol
%K transition support
%K support
%K WhatsApp
%K caregiver
%K health care provider
%D 2022

%7 21.1.2022
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Adolescents living with perinatally acquired HIV often have poor retention in care and viral suppression during the transition from pediatric to adult-based care. Objective: The aim of this study is to evaluate a mobile phone–based intervention, Interactive Transition Support for Adolescents Living With HIV using Social Media (InTSHA), among adolescents living with perinatally acquired HIV as they transition from pediatric to adult care in South Africa. Methods: InTSHA uses encrypted, closed group chats delivered via WhatsApp (Meta Platforms Inc) to develop peer support and improve communication between adolescents, their caregivers, and health care providers. The intervention is based on formative work with adolescents, caregivers, and health care providers and builds on several existing adolescent support programs as well as the Social-ecological Model of Adolescent and Young Adult Readiness for Transition (SMART). The final InTSHA intervention involves 10 modules conducted weekly through moderated WhatsApp group chats with adolescents and separately with their caregivers. We will randomly assign 80 South African adolescents living with perinatally acquired HIV who are aware of their HIV status and aged between 15 and 19 years to receive either the intervention (n=40) or standard of care (n=40). Results: We will measure acceptability of the intervention as the primary outcome and evaluate feasibility and preliminary effectiveness for retention in care and viral suppression after completion of the intervention and at least 6 months after randomization. In addition, we will measure secondary outcomes evaluating the impact of the InTSHA intervention on peer support, self-esteem, depression, stigma, sexual education, connection to health care providers, and transition readiness. Enrollment began on April 15, 2021. As of December 31, 2021 a total of 78 out of expected 80 participants have been enrolled. Conclusions: If successful, the intervention will be evaluated in a fully powered randomized controlled trial with a larger number of adolescents from urban and rural populations to further evaluate the generalizability of InTSHA. Trial Registration: ClinicalTrials.gov NCT03624413; https://clinicaltrials.gov/ct2/show/NCT03624413 International Registered Report Identifier (IRRID): DERR1-10.2196/35455 
%M 35060907
%R 10.2196/35455
%U https://www.researchprotocols.org/2022/1/e35455
%U https://doi.org/10.2196/35455
%U http://www.ncbi.nlm.nih.gov/pubmed/35060907

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 7
%N 1
%P e25105
%T Evaluation of a Web Platform to Record Lifestyle Habits in Subjects at Risk of Developing Type 2 Diabetes in a Middle-Income Population: Prospective Interventional Study
%A Sevilla-Gonzalez,Magdalena Del Rocio
%A Bourguet-Ramirez,Brigette
%A Lazaro-Carrera,Laura Sofia
%A Martagon-Rosado,Alexandro J
%A Gomez-Velasco,Donaji Veronica
%A Viveros-Ruiz,Tannia Leticia
%+ Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 100 Cambridge St, Boston, MA, 02114, United States, 1 6176435806, msevillagonzalez@mgh.harvard.edu
%K mHealth
%K prediabetes
%K type 2 diabetes
%K preventive medicine
%K diabetes
%K lifestyle
%K body mass index
%D 2022

%7 17.1.2022
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: Lifestyle is the focus of type 2 diabetes (T2D) prevention strategies. Prevention strategies using mobile health (mHealth)–based therapy have shown positive results for T2D prevention in high-income settings, but little is known about their effectiveness in low- and middle-income populations where the burden of T2D is substantial. “Vida Sana” is a web platform designed to record lifestyle habits and medication use within a lifestyle change program. Objective: We sought to identify the barriers, feasibility, usability, and effectiveness of Vida Sana to record lifestyle habits in subjects at risk of developing T2D in a middle-income setting. Methods: This was a 3-month prospective interventional study in Mexican individuals. A total of 77 subjects at risk of T2D (with prediabetes and BMI between 24 and 40 kg/m2) were selected. Feasibility was assessed by study retention. Usability was evaluated with the System Usability Scale (SUS). Effectiveness measures included changes in weight, body composition, BMI, glycated hemoglobin A1c (HbA1c), and fasting blood glucose from baseline to 3 months. Linear regression models were used to account for covariates. Results: The feasibility of Vida Sana was 42%, with 33 subjects using the platform, and the usability was 48.7 (SD 14.24). Reported barriers to platform usage were; difficulty in accessing the platform from difficulty of use (12 subjects, 36%), lack of time to record their habits (11 subjects, 34%), lack of interest to record their habits (6 subjects, 18%), and lack of resources (4 subjects, 11%). The platform was effective for lowering glucose in fasting (–3.1 mg/dL vs –0.11 [SD 8.08] mg/dL; P=.038) and at 2 hours (–16.9 mg/dL vs 2.5 [SD 26.1] mg/dL; P=.045), body fat percentage (–1.3 [–2.2 to –0.7] vs –1.02 [–1.9 to –0.3]; P=.02), and waist circumference (–3.2 [SD 5.1] cm vs –1.7 [SD 5.0] cm; P=.02) independent of their age, sex, treatment, and education level. Conclusions: The use of the web platform was effective for improving glycemic and anthropometric parameters in a population at risk of developing diabetes. Improving accessibility and ease of navigation could improve the acceptance of digital health solutions in a middle-income population. 
%M 35037888
%R 10.2196/25105
%U https://diabetes.jmir.org/2022/1/e25105
%U https://doi.org/10.2196/25105
%U http://www.ncbi.nlm.nih.gov/pubmed/35037888

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 1
%P e25863
%T Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice
%A Hyman,Antonia
%A Stacy,Elizabeth
%A Mohsin,Humaira
%A Atkinson,Kaitlin
%A Stewart,Kurtis
%A Novak Lauscher,Helen
%A Ho,Kendall
%+ Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 3rd Floor (Blusson Spinal Cord Centre), 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048228757, kurtis.stewart@ubc.ca
%K immigrants
%K community-based participatory action research
%K eHealth
%K delivery of health care
%K photovoice
%K South Asian
%K digital health
%K mobile phone
%D 2022

%7 13.1.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences. 
%M 35023842
%R 10.2196/25863
%U https://www.jmir.org/2022/1/e25863
%U https://doi.org/10.2196/25863
%U http://www.ncbi.nlm.nih.gov/pubmed/35023842

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 1
%P e27272
%T Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study
%A Chen,Nuoya
%A Liu,Pengqi
%+ Faculty of Global Studies, Justice and Rights, University of Macerata, Crescimbeni 30-32, Macerata, 62100, Italy, 39 0733 2582418, cny0824@gmail.com
%K telehealth solutions
%K preference
%K motivation
%K elderly user
%K China
%D 2022

%7 12.1.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users’ preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang. Objective: The goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization. Methods: The questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results. Results: Approximately 71.09% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions. Conclusions: The findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users’ health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions. 
%M 35019852
%R 10.2196/27272
%U https://mhealth.jmir.org/2022/1/e27272
%U https://doi.org/10.2196/27272
%U http://www.ncbi.nlm.nih.gov/pubmed/35019852

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 1
%P e31058
%T Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation
%A Bunova,Anna
%A Wiemker,Veronika
%A Gornyi,Boris
%A Ferreira-Borges,Carina
%A Neufeld,Maria
%+ National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow, 101990, Russian Federation, 7 9151416154, asbunova@gmail.com
%K alcohol
%K mHealth
%K mobile applications
%K screening and brief intervention
%K Mobile Application Rating Scale
%K App Behavior Change Scale
%K mobile phone
%D 2022

%7 10.1.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated. Objective: This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia. Methods: A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). Results: We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. Conclusions: Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458 
%M 35006083
%R 10.2196/31058
%U https://mhealth.jmir.org/2022/1/e31058
%U https://doi.org/10.2196/31058
%U http://www.ncbi.nlm.nih.gov/pubmed/35006083

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 10
%N 1
%P e25586
%T Dose–Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial
%A Li,Yiran
%A Guo,Yan
%A Hong,Y Alicia
%A Zeng,Yu
%A Monroe-Wise,Aliza
%A Zeng,Chengbo
%A Zhu,Mengting
%A Zhang,Hanxi
%A Qiao,Jiaying
%A Xu,Zhimeng
%A Cai,Weiping
%A Li,Linghua
%A Liu,Cong
%+ Department of Medical Statistics, School of Public Health, 74 Zhongshan 2nd Road, Guangzhou, 510080, China, 86 020 87333239, Yan.Guo1@umassmed.edu
%K mHealth
%K patient engagement
%K dose–response relationship
%K long-term effect
%K generalized linear mixed effects model
%D 2022

%7 4.1.2022
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The dose–response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed. Objective: This study aims to examine dose–response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months. Methods: This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4–time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose–response relationships between patient engagement and outcomes. Results: The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=−1.93; P=.008) and perceived stress (β=−1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively). Conclusions: This study revealed a positive long-term dose–response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 
%M 34982724
%R 10.2196/25586
%U https://mhealth.jmir.org/2022/1/e25586
%U https://doi.org/10.2196/25586
%U http://www.ncbi.nlm.nih.gov/pubmed/34982724

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 24
%N 1
%P e27696
%T A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial
%A Brody,Carinne
%A Chhoun,Pheak
%A Tuot,Sovannary
%A Fehrenbacher,Anne E
%A Moran,Alexander
%A Swendeman,Dallas
%A Yi,Siyan
%+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 87533823, siyan@nus.edu.sg
%K mHealth
%K female sex workers
%K HIV
%K sexually transmitted infection
%K linkage to services
%K sexual and reproductive health
%K gender-based violence
%K low- and middle-income countries
%D 2022

%7 4.1.2022
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Female entertainment workers (FEWs) in Cambodia experience a greater prevalence of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), psychological distress, substance abuse, and gender-based violence (GBV) than the general female population. Reaching FEWs with health education and linking them to services has been difficult because of their hidden and stigmatized status. Objective: This study evaluated the efficacy of the Mobile Link intervention in improving FEWs’ health by engaging and connecting them to existing HIV, sexual and reproductive health, and GBV services. Methods: A randomized controlled trial was conducted between March 2018 and June 2019 in the capital city and 3 other provinces in Cambodia. FEWs in the intervention arm received automated twice-weekly Short Message Service messages and voice messages with health information and direct links to outreach workers. The control group received the existing standard care, including free HIV and STI counseling and testing and a toll-free helpline staffed by trained counselors. We used a stratified random sampling method to select participants from 5 study sites in the 4 selected provinces. Initially, we randomly selected 600 participants from a list of 4000 FEWs by age group (18-24 and 25-30 years) and study site using a random number generator and enrolled them in person. The primary outcome measures included self-reported HIV and STI testing, condom use, and contraceptive use assessed through a face-to-face structured interview. We also measured secondary outcomes, including contact with outreach workers, escorted referral service use, forced drinking, and GBV experiences. Intervention effects were modeled using repeated measures, multilevel mixed-effects logistic regression. Results: A total of 1118 participants were recruited and enrolled in the study. We included 218 FEWs in the intervention arm and 170 FEWs in the control arm in the per protocol analyses after removing 730 dropouts. Evidence of positive intervention effects was detected for the following secondary outcomes: contacting an outreach worker (at 30 weeks: adjusted odds ratio [AOR] 3.29, 95% CI 1.28-8.47), receiving an escorted referral (at 30 weeks: AOR 2.86, 95% CI 1.09-7.52; at 60 weeks: AOR 8.15, 95% CI 1.65-40.25), and never being forced to drink at work (at 60 weeks: AOR 3.95, 95% CI 1.62-9.60). Over time, no significant differences between intervention and control groups were observed for any primary outcomes in the fully adjusted models. Conclusions: The Mobile Link intervention effectively connected FEWs with outreach workers and escorted referrals but did not show an effect on primary outcomes. Reduced forced drinking at work was also significantly more extensive in the intervention group than in the control group. Longer-term messaging may increase access to services and impact FEWs’ health outcomes in the future. Trial Registration: Clinicaltrials.gov NCT03117842; https://clinicaltrials.gov/ct2/show/NCT03117842 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2614-7  
%M 34982716
%R 10.2196/27696
%U https://www.jmir.org/2022/1/e27696
%U https://doi.org/10.2196/27696
%U http://www.ncbi.nlm.nih.gov/pubmed/34982716

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 12
%P e24792
%T Evaluation of a Healthy Relationship Smartphone App With Indigenous Young People: Protocol for a Co-designed Stepped Wedge Randomized Trial
%A Koziol-McLain,Jane
%A Wilson,Denise
%A Vandal,Alain C
%A Eruera,Moana
%A Nada-Raja,Shyamala
%A Dobbs,Terry
%A Roguski,Michael
%A Barbarich-Unasa,Te Wai
%+ Centre for Interdisciplinary Trauma Research, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 211213474, jane.koziol-mclain@aut.ac.nz
%K indigenous
%K Māori
%K young people
%K relationships
%K school
%K mHealth
%K smartphone app
%K mobile phone
%D 2021

%7 30.12.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: We co-designed a smartphone app, Harmonised, with taitamariki (young people aged 13-17 years) to promote healthy intimate partner relationships. The app also provides a pathway for friends and family, or whānau (indigenous Māori extended family networks), to learn how to offer better support to taitamariki. Objective: The aim of our taitamariki- and Māori-centered study is to evaluate the implementation of the app in secondary schools. The study tests the effectiveness of the app in promoting taitamariki partner relationship self-efficacy (primary outcome). Methods: We co-designed a pragmatic, randomized, stepped wedge trial (retrospectively registered on September 12, 2019) for 8 Aotearoa, New Zealand, secondary schools (years 9 through 13). The schools were randomly assigned to implement the app in 1 of the 2 school terms. A well-established evaluation framework (RE-AIM [Reach, Effectiveness, Adoption, Implementation, Maintenance]) guided the selection of mixed data collection methods. Our target sample size is 600 taitamariki enrolled across the 8 schools. Taitamariki will participate by completing 5 web-based surveys over a 15-month trial period. Taitamariki partner relationship self-efficacy (primary outcome) and well-being, general health, cybersafety management, and connectedness (secondary outcomes) will be assessed with each survey. The general effectiveness hypotheses will be tested by using a linear mixed model with nested participant, year-group, and school random effects. The primary analysis will also include testing effectiveness in the Māori subgroup. Results: The study was funded by the New Zealand Ministry of Business, Innovation, and Employment in October 2015 and approved by the Auckland University of Technology Ethics Committee on May 3, 2017 (application number: 17/71). Conclusions: This study will generate robust evidence evaluating the impact of introducing a healthy relationship app in secondary schools on taitamariki partner relationship self-efficacy, well-being, general health, cybersafety management, and connectedness. This taitamariki- and indigenous Māori–centered research fills an important gap in developing and testing strengths-based mobile health interventions in secondary schools. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001262190; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377584 International Registered Report Identifier (IRRID): RR1-10.2196/24792 
%M 34967750
%R 10.2196/24792
%U https://www.researchprotocols.org/2021/12/e24792
%U https://doi.org/10.2196/24792
%U http://www.ncbi.nlm.nih.gov/pubmed/34967750

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 12
%P e28709
%T Development of a Credible Virtual Clinician Promoting Colorectal Cancer Screening via Telehealth Apps for and by Black Men: Qualitative Study
%A Wilson-Howard,Danyell
%A Vilaro,Melissa J
%A Neil,Jordan M
%A Cooks,Eric J
%A Griffin,Lauren N
%A Ashley,Taylor T
%A Tavassoli,Fatemeh
%A Zalake,Mohan S
%A Lok,Benjamin C
%A Odedina,Folakemi T
%A Modave,Francois
%A Carek,Peter J
%A George,Thomas J
%A Krieger,Janice L
%+ Department of Natural Sciences, Bethune Cookman University, 640 Mary McLeod Blvd., Daytona, FL, 32114, United States, 1 3864812687, wilsonda@cookman.edu
%K telehealth
%K digital health
%K eHealth
%K colorectal cancer
%K Black men
%K virtual human
%K technology
%K cancer screening
%K app
%K cancer
%K prevention
%K development
%D 2021

%7 24.12.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Traditionally, promotion of colorectal cancer (CRC) screening among Black men was delivered by community health workers, patient navigators, and decision aids (printed text or video media) at clinics and in the community setting. A novel approach to increase CRC screening of Black men includes developing and utilizing a patient-centered, tailored message delivered via virtual human technology in the privacy of one’s home. Objective: The objective of this study was to incorporate the perceptions of Black men in the development of a virtual clinician (VC) designed to deliver precision messages promoting the fecal immunochemical test (FIT) kit for CRC screening among Black men in a future clinical trial. Methods: Focus groups of Black men were recruited to understand their perceptions of a Black male VC. Specifically, these men identified source characteristics that would enhance the credibility of the VC. The modality, agency, interactivity, and navigability (MAIN) model, which examines how interface features affect the user’s psychology through four affordances (modality, agency, interactivity, and navigability), was used to assess the presumed credibility of the VC and likability of the app from the focus group transcripts. Each affordance triggers heuristic cues that stimulate a positive or a negative perception of trustworthiness, believability, and understandability, thereby increasing source credibility. Results: In total, 25 Black men were recruited from the community and contributed to the development of 3 iterations of a Black male VC over an 18-month time span. Feedback from the men enhanced the visual appearance of the VC, including its movement, clothing, facial expressions, and environmental surroundings. Heuristics, including social presence, novelty, and authority, were all recognized by the final version of the VC, and creditably was established.  The VC was named Agent Leveraging Empathy for eXams (ALEX) and referred to as “brother-doctor,” and participants stated “wanting to interact with ALEX over their regular doctor.” Conclusions: Involving Black men in the development of a digital health care intervention is critical. This population is burdened by cancer health disparities, and incorporating their perceptions in telehealth interventions will create awareness of the need to develop targeted messages for Black men. 
%M 34780346
%R 10.2196/28709
%U https://formative.jmir.org/2021/12/e28709
%U https://doi.org/10.2196/28709
%U http://www.ncbi.nlm.nih.gov/pubmed/34780346

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 12
%P e30106
%T Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis
%A Silenou,Bernard C
%A Nyirenda,John L Z
%A Zaghloul,Ahmed
%A Lange,Berit
%A Doerrbecker,Juliane
%A Schenkel,Karl
%A Krause,Gérard
%+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, Braunschweig, 38124, Germany, 49 5316181 3100, Gerard.Krause@helmholtz-hzi.de
%K mobile applications
%K mHealth
%K epidemiological surveillance
%K communicable diseases
%K outbreak response
%K health information management
%K public health
%K review
%K transmission network
%D 2021

%7 23.12.2021
%9 Review
%J JMIR Public Health Surveill
%G English
                
%X Background: Gaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. Objective: The aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. Methods: We conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). Results: We identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). Conclusions: There is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization. 
%M 34941551
%R 10.2196/30106
%U https://publichealth.jmir.org/2021/12/e30106
%U https://doi.org/10.2196/30106
%U http://www.ncbi.nlm.nih.gov/pubmed/34941551

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 12
%P e27521
%T An Early Warning Mobile Health Screening and Risk Scoring App for Preventing In-Hospital Transmission of COVID-19 by Health Care Workers: Development and Feasibility Study
%A Mbiine,Ronald
%A Nakanwagi,Cephas
%A Lekuya,Herve Monka
%A Aine,Joan
%A Hakim,Kawesi
%A Nabunya,Lilian
%A Tomusange,Henry
%+ Makerere University College of Health Sciences, Mulago Hill Road, Kampala, 7072, Uganda, 256 774338585, mbiineron@gmail.com
%K mHealth
%K risk score for Covid-19
%K Africa
%K mobile health
%K digital health
%K pandemic
%K COVID-19
%K COVID
%K screening tool
%K healthcare workers
%K transmission
%K warning system
%D 2021

%7 17.12.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Hospitals have been identified as very high-risk places for COVID-19 transmission between health care workers and patients who do not have COVID-19. Health care workers are the most at-risk population to contract and transmit the infection, especially to already vulnerable patients who do not have COVID-19. In low-income countries, routine testing is not feasible due to the high cost of testing; therefore, presenting the risk of uncontrolled transmission within non–COVID-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA–polymerase chain reaction testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also enable efficient use of the limited testing kits. Objective: The aims of this study are to describe an early warning in-hospital mobile risk analysis app for screening COVID-19 and to determine the feasibility and user-friendliness of the app among health care workers. Methods: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported that the tool was easy to use. Results: The primary result of this research project was the development of a mobile-based daily early warning system for in-hospital transmission of COVID-19. Overall, the Early Warning System for In-Hospital Transmission of COVID-19 (EWAS) mobile app was found to be feasible, with 69% of the health care workers (69/100) having logged more than 67% of the required times. Of the 100 participants, 93 reported that the tool was easy to use. Conclusions: The EWAS mobile app is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of COVID-19. Although it was not designed to be a diagnostic tool but rather a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted COVID-19. 
%M 34793321
%R 10.2196/27521
%U https://formative.jmir.org/2021/12/e27521
%U https://doi.org/10.2196/27521
%U http://www.ncbi.nlm.nih.gov/pubmed/34793321

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 12
%P e28311
%T Privacy and Confidentiality Concerns Related to the Use of mHealth Apps for HIV Prevention Efforts Among Malaysian Men Who Have Sex With Men: Cross-sectional Survey Study
%A Shrestha,Roman
%A Fisher,Celia
%A Wickersham,Jeffrey A
%A Khati,Antoine
%A Kim,Rayne
%A Azwa,Iskandar
%A Mistler,Colleen
%A Goldsamt,Lloyd
%+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road Unit 1101, Storrs, CT, 06269, United States, 1 860 486 2446, roman.shrestha@uconn.edu
%K HIV
%K men who have sex with men
%K mHealth
%K ethics
%K Malaysia
%K mobile phone
%D 2021

%7 16.12.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The use of mobile health (mHealth), including smartphone apps, can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, the mHealth platform has the potential to open new frontiers for HIV prevention efforts. However, little guidance is available to inform researchers about privacy and confidentiality concerns unique to the development and implementation of app-based HIV prevention programs. Objective: Given the lack of empirical data in this area, we aim to understand the privacy and confidentiality concerns associated with participation in a hypothetical app-based research study for HIV prevention efforts. Methods: A cross-sectional, web-based survey was conducted between June and July 2020 among 355 Malaysian MSM. The survey included demographic and sexual health questions and a series of short videos describing a hypothetical app-based HIV prevention program, followed by questions related to privacy and confidentiality concerns in each step of the app-based program (ie, recruitment, clinical interaction, risk assessment, and weekly reminder). Multivariable logistic regression models were used to identify the correlates of willingness to use such an app-based program. Results: Most of the participants (266/355, 74.9%) indicated their willingness to participate in a hypothetical mHealth app–based HIV prevention program. Participants expressed concerns about privacy, confidentiality, data security, and risks and benefits of participating in all stages of the app-based HIV research process. Multivariate analyses indicated that participants who had a higher degree of perceived participation benefits (adjusted odds ratio [aOR] 1.873; 95% CI 1.274-2.755; P=.001) were more willing to participate. In contrast, participants who had increased concerns about app-based clinical interaction and e-prescription (aOR 0.610; 95% CI 0.445-0.838; P=.002) and those who had a higher degree of perceived risks of participating (aOR 0.731; 95% CI 0.594-0.899; P=.003) were less willing to participate. Conclusions: Overall, our results indicate that mHealth app–based HIV prevention programs are acceptable for future research on Malaysian MSM. The findings further highlighted the role of privacy and confidentiality, as well as the associated risks and benefits associated with participation in such a program. Given the ever-evolving nature of such technological platforms and the complex ethical–legal landscape, such platforms must be safe and secure to ensure widespread public trust and uptake. 
%M 34924355
%R 10.2196/28311
%U https://formative.jmir.org/2021/12/e28311
%U https://doi.org/10.2196/28311
%U http://www.ncbi.nlm.nih.gov/pubmed/34924355

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 12
%P e26381
%T mUzima Mobile Electronic Health Record (EHR) System: Development and Implementation at Scale
%A Were,Martin Chieng
%A Savai,Simon
%A Mokaya,Benard
%A Mbugua,Samuel
%A Ribeka,Nyoman
%A Cholli,Preetam
%A Yeung,Ada
%+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, United States, 1 615 322 9374, martin.c.were@vumc.org
%K mobile health
%K electronic medical records
%K developing countries
%K digital divide
%K digital health
%K global health
%D 2021

%7 14.12.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. Objective: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). Methods: The “Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)” checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima’s architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. Results: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO’s Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. Conclusions: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains. 
%M 34904952
%R 10.2196/26381
%U https://www.jmir.org/2021/12/e26381
%U https://doi.org/10.2196/26381
%U http://www.ncbi.nlm.nih.gov/pubmed/34904952

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 4
%P e27988
%T Caregiver Acceptability of Mobile Phone Use for Pediatric Cancer Care in Tanzania: Cross-sectional Questionnaire Study
%A Schroeder,Kristin
%A Maiarana,James
%A Gisiri,Mwitasrobert
%A Joo,Emma
%A Muiruri,Charles
%A Zullig,Leah
%A Masalu,Nestory
%A Vasudevan,Lavanya
%+ Department of Pediatric Oncology, Duke University Medical Center, Box 102382, Durham, NC, 27710, United States, 1 9196686288, kristin.schroeder@duke.edu
%K mHealth
%K literacy
%K smartphone use
%K developing countries
%K pediatric cancer
%K cancer
%K pediatrics
%K children
%K parents
%K caregivers
%K mobile health
%K smartphone
%K SMS
%K education
%K knowledge transfer
%K communication
%D 2021

%7 8.12.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: There is a 60% survival gap between children diagnosed with cancer in low- and middle-income countries (LMICs) and those in high-income countries. Low caregiver knowledge about childhood cancer and its treatment results in presentation delays and subsequent treatment abandonment in LMICs. However, in-person education to improve caregiver knowledge can be challenging due to health worker shortages and inadequate training. Due to the rapid expansion of mobile phone use worldwide, mobile health (mHealth) technologies offer an alternative to delivering in-person education. Objective: The aim of this study is to assess patterns of mobile phone ownership and use among Tanzanian caregivers of children diagnosed with cancer as well as their acceptability of an mHealth intervention for cancer education, patient communication, and care coordination. Methods: In July 2017, caregivers of children <18 years diagnosed with cancer and receiving treatment at Bugando Medical Centre (BMC) were surveyed to determine mobile phone ownership, use patterns, technology literacy, and acceptability of mobile phone use for cancer education, patient communication, and care coordination. Descriptive statistics were generated from the survey data by using mean and SD values for continuous variables and percentages for binary or categorical variables. Results: All eligible caregivers consented to participate and completed the survey. Of the 40 caregivers who enrolled in the study, most used a mobile phone (n=34, 85%) and expressed high acceptability in using these devices to communicate with a health care provider regarding treatment support (n=39, 98%), receiving laboratory results (n=37, 93%), receiving reminders for upcoming appointments (n=38, 95%), and receiving educational information on cancer (n=35, 88%). Although only 9% (3/34) of mobile phone owners owned phones with smartphone capabilities, about 74% (25/34) self-reported they could view and read SMS text messages. Conclusions: To our knowledge, this is the first study to assess patterns of mobile phone ownership and use among caregivers of children with cancer in Tanzania. The high rate of mobile phone ownership and caregiver acceptability for a mobile phone–based education and communication strategy suggests that a mobile phone–based intervention, particularly one that utilizes SMS technology, could be feasible in this setting. 
%M 34889763
%R 10.2196/27988
%U https://pediatrics.jmir.org/2021/4/e27988
%U https://doi.org/10.2196/27988
%U http://www.ncbi.nlm.nih.gov/pubmed/34889763

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 12
%P e30525
%T Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study
%A Trofholz,Amanda
%A Tate,Allan
%A Janowiec,Mark
%A Fertig,Angela
%A Loth,Katie
%A de Brito,Junia N
%A Berge,Jerica
%+ Humphrey School of Public Affairs, University of Minnestoa, 717 Delaware St SE, Room 454, Minneapolis, MN, 55414, United States, 1 6126247129, trofh002@umn.edu
%K methods
%K ecological momentary assessment
%K weight-related behaviors
%K racially and ethnically diverse
%K children
%K mobile phone
%D 2021

%7 1.12.2021
%9 Early Report
%J JMIR Res Protoc
%G English
                
%X Background: Ecological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors. Objective: To answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample. Methods: Family Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day). Results: A detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study. Conclusions: The results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment. International Registered Report Identifier (IRRID): DERR1-10.2196/30525 
%M 34855612
%R 10.2196/30525
%U https://www.researchprotocols.org/2021/12/e30525
%U https://doi.org/10.2196/30525
%U http://www.ncbi.nlm.nih.gov/pubmed/34855612

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 11
%P e27626
%T Evaluation of the National Tuberculosis Surveillance System in Sana’a, Yemen, 2018: Observational Study
%A Al kalali,Fadwa Salem Ahmed
%A Mahyoub,Essam
%A Al-Hammadi,Abdulbary
%A Anam,Labiba
%A Khader,Yousef
%+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Mazda St, Al Hasaba, Sana’a, 12093, Yemen, 967 778005123, fadwa20102011@yahoo.com
%K evaluation
%K surveillance system
%K tuberculosis
%K Yemen
%D 2021

%7 30.11.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective: This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods: A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention’s updated guidelines. The study was carried out in 10 districts in Sana’a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results: The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71%), flexibility (30/40, 75%), acceptability (174/264, 66%), data quality (4/6, 67%), and positive predictive value (78/107, 73%), and poor performance in simplicity (863/1452, 59%) and stability (15%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96%). Conclusions: The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance. 
%M 34851294
%R 10.2196/27626
%U https://publichealth.jmir.org/2021/11/e27626
%U https://doi.org/10.2196/27626
%U http://www.ncbi.nlm.nih.gov/pubmed/34851294

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e29214
%T mHealth-Based Health Promotion Intervention to Improve Use of Maternity Care Services Among Women in Rural Southwestern Uganda: Iterative Development Study
%A Atukunda,Esther Cathyln
%A Matthews,Lynn T
%A Musiimenta,Angella
%A Mugyenyi,Godfrey Rwambuka
%A Mugisha,Samuel
%A Ware,Norma C
%A Obua,Celestino
%A Siedner,Mark J
%+ Mbarara University of Science and Technology, Faculty of Medicine, Plot 11-18, Kabale Road, P O Box 1410, Mbarara City, Uganda, 256 702949832, eatukunda@must.ac.ug
%K mHealth app
%K app development
%K messaging
%K health education
%K health promotion
%K mobile phone
%D 2021

%7 25.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Antenatal care (ANC) prevents perinatal morbidity and mortality, but use of these services in Uganda remains low and maternal mortality rates are among the highest in the world. There is growing evidence that mobile health (mHealth) approaches improve timely communication of health-related information and produce positive health behavior change as well as health outcomes. However, there are limited data to guide development of such interventions in settings where ANC attendance and uptake of skilled maternity care are low. Objective: The aim of this study is to develop a novel patient-centered mHealth intervention to encourage and support women to use maternity care services in Mbarara district, southwestern Uganda. Methods: Using an iterative development approach, we conducted formative stakeholder interviews with 30 women and 5 health care providers (HCPs) to identify preferred key ANC topics and characterize the preferred messaging intervention; developed content for SMS text messaging and audio messaging with the help of 4 medical experts based on the identified topics; designed an app prototype through partnership with an mHealth development company; and pilot-tested the prototype and sought user experiences and feedback to refine the intervention through 3 sets of iterative interviews, a focus group discussion, and 5 cognitive interviews. Qualitative data were coded and analyzed using NVivo (version 12.0; QSR International). Results: Of the 75 women who completed interviews during the development of the prototype, 39 (52%) had at least a primary education and 75 (100%) had access to a mobile phone. The formative interviews identified 20 preferred perinatal health topics, ranging from native medicine use to comorbid disorders and danger signs during pregnancy. In all, 6 additional topics were identified by the interviewed HCPs, including birth preparedness, skilled delivery, male partner’s involvement, HCP interaction, immunization, and caring for the baby. Positive audio messaging and SMS text messaging content without authoritative tones was developed as characterized by the interviewed women. The postpilot iterative interviews and focus group discussion revealed a preference for customized messaging, reflecting an individual need to be included and connected. The women preferred short, concise, clear actionable messages that guided, supported, and motivated them to keep alert and seek professional help. Complementary weekly reminders to the women’s significant others were also preferred to encourage continuity or prompt the needed social support for care seeking. Conclusions: We used an iterative approach with diffuse stakeholders to develop a patient-centered audio messaging and SMS text messaging app designed to communicate important targeted health-related information and support rural pregnant women in southwestern Uganda. Involving both HCPs and end users in developing and formulating the mHealth intervention allowed us to tailor the intervention characteristics to the women’s preferences. Future work will address the feasibility, acceptability, and effectiveness of this design approach. 
%M 34842541
%R 10.2196/29214
%U https://formative.jmir.org/2021/11/e29214
%U https://doi.org/10.2196/29214
%U http://www.ncbi.nlm.nih.gov/pubmed/34842541

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 11
%P e26252
%T mHealth for Anemia Reduction: Protocol for an Entertainment Education–Based Dual Intervention
%A Pant,Ichhya
%A Rimal,Rajiv
%A Yilma,Hagere
%A Bingenheimer,Jeffrey
%A Sedlander,Erica
%A Behera,Sibabrata
%+ Department of Prevention and Community Health, School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC, 20052, United States, 1 4044619851, ipant@gwu.edu
%K mHealth
%K interactive
%K voice response
%K entertainment
%K education
%K rural
%K anemia
%K bystander
%K violence against women
%D 2021

%7 22.11.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India’s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education–based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women–related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study’s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms–based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women–related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 
%M 34812735
%R 10.2196/26252
%U https://www.researchprotocols.org/2021/11/e26252
%U https://doi.org/10.2196/26252
%U http://www.ncbi.nlm.nih.gov/pubmed/34812735

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 11
%P e30191
%T Health Education Through a Campaign and mHealth to Enhance Knowledge and Quality of Life Among Patients With Chronic Kidney Disease in Bangladesh: Protocol for a Randomized Controlled Trial
%A Sarker,Mohammad Habibur Rahman
%A Moriyama,Michiko
%A Rashid,Harun Ur
%A Rahman,Md Moshiur
%A Chisti,Mohammod Jobayer
%A Das,Sumon Kumar
%A Jahan,Yasmin
%A Saha,Samir Kumar
%A Arifeen,Shams El
%A Ahmed,Tahmeed
%A Faruque,A S G
%+ Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8553, Japan, 81 09028602013, d185558@hiroshima-u.ac.jp
%K chronic kidney disease
%K campaign
%K mHealth
%K knowledge
%K Bangladesh
%D 2021

%7 19.11.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective: The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods: A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results: Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions: It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration: ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID): DERR1-10.2196/30191 
%M 34806998
%R 10.2196/30191
%U https://www.researchprotocols.org/2021/11/e30191
%U https://doi.org/10.2196/30191
%U http://www.ncbi.nlm.nih.gov/pubmed/34806998

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e25824
%T The 4 Youth By Youth mHealth Photo Verification App for HIV Self-testing in Nigeria: Qualitative Analysis of User Experiences
%A Oladele,David
%A Iwelunmor,Juliet
%A Gbajabiamila,Titilola
%A Obiezu-Umeh,Chisom
%A Okwuzu,Jane Ogoamaka
%A Nwaozuru,Ucheoma
%A Musa,Adesola Zaidat
%A Idigbe,Ifeoma
%A Tahlil,Kadija
%A Tang,Weiming
%A Conserve,Donaldson F
%A Rosenberg,Nora E
%A David,Agatha N
%A Tucker,Joseph
%A Ezechi,Oliver
%+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 3149773280, juliet.iwelunmor@slu.edu
%K HIV self-testing
%K adolescents
%K young people
%K photo verification
%K mobile app
%K Nigeria
%D 2021

%7 17.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Despite the global expansion of HIV self-testing (HIVST), many research studies still rely on self-reported outcomes. New HIVST verification methods are needed, especially in resource-limited settings. Objective: This study aims to evaluate the user experience of a mobile health (mHealth) app to enhance HIVST result reporting and verification. Methods: Semistructured, in-depth interviews were used to evaluate the user experience of the 4 Youth By Youth mHealth photo verification app for HIVST. We used a think-aloud approach, and participants performed usability tasks and completed a qualitative exit interview. The app included HIV educational resources, step-by-step video instructions for performing HIVST, a 20-minute timer, a guide on interpreting results with linkages to care, an offline version, and a photo verification system. Demographic characteristics were reported by using descriptive statistics. Qualitative data were analyzed by using thematic analysis. Results: A total of 19 users—12 women and 7 men—with a mean age of 22 years, participated in the study. The users completed the usability tasks and successfully uploaded a photo of their test results by using the app without assistance. Four main themes were identified in the data. First, in terms of user-friendly design, the participants noted the user-friendly features of the offline version and the app’s low data use. However, some wanted the app to work in the background when using their mobile phone, and the font used should be more youth friendly. Second, in terms of ease of use, participants remarked that the app’s self-explanatory nature and instructions that guided them on how to use the app enhanced its use. Third, in terms of a user’s privacy, many participants reinforced the importance of privacy settings and tools that protect confidentiality among users. Finally, in terms of linkage to care, participants noted that the app’s linkage to care features were useful, particularly in relation to referrals to trained counselors upon the completion of the test. All the participants noted that the app provided a convenient and private means of verifying the HIV test results. Conclusions: Our findings demonstrated the importance of engaging end users in the development phase of health technology innovations that serve youth. Clinical trials are needed to determine the efficacy of using an mHealth app to verify HIVST results among young people. 
%M 34787579
%R 10.2196/25824
%U https://formative.jmir.org/2021/11/e25824
%U https://doi.org/10.2196/25824
%U http://www.ncbi.nlm.nih.gov/pubmed/34787579

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 11
%P e29020
%T Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh
%A Berry,Isha
%A Mangtani,Punam
%A Rahman,Mahbubur
%A Khan,Iqbal Ansary
%A Sarkar,Sudipta
%A Naureen,Tanzila
%A Greer,Amy L
%A Morris,Shaun K
%A Fisman,David N
%A Flora,Meerjady Sabrina
%+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 416 978 0901, isha.berry@mail.utoronto.ca
%K mobile telephone survey
%K health surveillance
%K survey methodology
%K Bangladesh
%D 2021

%7 12.11.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Population-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys. Objective: This study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh. Methods: A population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness. Results: A total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2% (1047/2006) and a co-operation rate of 89.0% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile. Conclusions: Probability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone–based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs. 
%M 34766914
%R 10.2196/29020
%U https://publichealth.jmir.org/2021/11/e29020
%U https://doi.org/10.2196/29020
%U http://www.ncbi.nlm.nih.gov/pubmed/34766914

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e23874
%T Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey
%A Chukwu,Emeka
%A Gilroy,Sonia
%A Addaquay,Kojo
%A Jones,Nki Nafisa
%A Karimu,Victor Gbadia
%A Garg,Lalit
%A Dickson,Kim Eva
%+ Department of Computer Information System, Faculty of Information and Communications Technology (ICT), University of Malta, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com
%K young people
%K short message service
%K SMS
%K chatbot
%K text message
%K interactive voice response
%K IVR
%K WhatsApp
%K Facebook
%K family planning
%K contraceptives
%K Sierra Leone
%D 2021

%7 12.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. 
%M 34766908
%R 10.2196/23874
%U https://formative.jmir.org/2021/11/e23874
%U https://doi.org/10.2196/23874
%U http://www.ncbi.nlm.nih.gov/pubmed/34766908

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 11
%P e32093
%T Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis
%A Lee,Bohee
%A Ibrahim,Siti Aishah
%A Zhang,Tiying
%+ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 1316503034, bohee.lee@ed.ac.uk
%K mobile apps
%K applications
%K eHealth
%K mHealth
%K mobile health
%K digital health
%K telemedicine
%K telehealth
%K COVID-19
%K coronavirus
%K pandemic
%K public health
%K health policy
%D 2021

%7 11.11.2021
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. 
%M 34748515
%R 10.2196/32093
%U https://mhealth.jmir.org/2021/11/e32093
%U https://doi.org/10.2196/32093
%U http://www.ncbi.nlm.nih.gov/pubmed/34748515

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e28951
%T Validation of a Mobile Health Technology Platform (FeverTracker) for Malaria Surveillance in India: Development and Usability Study
%A Pal Bhowmick,Ipsita
%A Chutia,Dibyajyoti
%A Chouhan,Avinash
%A Nishant,Nilay
%A Raju,P L N
%A Narain,Kanwar
%A Kaur,Harpreet
%A Pebam,Rocky
%A Debnath,Jayanta
%A Tripura,Rabindra
%A Gogoi,Kongkona
%A Ch Nag,Suman
%A Nath,Aatreyee
%A Tripathy,Debabrata
%A Debbarma,Jotish
%A Das,Nirapada
%A Sarkar,Ujjwal
%A Debbarma,Rislyn
%A Roy,Rajashree
%A Debnath,Bishal
%A Dasgupta,Dipanjan
%A Debbarma,Suraj
%A Joy Tripura,Kamal
%A Reang,Guneram
%A Sharma,Amit
%A Rahi,Manju
%A Chhibber-Goel,Jyoti
%+ International Centre for Genetic Engineering and Biotechnology, Vasant Kunj, New Delhi, 110067, India, 91 011 26741358 ext 170, jyotichhibbergoel@gmail.com
%K fever
%K health system
%K mHealth app
%K malaria
%K surveillance
%K mobile phone
%D 2021

%7 10.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: A surveillance system is the foundation for disease prevention and control. Malaria surveillance is crucial for tracking regional and temporal patterns in disease incidence, assisting in recorded details, timely reporting, and frequency of analysis. Objective: In this study, we aim to develop an integrated surveillance graphical app called FeverTracker, which has been designed to assist the community and health care workers in digital surveillance and thereby contribute toward malaria control and elimination. Methods: FeverTracker uses a geographic information system and is linked to a web app with automated data digitization, SMS text messaging, and advisory instructions, thereby allowing immediate notification of individual cases to district and state health authorities in real time. Results: The use of FeverTracker for malaria surveillance is evident, given the archaic paper-based surveillance tools used currently. The use of the app in 19 tribal villages of the Dhalai district in Tripura, India, assisted in the surveillance of 1880 suspected malaria patients and confirmed malaria infection in 93.4% (114/122; Plasmodium falciparum), 4.9% (6/122; P vivax), and 1.6% (2/122; P falciparum/P vivax mixed infection) of cases. Digital tools such as FeverTracker will be critical in integrating disease surveillance, and they offer instant data digitization for downstream processing. Conclusions: The use of this technology in health care and research will strengthen the ongoing efforts to eliminate malaria. Moreover, FeverTracker provides a modifiable template for deployment in other disease systems. 
%M 34757321
%R 10.2196/28951
%U https://formative.jmir.org/2021/11/e28951
%U https://doi.org/10.2196/28951
%U http://www.ncbi.nlm.nih.gov/pubmed/34757321

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e18969
%T Exploring the Barriers to and Motivators for Using Digital Mental Health Interventions Among Construction Personnel in Nigeria: Qualitative Study
%A Nwaogu,Janet Mayowa
%A Chan,Albert P C
%A Naslund,John A
%A Hon,Carol K H
%A Belonwu,Christopher
%A Yang,Jackie
%+ Department of Building and Real Estate, The Hong Kong Polytechnic University, Kowloon, Hong Kong, 852 52243597, janet.nwaogu@connect.polyu.hk
%K mental health
%K construction personnel
%K digital technology
%K digital intervention
%K barriers
%K motivators
%K mobile phone
%D 2021

%7 9.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Work-related stress in the construction industry increases the prevalence of depression and anxiety among personnel. In low-resource settings such as Nigeria, construction personnel face high demands and severe working conditions but only have a few services to address their mental health needs. With emerging research showing that digital interventions can be used to self-manage mental health across diverse settings, there may be new opportunities to support construction personnel in the construction industry. Objective: This study aims to determine the use of digital interventions for mental health management among construction personnel in Nigeria and to explore the factors that facilitate or impede the use of these interventions. Methods: This qualitative study explored the perspectives of a convenience sample of 62 construction personnel. The data were subjected to inductive content analysis. Results: A total of 6 barrier and 3 motivator themes were identified and categorized into 2 groups. The barrier themes were subcategorized into barriers to adoption and barriers to persistent use, whereas the motivator themes were subcategorized into intrinsic and extrinsic motivators. Lack of awareness and knowledge about the interventions may constitute a barrier to adoption and use. Participants frequently reported concerns regarding their effectiveness and usability. Conclusions: This study provides an understanding of the design needs required to facilitate sustained self-management of mental health based on the experiences and expectations of construction personnel with digital interventions. 
%M 34751652
%R 10.2196/18969
%U https://formative.jmir.org/2021/11/e18969
%U https://doi.org/10.2196/18969
%U http://www.ncbi.nlm.nih.gov/pubmed/34751652

%0 Journal Article
        
%@ 2291-9279
%I JMIR Publications
%V 9
%N 4
%P e30350
%T Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study
%A Malamsha,Maria Proches
%A Sauli,Elingarami
%A Luhanga,Edith Talina
%+ School of Computation and Communication Science and Engineering, Nelson Mandela African Institution of Science and Technology, PO Box 447, Nelson Mandela Rd, Arusha, United Republic of Tanzania, 255 715261702, selestinapro@gmail.com
%K child sexual abuse
%K social cultural belief
%K ecological setting
%K prevention
%K parents
%K caretakers
%K child experts
%K mobile game
%D 2021

%7 8.11.2021
%9 Original Paper
%J JMIR Serious Games
%G English
                
%X Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa—where sexual education is still taboo—that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods:  HappyToto children’s game was co-designed with 111 parents and caretakers (females: n=58, 52.3%; male: n=53, 47.7%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game’s interface, storylines, and options. To validate the application’s prototype, 32 parents (females: n=18, 56%; males: n=14, 44%) of children aged 3-5 years and 5 children (females: n=2, 40%; males: n=3, 60%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. 
%M 34747703
%R 10.2196/30350
%U https://games.jmir.org/2021/4/e30350
%U https://doi.org/10.2196/30350
%U http://www.ncbi.nlm.nih.gov/pubmed/34747703

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 11
%P e23852
%T Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study
%A Songtaweesin,Wipaporn Natalie
%A LeGrand,Sara
%A Bandara,Shashika
%A Piccone,Caitlin
%A Wongharn,Prissana
%A Moonwong,Juthamanee
%A Jupimai,Thidarat
%A Saisaengjan,Chutima
%A Theerawit,Tuangtip
%A Muessig,Kathryn
%A Hightow-Weidman,Lisa
%A Puthanakit,Thanyawee
%A Phanuphak,Nittaya
%A Tangmunkongvorakul,Arunrat
%+ Research Institute for Health Sciences, Chiang Mai University, 110 Intavarorot Road, Tambol Siphum, Amphur Muang, Chiang Mai, 50200, Thailand, 66 815942773, arunrat@rihes.org
%K mobile health
%K young men who have sex with men
%K pre-exposure prophylaxis
%K adherence
%K mobile phone
%D 2021

%7 4.11.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. Objective: This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. Methods: We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. Results: For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app’s features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. Conclusions: The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. Trial Registration: ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708 
%M 34734828
%R 10.2196/23852
%U https://www.jmir.org/2021/11/e23852
%U https://doi.org/10.2196/23852
%U http://www.ncbi.nlm.nih.gov/pubmed/34734828

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 11
%P e27114
%T Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study
%A Bhattacharjee,Ananya
%A Haque,S M Taiabul
%A Hady,Md Abdul
%A Alam,S M Raihanul
%A Rabbi,Mashfiqui
%A Kabir,Muhammad Ashad
%A Ahmed,Syed Ishtiaque
%+ Department of Computer Science, University of Toronto, 40 St George Street, Toronto, ON, M5S 2E4, Canada, 1 6476196982, ananya@cs.toronto.edu
%K Bangladesh
%K global south
%K social determinant
%K students
%K undergraduate
%K religion
%K women
%K mobile phone
%D 2021

%7 2.11.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied. Objective: This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health. Methods: We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns. Results: Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons). Conclusions: Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world. 
%M 34726609
%R 10.2196/27114
%U https://formative.jmir.org/2021/11/e27114
%U https://doi.org/10.2196/27114
%U http://www.ncbi.nlm.nih.gov/pubmed/34726609

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e27131
%T Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study
%A Sekandi,Juliet Nabbuye
%A Kasiita,Vicent
%A Onuoha,Nicole Amara
%A Zalwango,Sarah
%A Nakkonde,Damalie
%A Kaawa-Mafigiri,David
%A Turinawe,Julius
%A Kakaire,Robert
%A Davis-Olwell,Paula
%A Atuyambe,Lynn
%A Buregyeya,Esther
%+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 17063387993, jsekandi@uga.edu
%K tuberculosis
%K adherence
%K mHealth
%K video directly observed therapy
%K Uganda
%K mobile phone
%D 2021

%7 27.10.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective: This study explores stakeholders’ acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods: An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ≥18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results: The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ≥8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions: VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context. 
%M 34704961
%R 10.2196/27131
%U https://mhealth.jmir.org/2021/10/e27131
%U https://doi.org/10.2196/27131
%U http://www.ncbi.nlm.nih.gov/pubmed/34704961

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 10
%P e32921
%T Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study
%A Xiao,Jin
%A Luo,Jiebo
%A Ly-Mapes,Oriana
%A Wu,Tong Tong
%A Dye,Timothy
%A Al Jallad,Nisreen
%A Hao,Peirong
%A Ruan,Jinlong
%A Bullock,Sherita
%A Fiscella,Kevin
%+ Department of Family Medicine, University of Rochester Medical Center, 1381 South Avenue, Rochester, NY, 14620, United States, 1 585 506 9484, Kevin_Fiscella@URMC.Rochester.edu
%K artificial intelligence
%K smartphone app
%K mDentistry
%K dental caries
%K underserved population
%K mobile dentistry
%D 2021

%7 22.10.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence–powered smartphone app, AICaries, to be used by children’s parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence–powered caries detection using photos of children’s teeth taken by the parents’ smartphones, interactive caries risk assessment, and personalized education on reducing children’s ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children’s teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents’ satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children’s teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children’s caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 
%M 34529582
%R 10.2196/32921
%U https://www.researchprotocols.org/2021/10/e32921
%U https://doi.org/10.2196/32921
%U http://www.ncbi.nlm.nih.gov/pubmed/34529582

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 10
%P e25777
%T Effectiveness of Smartphone-Based Community Case Management on the Urgent Referral, Reconsultation, and Hospitalization of Children Aged Under 5 Years in Malawi: Cluster-Randomized, Stepped-Wedge Trial
%A Chirambo,Griphin Baxter
%A Thompson,Matthew
%A Hardy,Victoria
%A Ide,Nicole
%A Hwang,Phillip H
%A Dharmayat,Kanika
%A Mastellos,Nikolaos
%A Heavin,Ciara
%A O'Connor,Yvonne
%A Muula,Adamson S
%A Andersson,Bo
%A Carlsson,Sven
%A Tran,Tammy
%A Hsieh,Jenny Chen-Ling
%A Lee,Hsin-Yi
%A Fitzpatrick,Annette
%A Joseph Wu,Tsung-Shu
%A O'Donoghue,John
%+ Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Mzuzu, Malawi, 265 0999236092, gbchirambo@yahoo.co.uk
%K community case management
%K mobile health
%K pediatrics
%K childhood infection
%K mobile phone
%D 2021

%7 20.10.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Integrated community case management (CCM) has led to reductions in child mortality in Malawi resulting from illnesses such as malaria, pneumonia, and diarrhea. However, adherence to CCM guidelines is often poor, potentially leading to inappropriate clinical decisions and poor outcomes. We determined the impact of an e-CCM app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Objective: We determined the impact of an electronic version of a smartphone-based CCM (e-CCM) app on the referral, reconsultation, and hospitalization rates of children presenting to village clinics in Malawi. Methods: We used a stepped-wedge, cluster-randomized trial to compare paper-based CCM (control) with and without the use of an e-CCM app on smartphones from November 2016 to February 2017. A total of 102 village clinics from 2 districts in northern Malawi were assigned to 1 of 6 clusters, which were randomized on the sequencing of the crossover from the control phase to the intervention phase as well as the duration of exposure in each phase. Children aged ≥2 months to <5 years who presented with acute illness were enrolled consecutively by health surveillance assistants. The primary outcome of urgent referrals to higher-level facilities was evaluated by using multilevel mixed effects models. A logistic regression model with the random effects of the cluster and the fixed effects for each step was fitted. The adjustment for potential confounders included baseline factors, such as patient age, sex, and the geographical location of the village clinics. Calendar time was adjusted for in the analysis. Results: A total of 6965 children were recruited—49.11% (3421/6965) in the control phase and 50.88% (3544/6965) in the intervention phase. After adjusting for calendar time, children in the intervention phase were more likely to be urgently referred to a higher-level health facility than children in the control phase (odds ratio [OR] 2.02, 95% CI 1.27-3.23; P=.003). Overall, children in the intervention arm had lower odds of attending a repeat health surveillance assistant consultation (OR 0.45, 95% CI 0.34-0.59; P<.001) or being admitted to a hospital (OR 0.75, 95% CI 0.62-0.90; P=.002), but after adjusting for time, these differences were not significant (P=.07 for consultation; P=.30 for hospital admission). Conclusions: The addition of e-CCM decision support by using smartphones led to a greater proportion of children being referred to higher-level facilities, with no apparent increase in hospital admissions or repeat consultations in village clinics. Our findings provide support for the implementation of e-CCM tools in Malawi and other low- and middle-income countries with a need for ongoing assessments of effectiveness and integration with national digital health strategies. Trial Registration: ClinicalTrials.gov NCT02763345; https://clinicaltrials.gov/ct2/show/NCT02763345 
%M 34668872
%R 10.2196/25777
%U https://www.jmir.org/2021/10/e25777
%U https://doi.org/10.2196/25777
%U http://www.ncbi.nlm.nih.gov/pubmed/34668872

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e26358
%T Integration of mHealth Information and Communication Technologies Into the Clinical Settings of Hospitals in Sub-Saharan Africa: Qualitative Study
%A Ogundaini,Oluwamayowa Oaikhena
%A de la Harpe,Retha
%A McLean,Nyx
%+ Department of Information Technology, Faculty of Informatics and Design, Cape Peninsula University of Technology, District Six Campus, Hanover Street, 7925, Cape Town, 8000, South Africa, 27 735989341, ogundainio@cput.ac.za
%K mHealth
%K health care professionals
%K co-design
%K hospitals
%K ActAD model
%K work activity
%K Sub-Saharan Africa
%K referrals
%K VULA mobile app
%K WhatsApp
%K mobile phone
%D 2021

%7 13.10.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There is a rapid uptake of mobile-enabled technologies in lower- and upper-middle–income countries because of its portability, ability to reduce mobility, and facilitation of communication. However, there is limited empirical evidence on the usefulness of mobile health (mHealth) information and communication technologies (ICTs) to address constraints associated with the work activities of health care professionals at points of care in hospital settings. Objective: This study aims to explore opportunities for integrating mHealth ICTs into the work activities of health care professionals at points of care in clinical settings of hospitals in Sub-Saharan Africa. Thus, the research question is, “How can mHealth ICTs be integrated into the work activities of health care professionals at points of care in hospital settings?” Methods: A qualitative approach was adopted to understand the work activities and points at which mHealth ICTs could be integrated to support health care professionals. The techniques of inquiry were semistructured interviews and co-design activities. These techniques were used to ensure the participation of frontline end users and determine how mHealth ICTs could be integrated into the point of care in hospital settings. Purposive and snowball sampling techniques were used to select tertiary hospitals and participants for this study from South Africa and Nigeria. A total of 19 participants, including physicians, nurses, and hospital managers, were engaged in the study. Ethical clearance was granted by the University research committee and the respective hospitals. The data collected were sorted and interpreted using thematic analysis and Activity Analysis and Development model. Results: The findings show that mHealth ICTs are suitable at points where health care professionals consult with patients in the hospital clinics, remote communication is needed, and management of referrals and report writing are required. It was inferred that mHealth ICTs could be negatively disruptive, and some participants perceived the use of mobile devices while engaging with patients as unprofessional. These findings were informed by the outcomes of the interplay between human attributes and technology capabilities during the transformation of the motives of work activity into the intended goal, which is enhanced service delivery. Conclusions: The opportunities to integrate mHealth ICTs into clinical settings depend on the inefficiencies of interaction moments experienced by health care professionals at points of care during patient consultation, remote communication, referrals, and report writing. Thus, the timeliness of mHealth ICTs to address constraints experienced by health care professionals during work activities should take into consideration the type of work activity and the contextual factors that may result in contradictions in relation to technology features. This study contributes toward the design of mHealth ICTs by industry vendors and its usability evaluation for the work activity outcomes of health care professionals. 
%M 34643540
%R 10.2196/26358
%U https://mhealth.jmir.org/2021/10/e26358
%U https://doi.org/10.2196/26358
%U http://www.ncbi.nlm.nih.gov/pubmed/34643540

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 10
%P e26164
%T A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru
%A Vera Cruz dos Santos,Daniela
%A Coelho de Soárez,Patrícia
%A Cavero,Victoria
%A U Rocha,Thaís I
%A Aschar,Suzana
%A Daley,Kate Louise
%A Garcia Claro,Heloísa
%A Abud Scotton,George
%A Fernandes,Ivan
%A Diez-Canseco,Francisco
%A Brandt,Lena Rebeca
%A Toyama,Mauricio
%A Martins Castro,Hellen Carolina
%A Miranda,J Jaime
%A Araya,Ricardo
%A Quayle,Julieta
%A Rossi Menezes,Paulo
%+ Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 455 2º andar sala 2228, São Paulo, 01246-903, Brazil, 55 1130617444, patricia.soarez@usp.br
%K cost-effectiveness
%K depression
%K diabetes
%K hypertension
%K noncommunicable diseases
%K randomized trials
%K low- and middle-income countries
%K mHealth
%K task shifting
%K behavioral activation
%D 2021

%7 13.10.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. Objective: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. Methods: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top–down and bottom–up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. Results: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. Conclusions: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426 International Registered Report Identifier (IRRID): DERR1-10.2196/26164 
%M 34643538
%R 10.2196/26164
%U https://www.researchprotocols.org/2021/10/e26164
%U https://doi.org/10.2196/26164
%U http://www.ncbi.nlm.nih.gov/pubmed/34643538

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e28384
%T Identification and Evaluation of Methodologies to Assess the Quality of Mobile Health Apps in High-, Low-, and Middle-Income Countries: Rapid Review
%A Woulfe,Fionn
%A Fadahunsi,Kayode Philip
%A Smith,Simon
%A Chirambo,Griphin Baxter
%A Larsson,Emma
%A Henn,Patrick
%A Mawkin,Mala
%A O’ Donoghue,John
%+ School of Medicine, University College Cork, College Road, Cork, T12 K8AF, Ireland, 353 21 490 3000, fionnwoulfe@gmail.com
%K mHealth app
%K health app
%K mobile health
%K health website
%K quality
%K quality assessment
%K methodology
%K high-income country
%K low-income country
%K middle-income country
%K LMIC
%K mobile phone
%D 2021

%7 12.10.2021
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In recent years, there has been rapid growth in the availability and use of mobile health (mHealth) apps around the world. A consensus regarding an accepted standard to assess the quality of such apps has yet to be reached. A factor that exacerbates the challenge of mHealth app quality assessment is variations in the interpretation of quality and its subdimensions. Consequently, it has become increasingly difficult for health care professionals worldwide to distinguish apps of high quality from those of lower quality. This exposes both patients and health care professionals to unnecessary risks. Despite progress, limited understanding of the contributions of researchers in low- and middle-income countries (LMICs) exists on this topic. Furthermore, the applicability of quality assessment methodologies in LMIC settings remains relatively unexplored. Objective: This rapid review aims to identify current methodologies in the literature to assess the quality of mHealth apps, understand what aspects of quality these methodologies address, determine what input has been made by authors from LMICs, and examine the applicability of such methodologies in LMICs. Methods: This review was registered with PROSPERO (International Prospective Register of Systematic Reviews). A search of PubMed, EMBASE, Web of Science, and Scopus was performed for papers related to mHealth app quality assessment methodologies, which were published in English between 2005 and 2020. By taking a rapid review approach, a thematic and descriptive analysis of the papers was performed. Results: Electronic database searches identified 841 papers. After the screening process, 52 papers remained for inclusion. Of the 52 papers, 5 (10%) proposed novel methodologies that could be used to evaluate mHealth apps of diverse medical areas of interest, 8 (15%) proposed methodologies that could be used to assess apps concerned with a specific medical focus, and 39 (75%) used methodologies developed by other published authors to evaluate the quality of various groups of mHealth apps. The authors in 6% (3/52) of papers were solely affiliated to institutes in LMICs. A further 15% (8/52) of papers had at least one coauthor affiliated to an institute in an LMIC. Conclusions: Quality assessment of mHealth apps is complex in nature and at times subjective. Despite growing research on this topic, to date, an all-encompassing appropriate means for evaluating the quality of mHealth apps does not exist. There has been engagement with authors affiliated to institutes across LMICs; however, limited consideration of current generic methodologies for application in LMIC settings has been identified. Trial Registration: PROSPERO CRD42020205149; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205149 
%M 34636737
%R 10.2196/28384
%U https://mhealth.jmir.org/2021/10/e28384
%U https://doi.org/10.2196/28384
%U http://www.ncbi.nlm.nih.gov/pubmed/34636737

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e27478
%T Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial
%A Jiang,Nan
%A Nguyen,Nam
%A Siman,Nina
%A Cleland,Charles M
%A Nguyen,Trang
%A Doan,Hue Thi
%A Abroms,Lorien C
%A Shelley,Donna R
%+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Room #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org
%K smoking cessation
%K text messaging
%K mHealth
%K mobile health
%K low- and middle-income country
%K smoking
%K developing countries
%K SMS
%K Vietnam
%D 2021

%7 8.10.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 
%M 34623318
%R 10.2196/27478
%U https://mhealth.jmir.org/2021/10/e27478
%U https://doi.org/10.2196/27478
%U http://www.ncbi.nlm.nih.gov/pubmed/34623318

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 10
%P e23204
%T Development of a Mobile Health Application for HIV Prevention Among At-Risk Populations in Urban Settings in East Africa: A Participatory Design Approach
%A Mauka,Wilhellmuss
%A Mbotwa,Christopher
%A Moen,Kåre
%A Lichtwarck,Hanne Ochieng
%A Haaland,Inga
%A Kazaura,Method
%A Leyna,Germana H
%A Leshabari,Melkizedeck T
%A Mmbaga,Elia J
%+ Department of Behavioural Science, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, United Republic of Tanzania, 255 763225717, wilhemauka@yahoo.com
%K mHealth application
%K participatory design
%K HIV
%K pre-exposure prophylaxis
%K Africa
%K female sex workers
%K sex and gender minorities
%D 2021

%7 7.10.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is limited evidence in Africa on the design and development of mobile health (mHealth) applications to guide best practices and ensure effectiveness. A pragmatic trial for HIV pre-exposure prophylaxis roll-out among key populations in Tanzania is needed. Objective: We present the results of the development of a mobile app (Jichunge) intended to promote adherence to pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) and female sex workers (FSW) in Tanzania. Methods: A participatory design approach was employed and guided by the information system research framework. MSM and FSW were the target populations. A total of 15 MSM and 15 FSW were engaged in the relevance and design cycles, while the piloting phase included 10 MSM and 20 FSW. Results: The relevance cycle enabled the description of the existing problem, provided the compatible app features for the target population, and identified the need to develop an mHealth app that provides health services in a stigmatizing and discriminating environment. User involvement in the app’s design and evaluation provided an opportunity to incorporate social, cultural, and community-specific features that ensured usability. In addition, the participants suggested valuable information to inform the app, text message services, medication registration, and chat platform designs. Conclusions: The participatory design approach in the development of mHealth apps is useful in identifying and validating population-specific functional features, improve usability, and ensuring future health impacts. Through this participatory process, the Jichunge app took end-user needs, perspectives, and experiences into account, eliciting enthusiasm regarding its potential role in supporting pre-exposure prophylaxis adherence for HIV and related behavioral change promotion. Trial Registration: International Clinical Trials Registry Platform PACTR202003823226570; https://trialsearch.who.int/Trial2.aspx?TrialID=PACTR202003823226570 
%M 34617904
%R 10.2196/23204
%U https://formative.jmir.org/2021/10/e23204
%U https://doi.org/10.2196/23204
%U http://www.ncbi.nlm.nih.gov/pubmed/34617904

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 10
%P e30947
%T mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam
%A Larkin,Celine
%A Wijesundara,Jessica
%A Nguyen,Hoa L
%A Ha,Duc Anh
%A Vuong,Anh
%A Nguyen,Cuong Kieu
%A Amante,Daniel
%A Ngo,Chau Quy
%A Phan,Phuong Thu
%A Pham,Quyen Thi Le
%A Nguyen,Binh Ngoc
%A Nguyen,Anh Thi Phuong
%A Nguyen,Phuong Thi Thu
%A Person,Sharina
%A Allison,Jeroan J
%A Houston,Thomas K
%A Sadasivam,Rajani
%+ Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu
%K tobacco cessation
%K smoking cessation
%K mHealth
%K global health
%K Vietnam
%K randomized controlled trial
%D 2021

%7 7.10.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID): DERR1-10.2196/30947 
%M 34617915
%R 10.2196/30947
%U https://www.researchprotocols.org/2021/10/e30947
%U https://doi.org/10.2196/30947
%U http://www.ncbi.nlm.nih.gov/pubmed/34617915

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 10
%P e22653
%T Appropriation of mHealth Interventions for Maternal Health Care in Sub-Saharan Africa: Hermeneutic Review
%A Maliwichi,Priscilla
%A Chigona,Wallace
%A Sowon,Karen
%+ Department of Information Systems, Faculty of Commerce, University of Cape Town, Private Bag X1, Rondebosch, Cape Town, 7701, South Africa, 27 21 650 2261, pmaliwichi@must.ac.mw
%K mHealth
%K appropriation
%K mobile phones
%K model of technology appropriation
%K maternal health
%K community of purpose
%K hermeneutic literature review
%D 2021

%7 6.10.2021
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Many maternal clients from poorly resourced communities die from preventable pregnancy-related complications. The situation is especially grave in sub-Saharan Africa. Mobile health (mHealth) interventions have the potential to improve maternal health outcomes. mHealth interventions are used to encourage behavioral change for health care–seeking by maternal clients. However, the appropriation of such interventions among maternal health clients is not always guaranteed. Objective: This study aims to understand how maternal clients appropriate mHealth interventions and the factors that affect this appropriation. Methods: This study used a hermeneutic literature review informed by the model of technology appropriation. We used data from three mHealth case studies in sub-Saharan Africa: Mobile Technology for Community Health, MomConnect, and Chipatala Cha Pa Foni. We used the search and acquisition hermeneutic circle to identify and retrieve peer-reviewed and gray literature from the Web of Science, Google Scholar, Google, and PubMed. We selected 17 papers for analysis. We organized the findings using three levels of the appropriation process: adoption, adaptation, and integration. Results: This study found that several factors affected how maternal clients appropriated mHealth interventions. The study noted that it is paramount that mHealth designers and implementers should consider the context of mHealth interventions when designing and implementing interventions. However, the usefulness of an mHealth intervention may enhance how maternal health clients appropriate it. Furthermore, a community of purpose around the maternal client may be vital to the success of the mHealth intervention. Conclusions: The design and implementation of interventions have the potential to exacerbate inequalities within communities. To mitigate against inequalities during appropriation, it is recommended that communities of purpose be included in the design and implementation of maternal mHealth interventions. 
%M 34612835
%R 10.2196/22653
%U https://mhealth.jmir.org/2021/10/e22653
%U https://doi.org/10.2196/22653
%U http://www.ncbi.nlm.nih.gov/pubmed/34612835

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 9
%P e24671
%T Attitudes Toward the Environment and Use of Information and Communication Technologies to Address Environmental Health Risks in Marginalized Communities: Prospective Cohort Study
%A Perez-Ramos,Jose G
%A McIntosh,Scott
%A Barrett,Emily S
%A Velez Vega,Carmen M
%A Dye,Timothy D
%+ Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, 601 Elmwood Ave, Box 668, Rochester, NY, 14622, United States, 1 5852768755, j.perezramos@rochester.edu
%K community engagement
%K environmental health risk
%K epidemiology
%K ICT
%K mHealth
%K mobile phone
%K Puerto Rico
%D 2021

%7 23.9.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Information and communication technologies, including mobile health (mHealth), can help isolated communities address environmental health challenges. The Puerto Rican island of Culebra has faced multiple sociopolitical and economic factors that have distressed the island’s environment and health. Culebrenses are technologically engaged and have demonstrated a use of technology that transcends socioeconomic barriers. As a result, technological interventions could potentially help manage environmental risks on the island. Objective: This study aims to test and evaluate the potential benefits of an mHealth tool, termed ¡mZAP! (Zonas, Acción y Protección), for engaging communities with environmental risks through technology. Methods: Participants using ¡mZAP! (N=111) were surveyed. Bivariate analyses were used to examine associations of mHealth use with sociodemographics, technology use, an adapted environmental attitudes inventory, and the multidimensional health locus of control. Logistic regression was used to examine associations between attitudes toward environmental health risks and mHealth use. Results: Higher positive attitudes toward the environment were significantly associated with the use of ¡mZAP! (odds ratio 5.3, 95% CI 1.6-17.0). Environmental attitudes were also associated with the multidimensional health locus of control powerful others subscale (P=.02), indicating that attitudes toward the environment become more negative as feelings controlled by others increase. Participants felt that the authorities would resolve the challenges (63/111, 56.7%). Conclusions: Perceived lack of control could present barriers to collective actions to address salient environmental health challenges in communities. The ongoing dependency on government-based solutions to community problems is worrisome, especially after the hurricane experiences of 2017 (which may potentially continue to be an issue subsequent to the more recent 2020 earthquakes). 
%M 34554103
%R 10.2196/24671
%U https://www.jmir.org/2021/9/e24671
%U https://doi.org/10.2196/24671
%U http://www.ncbi.nlm.nih.gov/pubmed/34554103

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 9
%P e25558
%T Development of Digital Health Messages for Rural Populations in Tanzania: Multi- and Interdisciplinary Approach
%A Holst,Christine
%A Isabwe,Ghislain Maurice Norbert
%A Sukums,Felix
%A Ngowi,Helena
%A Kajuna,Flora
%A Radovanović,Danica
%A Mansour,Wisam
%A Mwakapeje,Elibariki
%A Cardellichio,Peter
%A Ngowi,Bernard
%A Noll,Josef
%A Winkler,Andrea Sylvia
%+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postbox 1130, Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no
%K digital health
%K eHealth
%K mHealth
%K Tanzania
%K health education
%K HIV/AIDS
%K tuberculosis
%K cysticercosis
%K tapeworm
%K anthrax
%K mobile phone
%D 2021

%7 22.9.2021
%9 Tutorial
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Health workers have traditionally delivered health promotion and education to rural communities in the Global South in paper leaflet formats or orally. With the rise of digital technologies, health promotion and education can be provided in innovative and more effective formats, which are believed to have a higher impact on disease prevention and treatment. Objective: The aim of this tutorial is to illustrate how a multi- and interdisciplinary approach can be applied in the design process of digital health messages for use in the Global South. Methods: The multi- and interdisciplinary team of the Non-discriminating access for Digital Inclusion (DigI) project digitalized and customized available government-approved paper-based health promotion messages into a screen-suitable format. The team worked closely together and used its diverse expertise to develop digital health messages with disease-specific content in Tanzania’s national language (Swahili) as well as English. The development process included the following phases: a local needs assessment; identification of government-approved health promotion materials in a nondigital format; identification of key health messages; creation of a practical and engaging story, easy to understand for the general public; drafting of a storyboard for an animated video with review, feedback, and revisions; forward and backward translation; audio recording of the story in both languages; finalization and presentation of the animations; development of relevant questions related to the health messages in each domain; and development of web and mobile apps to access the digital health messages. Results: Between 2017 and 2019, we developed key health messages, quizzes, and animated health videos to address HIV/AIDS, tuberculosis, Taenia solium cysticercosis and taeniasis, and anthrax, all of which are of public health importance in Tanzania. Feedback from local stakeholders and test users was included in various phases of the process. The 4 videos and other content are available in local information spots on a digital health platform (DigI platform), established by the DigI project, in both Tanzanian Swahili and English. Conclusions: Our methodological multi- and interdisciplinary approach ensures that the digital health messages for the public are clear, high quality, and align with the government’s objectives for health promotion. It also demonstrates the diversity of scientific disciplines required when collaborating on a digital health project. We recommend this approach to be applied to the development of other digital health messages for a wide range of diseases. International Registered Report Identifier (IRRID): RR2-10.2196/25128 
%M 34550081
%R 10.2196/25558
%U https://mhealth.jmir.org/2021/9/e25558
%U https://doi.org/10.2196/25558
%U http://www.ncbi.nlm.nih.gov/pubmed/34550081

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 9
%P e26602
%T Acceptance of a Smartphone-Based Visual Field Screening Platform for Glaucoma: Pre-Post Study
%A Nida,Esmael Kedir
%A Bekele,Sisay
%A Geurts,Luc
%A Vanden Abeele,Vero
%+ e-Media Lab, KU Leuven, Vesaliusstraat 13, Leuven, 3000, Belgium, 32 16 30 10 3, isma.kedir@gmail.com
%K mHealth acceptance
%K UTAUT
%K glaucoma screening
%K mhealth for eye care
%K mhealth
%K glaucoma
%K visual
%K eye
%K ophthalmology
%K ophthalmic
%K mobile phone
%D 2021

%7 17.9.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Glaucoma, the silent thief of sight, is a major cause of blindness worldwide. It is a burden for people in low-income countries, specifically countries where glaucoma-induced blindness accounts for 15% of the total incidence of blindness. More than half the people living with glaucoma in low-income countries are unaware of the disease until it progresses to an advanced stage, resulting in permanent visual impairment. Objective: This study aims to evaluate the acceptability of the Glaucoma Easy Screener (GES), a low-cost and portable visual field screening platform comprising a smartphone, a stereoscopic virtual reality headset, and a gaming joystick. Methods: A mixed methods study that included 24 eye care professionals from 4 hospitals in Southwest Ethiopia was conducted to evaluate the acceptability of GES. A pre-post design was used to collect perspectives before and after using the GES by using questionnaires and semistructured interviews. A Wilcoxon signed-rank test was used to determine the significance of any change in the scores of the questionnaire items (two-tailed, 95% CI; α=.05). The questionnaire and interview questions were guided by the Unified Theory of Acceptance and Use of Technology. Results: Positive results were obtained both before and after use, suggesting the acceptance of mobile health solutions for conducting glaucoma screening by using a low-cost headset with a smartphone and a game controller. There was a significant increase (two-tailed, 95% CI; α=.05) in the average scores of 86% (19/22) of postuse questionnaire items compared with those of preuse questionnaire items. Ophthalmic professionals perceived GES as easy to use and as a tool that enabled the conduct of glaucoma screening tests, especially during outreach to rural areas. However, positive evaluations are contingent on the accuracy of the tool. Moreover, ophthalmologists voiced the need to limit the tool to screening only (ie, not for making diagnoses). Conclusions: This study supports the feasibility of using a mobile device in combination with a low-cost virtual reality headset and classic controller for glaucoma screening in rural areas. GES has the potential to reduce the burden of irreversible blindness caused by glaucoma. However, further assessment of its sensitivity and specificity is required. 
%M 34533462
%R 10.2196/26602
%U https://formative.jmir.org/2021/9/e26602
%U https://doi.org/10.2196/26602
%U http://www.ncbi.nlm.nih.gov/pubmed/34533462

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 3
%P e30240
%T Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study
%A Levey,Elizabeth J
%A Onyeaka,Henry
%A Bartles,Sophia M
%A Sanchez Calderon,Elena
%A Sanchez,Sixto E
%A Prom,Maria C
%A Fesseha,Eden M
%A Gelaye,Bizu
%+ Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 726 2000, elevey@mgh.harvard.edu
%K access to care
%K adolescent motherhood
%K LMICs
%K mobile phone
%K perinatal mental health
%K telehealth
%D 2021

%7 17.9.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. Objective: This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. Methods: This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. Results: All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. Conclusions: These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed. 
%M 34533473
%R 10.2196/30240
%U https://pediatrics.jmir.org/2021/3/e30240
%U https://doi.org/10.2196/30240
%U http://www.ncbi.nlm.nih.gov/pubmed/34533473

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 9
%P e24182
%T Acceptability and Potential Effectiveness of eHealth Tools for Training Primary Health Workers From Nigeria at Scale: Mixed Methods, Uncontrolled Before-and-After Study
%A Hicks,Joseph Paul
%A Allsop,Matthew John
%A Akaba,Godwin O
%A Yalma,Ramsey M
%A Dirisu,Osasuyi
%A Okusanya,Babasola
%A Tukur,Jamilu
%A Okunade,Kehinde
%A Akeju,David
%A Ajepe,Adegbenga
%A Okuzu,Okey
%A Mirzoev,Tolib
%A Ebenso,Bassey
%+ Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9LU, United Kingdom, 44 113434185, m.j.allsop@leeds.ac.uk
%K primary health worker training
%K digital health technology
%K eHealth
%K video-based training
%K maternal and child health
%K Nigeria
%K mobile phone
%D 2021

%7 16.9.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The in-service training of frontline health workers (FHWs) in primary health care facilities plays an important role in improving the standard of health care delivery. However, it is often expensive and requires FHWs to leave their posts in rural areas to attend courses in urban centers. This study reports the implementation of a digital health tool for providing video training (VTR) on maternal, newborn, and child health (MNCH) care to provide in-service training at scale without interrupting health services. The VTR intervention was supported by satellite communications technology and existing 3G mobile networks. Objective: This study aims to determine the feasibility and acceptability of these digital health tools and their potential effectiveness in improving clinical knowledge, attitudes, and practices related to MNCH care. Methods: A mixed methods design, including an uncontrolled pre- and postquantitative evaluation, was adopted. From October 2017 to May 2018, a VTR mobile intervention was delivered to FHWs in 3 states of Nigeria. We examined changes in workers’ knowledge and confidence in delivering MNCH services through a pre- and posttest survey. Stakeholders’ experiences with the intervention were explored through semistructured interviews that drew on the technology acceptance model to frame contextual factors that shaped the intervention’s acceptability and usability in the work environment. Results: In total, 328 FHWs completed both pre- and posttests. FHWs achieved a mean pretest score of 51% (95% CI 48%-54%) and mean posttest score of 69% (95% CI 66%-72%), reflecting, after adjusting for key covariates, a mean increase between the pre- and posttest of 17 percentage points (95% CI 15-19; P<.001). Variation was identified in pre- and posttest scores by the sex and location of participants alongside topic-specific areas where scores were lowest. Stakeholder interviews suggested a wide acceptance of VTR Mobile (delivered via digital technology) as an important tool for enhancing the quality of training, reinforcing knowledge, and improving health outcomes. Conclusions: This study found that VTR supported through a digital technology approach is a feasible and acceptable approach for supporting improvements in clinical knowledge, attitudes, and reported practices in MNCH. The determinants of technology acceptance included ease of use, perceived usefulness, access to technology and training contents, and the cost-effectiveness of VTR, whereas barriers to the adoption of VTR were poor electricity supply, poor internet connection, and FHWs’ workload. The evaluation also identified the mechanisms of the impact of delivering VTR Mobile at scale on the micro (individual), meso (organizational), and macro (policy) levels of the health system. Future research is required to explore the translation of this digital health approach for the VTR of FHWs and its impact across low-resource settings to ameliorate the financial and time costs of training and support high-quality MNCH care delivery. Trial Registration: ISRCTN Registry 32105372; https://www.isrctn.com/ISRCTN32105372 
%M 34528891
%R 10.2196/24182
%U https://mhealth.jmir.org/2021/9/e24182
%U https://doi.org/10.2196/24182
%U http://www.ncbi.nlm.nih.gov/pubmed/34528891

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 9
%P e31389
%T The Food Equity and Environmental Data Sovereignty (FEEDS) Project: Protocol for a Quasi-Experimental Study Evaluating a Digital Platform for Climate Change Preparedness
%A Bhawra,Jasmin
%A Skinner,Kelly
%A Favel,Duane
%A Green,Brenda
%A Coates,Ken
%A Katapally,Tarun Reddy
%+ Johnson Shoyama Graduate School of Public Policy, University of Saskatchewan, 101 Diefenbaker Place, Saskatoon, SK, S7N 5B8, Canada, 1 3065854544, jasmin.bhawra@usask.ca
%K food security
%K food sovereignty
%K food equity
%K mental health
%K solastalgia
%K climate change impacts
%K climate change preparedness
%K digital health
%K digital dashboards
%K Indigenous health
%K mobile phone
%D 2021

%7 15.9.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Despite having the tools at our disposal to enable an adequate food supply for all people, inequities in food acquisition, distribution, and most importantly, food sovereignty, worsen food insecurity. The detrimental impact of climate change on food systems and mental health is further exacerbated by a lack of food sovereignty. We urgently require innovative solutions to enable food sovereignty, minimize food insecurity, and address climate change–related mental distress (ie, solastalgia). Indigenous communities have a wealth of Traditional Knowledge for climate change adaptation and preparedness to strengthen food systems. Traditional Knowledge combined with Western methods can revolutionize ethical data collection, engagement, and knowledge mobilization. Objective: The Food Equity and Environmental Data Sovereignty (FEEDS) Project takes a participatory action, citizen science approach for early detection and warning of climate change impacts on food sovereignty, food security, and solastalgia. The aim of this project is to develop and implement a sustainable digital platform that enables real-time decision-making to mitigate climate change–related impacts on food systems and mental well-being. Methods: Citizen science enables citizens to actively contribute to all aspects of the research process. The FEEDS Project is being implemented in five phases: participatory project planning, digital climate change platform customization, community-led evaluation, digital platform and project refinement, and integrated knowledge translation. The project is governed by a Citizen Scientist Advisory Council comprising Elders, Traditional Knowledge Keepers, key community decision makers, youth, and FEEDS Project researchers. The Council governs all phases of the project, including coconceptualizing a climate change platform, which consists of a smartphone app and a digital decision-making dashboard. Apart from capturing environmental and health-related big data (eg, weather, permafrost degradation, fire hazards, and human movement), the custom-built app uses artificial intelligence to engage and enable citizens to report on environmental hazards, changes in biodiversity or wildlife, and related food and mental health issues in their communities. The app provides citizens with valuable information to mitigate health-related risks and relays big data in real time to a digital dashboard. Results: This project is currently in phase 1, with the subarctic Métis jurisdiction of Île-à-la-Crosse, Saskatchewan, Canada. Conclusions: The FEEDS Project facilitates Indigenous Peoples’ self-determination, governance, and data sovereignty. All citizen data are anonymous and encrypted, and communities have ownership, access, control, and possession of their data. The digital dashboard system provides decision makers with real-time data, thereby increasing the capacity to self-govern. The participatory action research approach, combined with digital citizen science, advances the cocreation of knowledge and multidisciplinary collaboration in the digital age. Given the urgency of climate change, leveraging technology provides communities with tools to respond to existing and emerging crises in a timely manner, as well as scientific evidence regarding the urgency of current health and environmental issues. International Registered Report Identifier (IRRID): PRR1-10.2196/31389 
%M 34524106
%R 10.2196/31389
%U https://www.researchprotocols.org/2021/9/e31389
%U https://doi.org/10.2196/31389
%U http://www.ncbi.nlm.nih.gov/pubmed/34524106

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 9
%P e31097
%T Exploring the Shift in International Trends in Mobile Health Research From 2000 to 2020: Bibliometric Analysis
%A Cao,Jianfei
%A Lim,Yeongjoo
%A Sengoku,Shintaro
%A Guo,Xitong
%A Kodama,Kota
%+ Graduate School of Technology Management, Ritsumeikan University, Ibaraki, Japan, 81 0726652448, kkodama@fc.ritsumei.ac.jp
%K mobile health
%K digital health
%K digital medicine
%K bibliometric analysis
%K journalology
%K data visualization
%K co-occurrence analysis
%K research trends
%K mental health
%K mHealth
%K paradigm
%K innovation
%K smartphone
%K research
%K trend
%K literature
%K bibliometric
%K review
%K app
%K cooperation
%K development
%K public health
%K health policy
%K self-management
%K adolescent
%D 2021

%7 8.9.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Smartphones have become an integral part of our lives with unprecedented popularity and a diverse selection of apps. The continuous upgrading of information technology has also enabled smartphones to display great potential in the field of health care. Objective: We aimed to determine the future research direction of mobile health (mHealth) by analyzing its research trends and latest research hotspots. Methods: This study collected mHealth-related literature published between 2000 and 2020 from the Web of Science database. Descriptive statistics of publication trends of mHealth research were determined by analyzing the annual number of publications in the literature and annual number of publications by country. We constructed visualization network maps of country (or regional) collaborations and author-provided keyword co-occurrences, as well as overlay visualization maps of the average publication year of author-provided keywords to analyze the hotspots and research trends in mHealth research. Results: In total, 12,593 mHealth-related research papers published between 2000 and 2020 were found. The results showed an exponential growth trend in the number of annual publications in mHealth literature. JMIR mHealth and uHealth, the Journal of Medical Internet Research, and JMIR Research Protocols were the 3 top journals with respect to number of publications. The United States remained the leading contributor to the literature in this area (5294/12,593, 42.0%), well ahead of other countries and regions. Other countries and regions also showed a clear trend of annual increases in the number of mHealth publications. The 4 countries with the largest number of publications—the United States, the United Kingdom, Canada, and Australia—were found to cooperate more closely. The rest of the countries and regions showed a clear geographic pattern of cooperation. The keyword co-occurrence analysis of the top 100 authors demonstrated 5 clusters, namely, development of mHealth medical technology and its application to various diseases, use of mHealth technology to improve basic public health and health policy, mHealth self-health testing and management in daily life, adolescent use of mHealth, and mHealth in mental health. The research trends revealed a gradual shift in mHealth research from health policy and improving public health care to the development and social application of mHealth technologies. Conclusions: To the best of our knowledge, the most current bibliometric analysis dates back to 2016. However, the number of mHealth research published between 2017 and 2020 exceeds the previous total. The results of this study shed light on the latest hotspots and trends in mHealth research. These findings provide a useful overview of the development of the field; they may also serve as a valuable reference and provide guidance for researchers in the digital health field. 
%M 34494968
%R 10.2196/31097
%U https://mhealth.jmir.org/2021/9/e31097
%U https://doi.org/10.2196/31097
%U http://www.ncbi.nlm.nih.gov/pubmed/34494968

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 3
%P e21471
%T Development of a Mobile App to Improve Numeracy Skills of Children With Autism Spectrum Disorder: Participatory Design and Usability Study
%A Ntalindwa,Theoneste
%A Nduwingoma,Mathias
%A Karangwa,Evariste
%A Rashid Soron,Tanjir
%A Uworwabayeho,Alphonse
%A Uwineza,Annette
%+ Telepsychiatry Research and Innovation Network Ltd, Rupayon Trade Center, Dhaka, 1215, Bangladesh, 880 1718827138, tanjirsoron@gmail.com
%K autism spectrum disorder
%K mobile app
%K learning
%K information and communication technologies
%K education
%K numeracy
%K mathematics
%D 2021

%7 31.8.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: The use of information and communication technologies is transforming the lives of millions of people including children with autism spectrum disorder (ASD). However, the process of developing a user-friendly and effective mobile app needs to follow a complex standard protocol and culture-sensitive customization, and involves multiple sectors. This complex work becomes even more challenging when considering children with ASD in low- and middle-income countries as the users. Objective: This study aimed to design and develop a more intuitive mobile app to improve numeracy skills of children with ASD in Rwanda and evaluate the usability of the app. Methods: A participatory design approach was utilized in this study in which 40 children with ASD, 5 teachers, and 10 parents of children with ASD participated in focus group discussions (FGDs) and usability testing. A narrative literature review was performed to explore existing mobile apps and compare previous studies to design the questions for FGD and facilitate a framework for designing the app. The agile methodology was used to develop the mobile app, and the heuristics evaluation method was used to test and evaluate the usability of the initial version of the app to improve its functionalities. The interviews were recorded, transcribed, and analyzed following the guidelines of the qualitative narrative analysis (QNA) method. Results: During the FGDs the respondents shared their need for a mobile app in teaching and learning numeracy for children with ASD and pointed to possibilities of integrating the mobile app into existing curriculum. Ten themes emerged from the FGDs and exercise of developing the mobile app. The themes were related to (1) teaching and learning numeracy for children with ASD, (2) planning and development of a mobile app for a person with ASD, (3) testing a mobile app, (4) strength of the developed app against the existing ones, (5) behavioral maintenance and relapse prevention, (6) possibilities to integrate the mobile app into the existing curriculum, (7) data protection for users, (8) social implications, (9) challenges in Rwanda, and (10) focus on future. Conclusions: The community plays an important role in the planning, development, and evaluation of a mobile app for children with ASD. In this study, inputs from teachers and parents resulted in an optimally designed mobile app that can improve numeracy skills in children diagnosed with ASD to support the implementation of competency-based curriculum in Rwanda. 
%M 34463629
%R 10.2196/21471
%U https://pediatrics.jmir.org/2021/3/e21471
%U https://doi.org/10.2196/21471
%U http://www.ncbi.nlm.nih.gov/pubmed/34463629

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 8
%P e29957
%T Exploring the Utility of Google Mobility Data During the COVID-19 Pandemic in India: Digital Epidemiological Analysis
%A Kishore,Kamal
%A Jaswal,Vidushi
%A Verma,Madhur
%A Koushal,Vipin
%+ All India Institute of Medical Sciences, Jodhpur Romana Road, Bathinda, 151001, India, 91 9466445513, drmadhurverma@gmail.com
%K COVID-19
%K lockdown
%K nonpharmaceutical Interventions
%K social distancing
%K digital surveillance
%K Google Community Mobility Reports
%K community mobility
%D 2021

%7 30.8.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. Objective: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. Methods: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. Results: At the national level, mobility decreased from –38% to –77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a –60% reduction in mobility depicted more mobility compared to –82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (–0.05 to –0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. Conclusions: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance. 
%M 34174780
%R 10.2196/29957
%U https://publichealth.jmir.org/2021/8/e29957
%U https://doi.org/10.2196/29957
%U http://www.ncbi.nlm.nih.gov/pubmed/34174780

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 8
%P e21686
%T The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial
%A Schaub,Michael P
%A Tiburcio,Marcela
%A Martínez-Vélez,Nora
%A Ambekar,Atul
%A Bhad,Roshan
%A Wenger,Andreas
%A Baumgartner,Christian
%A Padruchny,Dzianis
%A Osipchik,Sergey
%A Poznyak,Vladimir
%A Rekve,Dag
%A Landi Moraes,Fabricio
%A Monezi Andrade,André Luiz
%A Oliveira Souza-Formigoni,Maria Lucia
%A ,
%+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 44 448 22 60, michael.schaub@isgf.uzh.ch
%K alcohol
%K internet
%K public health
%K self-help
%K World Health Organization
%D 2021

%7 27.8.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program “Alcohol e-Health.” Objective: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial. Methods: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8). Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=−4.18, 95% CI −5.42 to −2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=−9.34, 95% CI −15.90 to −2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results. Conclusions: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results. Trial Registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475 International Registered Report Identifier (IRRID): RR2-10.1111/add.14034 
%M 34448710
%R 10.2196/21686
%U https://www.jmir.org/2021/8/e21686
%U https://doi.org/10.2196/21686
%U http://www.ncbi.nlm.nih.gov/pubmed/34448710

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 8
%P e29923
%T Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan
%A Shoji,Masahiro
%A Ito,Asei
%A Cato,Susumu
%A Iida,Takashi
%A Ishida,Kenji
%A Katsumata,Hiroto
%A McElwain,Kenneth Mori
%+ Institute of Social Science, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 4927, shoji@iss.u-tokyo.ac.jp
%K COVID-19
%K contact tracing app
%K place attachment
%K place identity
%K contact tracing
%K pandemic
%K mHealth
%K health policy
%D 2021

%7 19.8.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens’ voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens’ concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals’ prosociality and uptake. Objective: The objective of our study was to examine the role of individuals’ prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. Methods: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. Results: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). Conclusions: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools. 
%M 34313601
%R 10.2196/29923
%U https://mhealth.jmir.org/2021/8/e29923
%U https://doi.org/10.2196/29923
%U http://www.ncbi.nlm.nih.gov/pubmed/34313601

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 8
%P e31072
%T Optimizing Social-Emotional-Communication Development in Infants of Mothers With Depression: Protocol for a Randomized Controlled Trial of a Mobile Intervention Targeting Depression and Responsive Parenting
%A Baggett,Kathleen M
%A Davis,Betsy
%A Sheeber,Lisa
%A Miller,Katy
%A Leve,Craig
%A Mosley,Elizabeth A
%A Landry,Susan H
%A Feil,Edward G
%+ Georgia State University, 14 Marietta St NW, Atlanta, GA, 30303, United States, 1 404 413 1571, kbaggett@gsu.edu
%K maternal depression
%K parenting
%K infant social-emotional and social-communication development
%K mobile intervention
%K remote coaching
%K trial protocol
%K mobile phone
%D 2021

%7 18.8.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Postpartum depression interferes with maternal engagement in interventions that are effective in improving infant social-emotional and social-communication outcomes. There is an absence of integrated interventions with demonstrated effectiveness in both reducing maternal depression and promoting parent-mediated practices that optimize infant social-emotional and social-communication competencies. Interventions targeting maternal depression are often separate from parent-mediated interventions. To address the life course needs of depressed mothers and their infants, we need brief, accessible, and integrated interventions that target both maternal depression and specific parent practices shown to improve infant social-emotional and social-communication trajectories. Objective: The aim of this study is to evaluate the efficacy of a mobile internet intervention, Mom and Baby Net, with remote coaching to improve maternal mood and promote parent practices that optimize infant social-emotional and social-communication development. Methods: This is a two-arm, randomized controlled intent-to-treat trial. Primary outcomes include maternal depression symptoms and observed parent and infant behaviors. Outcomes are measured via direct observational assessments and standardized questionnaires. The sample is being recruited from the urban core of a large southern city in the United States. Study enrollment was initiated in 2017 and concluded in 2020. Participants are biological mothers with elevated depression symptoms, aged 18 years or older, and who have custody of an infant less than 12 months of age. Exclusion criteria at the time of screening include maternal homelessness or shelter residence, inpatient mental health or substance abuse treatment, or maternal or infant treatment of a major mental or physical illness that would hinder meaningful study participation. Results: The start date of this grant-funded randomized controlled trial (RCT) was September 1, 2016. Data collection is ongoing. Following the institutional review board (IRB)–approved pilot work, the RCT was approved by the IRB on November 17, 2017. Recruitment was initiated immediately following IRB approval. Between February 15, 2018, and March 11, 2021, we successfully recruited a sample of 184 women and their infants into the RCT. The sample is predominantly African American and socioeconomically disadvantaged. Conclusions: Data collection is scheduled to be concluded in March 2022. We anticipate that relative to the attention control condition, which is focused on education around maternal depression and infant developmental milestones with matching technology and coaching structure, mothers in the Mom and Baby Net intervention will experience greater reductions in depression and gains in sensitive and responsive parent practices and that their infants will demonstrate greater gains in social-emotional and social-communication behavior. Trial Registration: ClinicalTrials.gov NCT03464630; https://clinicaltrials.gov/ct2/show/NCT03464630 International Registered Report Identifier (IRRID): DERR1-10.2196/31072 
%M 34406122
%R 10.2196/31072
%U https://www.researchprotocols.org/2021/8/e31072
%U https://doi.org/10.2196/31072
%U http://www.ncbi.nlm.nih.gov/pubmed/34406122

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 8
%P e24393
%T Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study
%A McCall,Terika
%A Ali,Muhammad Osama
%A Yu,Fei
%A Fontelo,Paul
%A Khairat,Saif
%+ Center for Medical Informatics, Yale School of Medicine, 300 George Street, Suite 501, New Haven, CT, 06511, United States, 1 203 737 5379, terika.mccall@yale.edu
%K African Americans
%K women
%K mental health
%K anxiety
%K depression
%K telemedicine
%K mHealth
%K mobile applications
%K digital health
%K user-centered design
%K mobile phone
%D 2021

%7 17.8.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants’ visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants’ acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. 
%M 34133313
%R 10.2196/24393
%U https://formative.jmir.org/2021/8/e24393
%U https://doi.org/10.2196/24393
%U http://www.ncbi.nlm.nih.gov/pubmed/34133313

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 8
%P e24112
%T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study
%A Derksen,Marloes E
%A Jaspers,Monique WM
%A van Strijp,Sander
%A Fransen,Mirjam P
%+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl
%K think aloud
%K heuristic evaluation
%K usability
%K mHealth
%K game elements
%K smoking prevention
%K user-centered design
%K mobile phone
%D 2021

%7 4.8.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. 
%M 34346895
%R 10.2196/24112
%U https://formative.jmir.org/2021/8/e24112
%U https://doi.org/10.2196/24112
%U http://www.ncbi.nlm.nih.gov/pubmed/34346895

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 7
%P e30450
%T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach
%A Weber,Summer J
%A Shearer,Elyse
%A Mulvaney,Shelagh A
%A Schmidt,Douglas
%A Thompson,Chris
%A Jones,Jessica
%A Ahmad,Haseeb
%A Coe,Martina
%A Hull,Pamela C
%+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu
%K WIC
%K mobile technology
%K maternal-child health
%K childhood obesity
%K nutrition
%K government programs
%K mobile app
%K user-centered design
%K low income
%K women
%K infant
%K child
%K formative
%K development
%D 2021

%7 30.7.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. 
%M 34328432
%R 10.2196/30450
%U https://formative.jmir.org/2021/7/e30450
%U https://doi.org/10.2196/30450
%U http://www.ncbi.nlm.nih.gov/pubmed/34328432

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 7
%P e25947
%T Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives
%A Yousef,Hind
%A Al-Sheyab,Nihaya
%A Al Nsour,Mohannad
%A Khader,Yousef
%A Al Kattan,Malika
%A Bardus,Marco
%A Alyahya,Mohammad
%A Taha,Hana
%A Amiri,Mirwais
%+ Global Health Development | Eastern Mediterranean Public Health Network, 4 Abu Al Ataheya St. Apt 5, Sport City, Amman, Jordan, 962 790883656, hyousif@globalhealthdev.org
%K family planning
%K mobile apps
%K social media
%K digital technology
%K contraceptives
%D 2021

%7 28.7.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women’s empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman’s awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices. 
%M 34319250
%R 10.2196/25947
%U https://www.jmir.org/2021/7/e25947
%U https://doi.org/10.2196/25947
%U http://www.ncbi.nlm.nih.gov/pubmed/34319250

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 7
%P e25548
%T Efficacy and Safety of Text Messages Targeting Adherence to Cardiovascular Medications in Secondary Prevention: TXT2HEART Colombia Randomized Controlled Trial
%A Bermon,Anderson
%A Uribe,Ana Fernanda
%A Pérez-Rivero,Paula Fernanda
%A Prieto-Merino,David
%A Saaibi,Jose Federico
%A Silva,Federico Arturo
%A Canon,Diana Ivonne
%A Castillo-Gonzalez,Karol Melissa
%A Cáceres-Rivera,Diana Isabel
%A Guio,Elizabeth
%A Meneses-Castillo,Karen Janneth
%A Castillo-Meza,Alberto
%A Atkins,Louise
%A Horne,Robert
%A Murray,Elizabeth
%A Serrano,Norma Cecilia
%A Free,Caroline
%A Casas,Juan Pablo
%A Perel,Pablo
%+ Research Center, Fundación Cardiovascular de Colombia, Calle 155A #23-58, Floridablanca, 681001, Colombia, 57 3002053041, andebermon@gmail.com
%K randomized controlled trial
%K Colombia
%K text messaging
%K cardiovascular disease
%K secondary prevention
%D 2021

%7 28.7.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality worldwide, with a prevalence of approximately 100 million patients. There is evidence that antiplatelet agents and antihypertensive medications could reduce the risk of new vascular events in this population; however, treatment adherence is very low. An SMS text messaging intervention was recently developed based on behavior change techniques to increase adherence to pharmacological treatment among patients with a history of ASCVD. Objective: This study aims to evaluate the efficacy and safety of an SMS text messaging intervention to improve adherence to cardiovascular medications in patients with ASCVD. Methods: A randomized controlled clinical trial for patients with a prior diagnosis of cardiovascular events, such as acute myocardial infarction, unstable angina, cerebrovascular disease, or peripheral artery disease, in one center in Colombia was conducted. Patients randomized to the intervention arm were assigned to receive SMS text messages daily for the first 4 weeks, 5 SMS text messages on week 5, 3 SMS text messages each in weeks 6 and 7, and 1 SMS text message weekly from week 8 until week 52. In contrast, patients in the control arm received a monthly SMS text message reminding them of the next study appointment and the importance of the study, requesting information about changes in their phone number, and thanking them for participating in the study. The primary endpoint was the change in low-density lipoprotein cholesterol (LDL-C) levels, whereas the secondary endpoints were the changes in thromboxane B2 levels, heart rate, systolic and diastolic blood pressure, medication adherence, cardiac and noncardiac mortality, and hospitalization. Linear regression analyses and bivariate tests were performed. Results: Of the 930 randomized patients, 805 (86.5%) completed follow-up and were analyzed for the primary endpoint. There was no evidence that the intervention changed the primary outcome (LDL-C levels; P=.41) or any of the secondary outcomes evaluated (all P>.05). There was also no evidence that the intervention was associated with adverse events. Conclusions: In this study, there was no evidence that a behavior modification intervention delivered by SMS text messaging improved LDL-C levels, blood pressure levels, or adherence at 12 months. More research is needed to evaluate whether different SMS text messaging strategies, including personalized messages and different timings, are effective; future studies should include mixed methods to better understand why, for whom, and in which context (eg, health system or social environment) SMS text messaging interventions work (or not) to improve adherence in patients with ASCVD. Trial Registration: ClinicalTrials.gov NCT03098186; https://clinicaltrials.gov/ct2/show/NCT03098186 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028017 
%M 34319247
%R 10.2196/25548
%U https://mhealth.jmir.org/2021/7/e25548
%U https://doi.org/10.2196/25548
%U http://www.ncbi.nlm.nih.gov/pubmed/34319247

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 7
%P e25926
%T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial
%A Mhende,Josephine
%A Bell,Sharrill A
%A Cottrell-Daniels,Cherell
%A Luong,Jackie
%A Streiff,Micah
%A Dannenfelser,Mark
%A Hayat,Matthew J
%A Spears,Claire Adams
%+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu
%K acceptability
%K addiction
%K African American
%K cessation
%K COVID-19
%K feasibility
%K income
%K low socioeconomic status
%K mHealth
%K mindfulness
%K minority
%K smoking
%K SMS
%K text messaging
%K treatment
%D 2021

%7 23.7.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of <US $24,000. They were randomly assigned to either 8 weeks of iQuit Mindfully as a fully automated standalone intervention or iQuit Mindfully in combination with therapist-led in-person group treatment. For participant safety, in-person mindfulness groups were transitioned to the internet and assessments also took place over the internet. Survey questions asked participants about changes in their stress, smoking habits and quit attempts, and their perceptions of the mindfulness and text messaging intervention in the context of the pandemic. Results: Most participants (n=15 of 21, 71.4%) indicated a change in stress due to the pandemic, of whom 14 (93.3%) indicated higher stress. Participants shared concerns about finances, homelessness, health, and social isolation. Most (n=17 of 21, 80.9%) believed that smoking increases the risk of contracting COVID-19, and although that was motivating for some, others expressed lower motivation to quit smoking because of higher stress. Most (n=18 of 21, 85.7%) stated that practicing mindfulness was helpful during the pandemic. Mean ratings of the helpfulness of text messages and the extent to which they would recommend the program to others were 7.1 (median 8 on a 10-point scale, SD 2.9) and 8.2 (median 9, SD 2.5), respectively. Through open-ended program evaluations, participants shared details about how mindfulness practices and the text messages helped them manage stress and feel a sense of social support during the pandemic. Moreover, 10 of 19 (52.6%) of participants achieved 7-day abstinence from smoking, with no differences between conditions. Conclusions: This study supports the promise of text messaging and the use of teleconferencing to provide mindfulness and smoking cessation services to underserved populations during a pandemic. 
%M 34033580
%R 10.2196/25926
%U https://formative.jmir.org/2021/7/e25926
%U https://doi.org/10.2196/25926
%U http://www.ncbi.nlm.nih.gov/pubmed/34033580

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 7
%P e27168
%T Web-Based Multifaceted Approach for Community-Based HIV Self-Testing Among Female Sex Workers in Indonesia: Protocol for a Randomized Community Trial
%A Yunus,Jessie Olivia
%A Sawitri,Anak Agung Sagung
%A Wirawan,Dewa Nyoman
%A Mahendra,I Gusti Agung Agus
%A Susanti,Dewi
%A Utami Ds,Ni Kadek Ayu Dwi
%A Asanab,Dedison
%A Narayani,Ida Ayu
%A Mukuan,Oldri Sherli
%A Widihastuti,Asti
%A Magnani,Robert
%A Januraga,Pande Putu
%+ Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Jalan PB Sudirman, Denpasar Bali, 80232, Indonesia, 62 361222510, sagung_sawitri@unud.ac.id
%K HIV
%K self-testing
%K oral fluid test
%K community-based screening
%K female sex worker
%K Indonesia
%D 2021

%7 21.7.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: New HIV infections in Indonesia continue to be concentrated among key populations, including female sex workers (FSWs). However, increasing HIV testing among this subpopulation remains a challenge, necessitating exploration into alternative testing modalities. Objective: This study aims to assess whether the addition of an oral fluid testing option in community settings would increase the rate of HIV case identification among FSWs. Because the study was implemented early in the outbreak of COVID-19 in Indonesia, a secondary objective is to assess approaches and tools for implementing both community outreach and community HIV screening for FSWs during pandemic conditions. Methods: We undertook a community-based randomized trial in 23 national priority districts in which community outreach services were being provided. Community-based screening using an oral fluid-based rapid test was added to the community outreach standard of care in intervention districts with clients having the option of performing the test themselves or being assisted by outreach workers. A web-based system was created to screen for eligibility and collect participant data and test results, facilitating the process for both unassisted and assisted participants. Participants with reactive screening results were encouraged to undergo HIV testing at a health facility to confirm their diagnosis and initiate antiretroviral treatment as needed. Multiple means of recruitment were deployed including through outreach workers and social media campaigns. Results: Of the 1907 FSWs who registered, met the eligibility criteria, and gave consent to participate, 1545 undertook community oral fluid test (OFT) screening. Most (1516/1545, 98.1%) opted for assisted screening. Recruitment via social media fell far short of expectations as many who registered independently for the OFT because of the social media campaign did not identify as FSWs. They were eventually not eligible to participate, but their interest points to the possibility of implementing HIV self-testing in the general population. The successful recruitment through outreach workers, facilitated by social media, indicates that their roles remain crucial in accessing FSW networks and improving HIV testing uptake. Conclusions: The addition of HIV self-testing to the standard of care supported by a web-based data collection system was able to increase HIV case identification among FSWs in intervention districts. The high satisfaction of OFT users and the interest of the general population toward this alternative testing modality are promising for scaling up community HIV screening nationally. Trial Registration: ClinicalTrials.gov NCT04578145; https://clinicaltrials.gov/ct2/show/NCT04578145 International Registered Report Identifier (IRRID): RR1-10.2196/27168 
%M 34287217
%R 10.2196/27168
%U https://www.researchprotocols.org/2021/7/e27168
%U https://doi.org/10.2196/27168
%U http://www.ncbi.nlm.nih.gov/pubmed/34287217

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 7
%P e22693
%T Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial
%A Beres,Laura K
%A Mbabali,Ismail
%A Anok,Aggrey
%A Katabalwa,Charles
%A Mulamba,Jeremiah
%A Thomas,Alvin G
%A Bugos,Eva
%A Nakigozi,Gertrude
%A Grabowski,Mary K
%A Chang,Larry W
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5031, Baltimore, MD, 21205, United States, 1 410 955 7159, laura.beres@jhu.edu
%K ecological momentary assessment
%K ecological momentary intervention
%K mHealth
%K digital health
%K smartphone
%K mobile phone
%K randomized trial
%K Uganda
%K Africa
%D 2021

%7 20.7.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual’s natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non–long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48% women; median age 31 years). EMA data collection was feasible, with 85.5% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6% of days to P2, 4.3% of days; intervention: P1, 7.2% of days to P3, 2.4% of days). Decreases in sex with a non–long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9% of days to 1% of days; intervention: 6.6% of days to 1.3% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6% of days to 76.6% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8% decrease in the mean proportion of days vegetables consumed; intervention: 11.1% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 
%M 34283027
%R 10.2196/22693
%U https://formative.jmir.org/2021/7/e22693
%U https://doi.org/10.2196/22693
%U http://www.ncbi.nlm.nih.gov/pubmed/34283027

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 7
%P e13496
%T Effect of Adherence to Smartphone App Use on the Long-term Effectiveness of Weight Loss in Developing and OECD Countries: Retrospective Cohort Study
%A Han,Myeunghee
%A Rhee,Sang Youl
%+ Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, 23 Kyungheedae-ro, Seoul, 02447, Korea, Seoul, Republic of Korea, 82 029610274, bard95@hanmail.net
%K low-income countries
%K Organization for Economic Co-operation and Development
%K body weight
%K mobile app self-management
%K diet
%K exercise
%K mobile phone
%D 2021

%7 12.7.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Globally, 71% of deaths occur due to noncommunicable diseases (NCDs). Poor diet quality and physical activity have a significant impact on NCDs. At present, behavior change interventions using smartphone apps have rapidly increased worldwide to prevent NCDs. However, most previous studies on the use and effectiveness of apps have been conducted in Organization for Economic Co-operation and Development (OECD) countries. As such, relevant research in low-income countries is scarce. Objective: This retrospective cohort study aims to investigate the characteristics of adherence to the use of the Noom app. We also aim to compare the effects of using the app on body weight changes over time according to adherence to the use of the app between users in low-income and OECD countries. In addition, the differences in weight loss are compared among users who use the free and paid versions of the app. Methods: A secondary data analysis was conducted using repeated measures. The data were collected from users in low-income countries (n=312) and OECD countries (n=8041) who used the app for 12 months. The app provided programs for the self-monitoring of physical activity, dietary intake, and body weight. Descriptive statistics, independent two-tailed t tests, chi-square tests, and linear mixed models were used for the analysis. Results: During the first 3 months of using the Noom app, users from OECD countries entered data into the app more frequently; however, users in low-income countries entered data more frequently from 3 months to 12 months. Users in OECD countries consumed significantly more calories than those in low-income countries for 12 months. The body weight of all users significantly decreased over time (−1.8 kg; P<.001); however, no statistically significant differences in the change in body weight for 12 months were observed between users from low-income and OECD countries (β=−.2; P=.19). The users who frequently monitored their lunch (β=−.1; P<.001), dinner (β=−.1; P<.001), body weight (β=−.1; P<.001), evening snack (β=−.1; P<.001), and exercise (β=−.03; P<.001) exhibited significant weight loss over time. We found no significant differences in the body weight changes between users who used the free and paid versions of the app (β=−.2; P=.19). Conclusions: This study found that using the app has a significant effect on weight loss regardless of users’ country of residence. The results of this study suggest that the frequency of monitoring health-related behaviors by entering data into the app plays a pivotal role in losing weight. In conclusion, regardless of where users live and what versions of the app they use, it is important to monitor health-related behaviors by frequently entering data into the app to efficiently lose weight. 
%M 34255708
%R 10.2196/13496
%U https://mhealth.jmir.org/2021/7/e13496
%U https://doi.org/10.2196/13496
%U http://www.ncbi.nlm.nih.gov/pubmed/34255708

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 7
%P e26582
%T An Unstructured Supplementary Service Data System for Daily Tracking of Patient Samples and Diagnostic Results in a Diagnostic Network in Malawi: System Development and Field Trial
%A Killian,Daniel
%A Gibson,Emma
%A Kachule,Mphatso
%A Palamountain,Kara
%A Bangoh,Joseph Bitilinyu
%A Deo,Sarang
%A Jonasson,Jonas Oddur
%+ MIT Sloan School of Management, Massachusetts Institute of Technology, 100 Main Street, Cambridge, MA, 02139, United States, 1 617 715 5109, joj@mit.edu
%K diagnostic networks
%K mobile phone
%K sample transportation
%K sub-Saharan Africa
%K data collection
%D 2021

%7 6.7.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Diagnostics in many low- and middle-income countries are conducted through centralized laboratory networks. Samples are collected from patients at remote point-of-care health facilities, and diagnostic tests are performed at centralized laboratories. Sample transportation systems that deliver diagnostic samples and test results are crucial for timely diagnosis and treatment in such diagnostic networks. However, they often lack the timely and accurate data (eg, the quantity and location of samples prepared for collection) required for efficient operation. Objective: This study aims to demonstrate the feasibility, adoption, and accuracy of a distributed data collection system that leverages basic mobile phone technology to gather reports on the quantity and location of patient samples and test results prepared for delivery in the diagnostic network of Malawi. Methods: We designed a system that leverages unstructured supplementary service data (USSD) technology to enable health workers to submit daily reports describing the quantity of transportation-ready diagnostic samples and test results at specific health care facilities, free of charge with any mobile phone, and aggregate these data for sample transportation administrators. We then conducted a year-long field trial of this system in 51 health facilities serving 3 districts in Malawi. Between July 2019 and July 2020, the participants submitted daily reports containing the number of patient samples or test results designated for viral load, early infant diagnosis, and tuberculosis testing at each facility. We monitored daily participation and compared the submitted USSD reports with program data to assess system feasibility, adoption, and accuracy. Results: The participating facilities submitted 37,771 reports over the duration of the field trial. Daily facility participation increased from an average of 50% (26/51) in the first 2 weeks of the trial to approximately 80% (41/51) by the midpoint of the trial and remained at or above 80% (41/51) until the conclusion of the trial. On average, more than 80% of the reports submitted by a facility for a specific type of sample matched the actual number of patient samples collected from that facility by a courier. Conclusions: Our findings suggest that a USSD-based system is a feasible, adoptable, and accurate solution to the challenges of untimely, inaccurate, or incomplete data in diagnostic networks. Certain design characteristics of our system, such as the use of USSD, and implementation characteristics, such as the supportive role of the field team, were necessary to ensure high participation and accuracy rates without any explicit financial incentives. 
%M 34255690
%R 10.2196/26582
%U https://www.jmir.org/2021/7/e26582
%U https://doi.org/10.2196/26582
%U http://www.ncbi.nlm.nih.gov/pubmed/34255690

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 8
%N 7
%P e28526
%T A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study
%A Ben-Zeev,Dror
%A Meller,Suzanne
%A Snyder,Jaime
%A Attah,Dzifa A
%A Albright,Liam
%A Le,Hoa
%A Asafo,Seth M
%A Collins,Pamela Y
%A Ofori-Atta,Angela
%+ BRiTE Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 2066859655, dbenzeev@uw.edu
%K mobile phone
%K low- and middle-income country
%K schizophrenia
%K bipolar disorder
%D 2021

%7 2.7.2021
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. Objective: The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. Results: A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi. The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable. Conclusions: This study is the first to develop a digital mental health toolkit for healers in West Africa. Engaging healers in user-centered development produced an accessible and acceptable resource. Future field testing will determine whether M-Healer can improve healer practices and reduce human rights abuses. 
%M 34255712
%R 10.2196/28526
%U https://mental.jmir.org/2021/7/e28526
%U https://doi.org/10.2196/28526
%U http://www.ncbi.nlm.nih.gov/pubmed/34255712

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 6
%P e28094
%T Mobile Tuberculosis Treatment Support Tools to Increase Treatment Success in Patients with Tuberculosis in Argentina: Protocol for a Randomized Controlled Trial
%A Iribarren,Sarah
%A Milligan,Hannah
%A Goodwin,Kyle
%A Aguilar Vidrio,Omar Alfonso
%A Chirico,Cristina
%A Telles,Hugo
%A Morelli,Daniela
%A Lutz,Barry
%A Sprecher,Jennifer
%A Rubinstein,Fernando
%+ Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB, Box 357266, Seattle, WA, 98195, United States, 1 2065435211, sjiribar@uw.edu
%K tuberculosis
%K disease management
%K infectious disease
%K mHealth
%K digital health
%K direct drug metabolite test
%K mobile phone
%D 2021

%7 21.6.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Tuberculosis (TB) is an urgent global health threat and the world’s deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Mobile health interventions hold promise to provide the required adherence support to improve TB treatment outcomes. Objective: This study aims to evaluate the effectiveness of the TB treatment support tools (TB-TSTs) intervention on treatment outcomes (success and default) and to assess patient and provider perceptions of the facilitators and barriers to TB-TSTs implementation. Methods: The TB-TSTs study is an open-label, randomized controlled trial with 2 parallel groups in which 400 adult patients newly diagnosed with TB will be randomly assigned to receive usual care or usual care plus TB-TSTs. Participants will be recruited on a rolling basis from 4 clinical sites in Argentina. The intervention consists of a smartphone progressive web app, a treatment supporter (eg, TB nurse, physician, or social worker), and a direct adherence test strip engineered for home use. Intervention group participants will report treatment progress and interact with a treatment supporter using the app and metabolite urine test strip. The primary outcome will be treatment success. Secondary outcomes will include treatment default rates, self-reported adherence, technology use, and usability. We will assess patients’ and providers’ perceptions of barriers to implementation and synthesize lessons learned. We hypothesize that the TB-TSTs intervention will be more effective because it allows patients and TB supporters to monitor and address issues in real time and provide tailored support. We will share the results with stakeholders and policy makers. Results: Enrollment began in November 2020, with a delayed start due to the COVID-19 pandemic, and complete enrollment is expected by approximately July 2022. Data collection and follow-up are expected to be completed 6 months after the last patient is enrolled. Results from the analyses based on the primary end points are expected to be submitted for publication within a year of data collection completion. Conclusions: To our knowledge, this randomized controlled trial will be the first study to evaluate a patient-centered remote treatment support strategy using a mobile tool and a home-based direct drug metabolite test. The results will provide robust scientific evidence on the effectiveness, implementation, and adoption of mobile health tools. The findings have broader implications not only for TB adherence but also more generally for chronic disease management and will improve our understanding of how to support patients facing challenging treatment regimens. Trial Registration: ClinicalTrials.gov NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789. International Registered Report Identifier (IRRID): DERR1-10.2196/28094 
%M 34152281
%R 10.2196/28094
%U https://www.researchprotocols.org/2021/6/e28094
%U https://doi.org/10.2196/28094
%U http://www.ncbi.nlm.nih.gov/pubmed/34152281

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 6
%P e27603
%T Effect of Mobile Phone Text Message Reminders on the Completion and Timely Receipt of Routine Childhood Vaccinations: Superiority Randomized Controlled Trial in Northwest Ethiopia
%A Mekonnen,Zeleke Abebaw
%A Gelaye,Kassahun Alemu
%A Were,Martin
%A Tilahun,Binyam
%+ Department of Health Informatics, Institute of Public Health, University of Gondar, Chechela Street, Gondar, 196, Ethiopia, 251 913747092, zelekeabebaw7@gmail.com
%K mHealth
%K eHealth
%K mobile phone
%K text message
%K short message service
%K reminder
%K immunization
%K vaccination
%K Ethiopia
%D 2021

%7 15.6.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Nonattendance at vaccination appointments is a big challenge for health workers as it is difficult to track routine vaccination schedules. In Ethiopia, 3 out of 10 children have incomplete vaccination and the timely receipt of the recommended vaccines is low. Thus, innovative strategies are required to reach the last mile where mobile technology can be effectively utilized to achieve better compliance. Despite this promising technology, little is known about the role of text message–based mobile health interventions in improving the complete and timely receipt of routine childhood vaccinations in Ethiopia. Objective: This trial aimed to determine the effect of mobile phone text message reminders on the completion and timely receipt of routine childhood vaccinations in northwest Ethiopia. Methods: A two-arm, parallel, superiority randomized controlled trial was conducted in 9 health facilities in northwest Ethiopia. A sample size of 434 mother-infant pairs was considered in this trial. Randomization was applied in selected health facilities during enrollment with a 1:1 allocation ratio by using sealed and opaque envelopes. Participants assigned to the intervention group received mobile phone text message reminders one day before the scheduled vaccination visits. Owing to the nature of the intervention, blinding of participants was not possible. Primary outcomes of full and timely completion of vaccinations were measured objectively at 12 months. A two-sample test of proportion and log-binomial regression analyses were used to compare the outcomes between the study groups. A modified intention-to-treat analysis approach was applied and a one-tailed test was reported, considering the superiority design of the trial. Results: A total of 426 participants were included for the analysis. We found that a higher proportion of infants in the intervention group received Penta-3 (204/213, 95.8% vs 185/213, 86.9%, respectively; P<.001), measles (195/213, 91.5% vs 169/213, 79.3%, respectively; P<.001), and full vaccination (176/213, 82.6% vs 151/213, 70.9%, respectively; P=.002; risk ratio 1.17, 95% lower CI 1.07) compared to infants in the usual care group. Similarly, a higher proportion of infants in the intervention group received Penta-3 (181/204, 88.7% vs 128/185, 69.2%, respectively; P<.001), measles (170/195, 87.1% vs 116/169, 68.6%, respectively; P<.001), and all scheduled vaccinations (135/213, 63.3% vs 85/213, 39.9%, respectively; P<.001; risk ratio 1.59, 95% lower CI 1.35) on time compared to infants in the usual care group. Of the automatically sent 852 mobile phone text messages, 764 (89.7%) were delivered successfully to the participants. Conclusions: Mobile phone text message reminders significantly improved complete and timely receipt of all recommended vaccines. Besides, they had a significant effect in improving the timely receipt of specific vaccines. Thus, text message reminders can be used to supplement the routine immunization program in resource-limited settings. Considering different contexts, studies on the implementation challenges of mobile health interventions are recommended. Trial Registration: Pan African Clinical Trial Registry PACTR201901533237287; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=5839 
%M 34128813
%R 10.2196/27603
%U https://mhealth.jmir.org/2021/6/e27603
%U https://doi.org/10.2196/27603
%U http://www.ncbi.nlm.nih.gov/pubmed/34128813

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 6
%P e26195
%T An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study
%A Larsen,Britta
%A Greenstadt,Emily D
%A Olesen,Brittany L
%A Marcus,Bess H
%A Godino,Job
%A Zive,Michelle M
%+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr., San Diego, CA, United States, 1 8585348429, blarsen@ucsd.edu
%K mobile health
%K human-centered design
%K qualitative research
%K adolescent health
%K health disparities
%K mobile phone
%D 2021

%7 15.6.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Only 3% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population.  Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework.  Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases.  Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. 
%M 34128823
%R 10.2196/26195
%U https://formative.jmir.org/2021/6/e26195
%U https://doi.org/10.2196/26195
%U http://www.ncbi.nlm.nih.gov/pubmed/34128823

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 6
%P e24115
%T Adaptation of the World Health Organization Electronic Mental Health Gap Action Programme Intervention Guide App for Mobile Devices in Nepal and Nigeria: Protocol for a Feasibility Cluster Randomized Controlled Trial
%A Taylor Salisbury,Tatiana
%A Kohrt,Brandon A
%A Bakolis,Ioannis
%A Jordans,Mark JD
%A Hull,Louise
%A Luitel,Nagendra P
%A McCrone,Paul
%A Sevdalis,Nick
%A Pokhrel,Pooja
%A Carswell,Kenneth
%A Ojagbemi,Akin
%A Green,Eric P
%A Chowdhary,Neerja
%A Kola,Lola
%A Lempp,Heidi
%A Dua,Tarun
%A Milenova,Maria
%A Gureje,Oye
%A Thornicroft,Graham
%+ Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychology, Psychiatry & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 5071, tatiana.salisbury@kcl.ac.uk
%K mental health
%K community mental health
%K digital technology
%K primary health care
%K intervention
%K eHealth
%K mHealth
%K LMIC
%K remote supervision
%K training
%K mobile phone
%D 2021

%7 15.6.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There is a growing global need for scalable approaches to training and supervising primary care workers (PCWs) to deliver mental health services. Over the past decade, the World Health Organization Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) and associated training and implementation guidance have been disseminated to more than 100 countries. On the basis of the opportunities provided by mobile technology, an updated electronic Mental Health Gap Action Programme Intervention Guide (e-mhGAP-IG) is now being developed along with a clinical dashboard and guidance for the use of mobile technology in supervision. Objective: This study aims to assess the feasibility, acceptability, adoption, and other implementation parameters of the e-mhGAP-IG for diagnosis and management of depression in 2 lower-middle-income countries (Nepal and Nigeria) and to conduct a feasibility cluster randomized controlled trial (cRCT) to evaluate trial procedures for a subsequent fully powered trial comparing the clinical effectiveness and cost-effectiveness of the e-mhGAP-IG and remote supervision with standard mhGAP-IG implementation. Methods: A feasibility cRCT will be conducted in Nepal and Nigeria to evaluate the feasibility of the e-mhGAP-IG for use in depression diagnosis and treatment. In each country, an estimated 20 primary health clinics (PHCs) in Nepal and 6 PHCs in Nigeria will be randomized to have their staff trained in e-mhGAP-IG or the paper version of mhGAP-IG v2.0. The PHC will be the unit of clustering. All PCWs within a facility will receive the same training (e-mhGAP-IG vs paper mhGAP-IG). Approximately 2-5 PCWs, depending on staffing, will be recruited per clinic (estimated 20 health workers per arm in Nepal and 15 per arm in Nigeria). The primary outcomes of interest will be the feasibility and acceptability of training, supervision, and care delivery using the e-mhGAP-IG. Secondary implementation outcomes include the adoption of the e-mhGAP-IG and feasibility of trial procedures. The secondary intervention outcome—and the primary outcome for a subsequent fully powered trial—will be the accurate identification of depression by PCWs. Detection rates before and after training will be compared in each arm. Results: To date, qualitative formative work has been conducted at both sites to prepare for the pilot feasibility cRCT, and the e-mhGAP-IG and remote supervision guidelines have been developed. Conclusions: The incorporation of mobile digital technology has the potential to improve the scalability of mental health services in primary care and enhance the quality and accuracy of care. Trial Registration: ClinicalTrials.gov NCT04522453; https://clinicaltrials.gov/ct2/show/NCT04522453. International Registered Report Identifier (IRRID): PRR1-10.2196/24115 
%M 34128819
%R 10.2196/24115
%U https://www.researchprotocols.org/2021/6/e24115
%U https://doi.org/10.2196/24115
%U http://www.ncbi.nlm.nih.gov/pubmed/34128819

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 6
%P e22999
%T Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries
%A Tyrovolas,Stefanos
%A Giné-Vázquez,Iago
%A Fernández,Daniel
%A Morena,Marianthi
%A Koyanagi,Ai
%A Janko,Mark
%A Haro,Josep Maria
%A Lin,Yang
%A Lee,Paul
%A Pan,William
%A Panagiotakos,Demosthenes
%A Molassiotis,Alex
%+ School of Nursing, Hong Kong Polytechnic University, PQ402, Hung Hom, Kowloon, Hong Kong, 852 2766 5648, stefanos.tyrovolas@polyu.edu.hk
%K COVID-19
%K transmission
%K digital public health
%K social distancing
%K policy
%K mobile data
%K estimate
%K real-time
%K pattern
%K surveillance
%K low and middle-income countries
%K emerging countries
%K database
%K surveillance
%D 2021

%7 14.6.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: On January 21, 2020, the World Health Organization reported the first case of severe acute respiratory syndrome coronavirus 2, which rapidly evolved to the COVID-19 pandemic. Since then, the virus has also rapidly spread among Latin American, Caribbean, and African countries. Objective: The first aim of this study is to identify new emerging COVID-19 clusters over time and space (from January 21 to mid-May 2020) in Latin American, Caribbean, and African regions, using a prospective space–time scan measurement approach. The second aim is to assess the impact of real-time population mobility patterns between January 21 and May 18, 2020, under the implemented government interventions, measurements, and policy restrictions on COVID-19 spread among those regions and worldwide. Methods: We created a global COVID-19 database, of 218 countries and territories, merging the World Health Organization daily case reports with other measures such as population density and country income levels for January 21 to May 18, 2020. A score of government policy interventions was created for low, intermediate, high, and very high interventions. The population’s mobility patterns at the country level were
obtained from Google community mobility reports. The prospective space–time scan statistic method was applied in five time periods between January and May 2020, and a regression mixed model analysis was used. Results: We found that COVID-19 emerging clusters within these five periods of time increased from 7 emerging clusters to 28 by mid-May 2020. We also detected various increasing and decreasing relative risk estimates of COVID-19 spread among Latin American, Caribbean, and African countries within the period of analysis. Globally, population mobility to parks and similar leisure areas during at least a minimum of implemented intermediate-level control policies (when compared to low-level control policies) was related to accelerated COVID-19 spread. Results were almost consistent when regional stratified analysis was applied. In addition, worldwide population mobility due to working during high implemented control policies and very high implemented control policies, when compared to low-level control policies, was related to positive COVID-19 spread. Conclusions: The prospective space–time scan is an approach that low-income and middle-income countries could use to detect emerging clusters in a timely manner and implement specific control policies and interventions to slow down COVID-19 transmission. In addition, real-time population mobility obtained from crowdsourced digital data could be useful for current and future targeted public health and mitigation policies at a global and regional level. 
%M 33950850
%R 10.2196/22999
%U https://www.jmir.org/2021/6/e22999
%U https://doi.org/10.2196/22999
%U http://www.ncbi.nlm.nih.gov/pubmed/33950850

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 6
%P e17418
%T Acceptability of a Mobile Phone Support Tool (Call for Life Uganda) for Promoting Adherence to Antiretroviral Therapy Among Young Adults in a Randomized Controlled Trial: Exploratory Qualitative Study
%A Twimukye,Adelline
%A Bwanika Naggirinya,Agnes
%A Parkes-Ratanshi,Rosalind
%A Kasirye,Ronnie
%A Kiragga,Agnes
%A Castelnuovo,Barbara
%A Wasswa,Jacob
%A Nabaggala,Maria Sarah
%A Katabira,Elly
%A Lamorde,Mohammed
%A King,Rachel Lisa
%+ Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O. Box 22418, University Hall Lane, Kampala, 10218, Uganda, 256 256 312 307000, anaggirinya@idi.co.ug
%K HIV
%K mHealth
%K young adults
%K adherence
%K qualitative
%K Uganda
%D 2021

%7 14.6.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Adherence to treatment is critical for successful treatment outcomes. Although factors influencing antiretroviral therapy (ART) adherence vary, young adults are less likely to adhere owing to psychosocial issues such as stigma, ART-related side effects, and a lack of access to treatment. The Call for Life Uganda (CFLU) mobile health (mHealth) tool is a mobile phone–based technology that provides text messages or interactive voice response functionalities through a web interface and offers 4 modules of support. Objective: This study aims to describe the acceptability and feasibility of a mobile phone support tool to promote adherence to ART among young adults in a randomized controlled trial. Methods: An exploratory qualitative design with a phenomenological approach at 2 study sites was used. A total of 17 purposively selected young adults with HIV infection who had used the mHealth tool CFLU from 2 clinics were included. In total, 11 in-depth interviews and 1 focus group discussion were conducted to examine the following topics: experience with the CFLU tool (benefits and challenges), components of the tool, the efficiency of the system (level of comfort, ease, or difficulty in using the system), how CFLU resolved adherence challenges, and suggestions to improve CFLU. Participants belonged to 4 categories of interest: young adults on ART for the prevention of mother-to-child transmission, young adults switching to or on the second-line ART, positive partners in an HIV-discordant relationship, and young adults initiating the first-line ART. All young adults had 12 months of daily experience using the tool. Data were analyzed using NVivo version 11 software (QSR International Limited) based on a thematic approach. Results: The CFLU mHealth tool was perceived as an acceptable intervention; young adults reported improvement in medication adherence, strengthened clinician-patient relationships, and increased health knowledge from health tips. Appointment reminders and symptom reporting were singled out as beneficial and helped to address the problems of forgetfulness and stigma-related issues. HIV-related stigma was reported by a few young people. Participants requested extra support for scaling up CFLU to make it more youth friendly. Improving the tool to reduce technical issues, including network outages and a period of software failure, was suggested. They suggested that in addition to digital solutions, other support, including the promotion of peer support meetings and the establishment of a designated space and staff members for youth, was also important. Conclusions: This mHealth tool was an acceptable and feasible strategy for improving ART adherence and retention among young adults in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 
%M 34121665
%R 10.2196/17418
%U https://mhealth.jmir.org/2021/6/e17418
%U https://doi.org/10.2196/17418
%U http://www.ncbi.nlm.nih.gov/pubmed/34121665

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 6
%P e23884
%T Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study
%A Donevant,Sara
%A Heiney,Sue P
%A Wineglass,Cassandra
%A Schooley,Benjamin
%A Singh,Akanksha
%A Sheng,Jingxi
%+ College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, United States, 1 803 777 7672, Donevant@mailbox.sc.edu
%K mHealth
%K breast cancer survivors
%K medication adherence
%K cultural considerations
%K mobile health applications
%D 2021

%7 11.6.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. 
%M 34114955
%R 10.2196/23884
%U https://formative.jmir.org/2021/6/e23884
%U https://doi.org/10.2196/23884
%U http://www.ncbi.nlm.nih.gov/pubmed/34114955

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 6
%P e20330
%T mHealth Interventions for Treatment Adherence and Outcomes of Care for Cardiometabolic Disease Among Adults Living With HIV: Systematic Review
%A Odukoya,Oluwakemi Ololade
%A Ohazurike,Chidumga
%A Akanbi,Maxwell
%A O'Dwyer,Linda C
%A Isikekpei,Brenda
%A Kuteyi,Ewemade
%A Ameh,Idaomeh O
%A Osadiaye,Olanlesi
%A Adebayo,Khadijat
%A Usinoma,Adewunmi
%A Adewole,Ajoke
%A Odunukwe,Nkiruka
%A Okuyemi,Kola
%A Kengne,Andre Pascal
%+ Department of Community Health and Primary Care, College of Medicine, University of Lagos, #16 Ishaga Road, Idi-Araba, Lagos, PMB 12003, Nigeria, 234 8023200770, drolukemiodukoya@yahoo.com
%K mHealth
%K HIV
%K cardiometabolic disease
%K text messaging
%K mobile
%K systematic review
%K telephone calls
%K wearable devices
%K smartphones
%K desktop
%K web-based
%K mobile apps
%D 2021

%7 9.6.2021
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The success of antiretroviral therapy has led to an increase in life expectancy and an associated rise in the risk of cardiometabolic diseases (CMDs) among people living with HIV. Objective: Our aim was to conduct a systematic review to synthesize the existing literature on the patterns of use and effects of mobile health (mHealth) interventions for improving treatment adherence and outcomes of care for CMD among people living with HIV. Methods: A systematic search of multiple databases, including PubMed-MEDLINE, Embase, CINAHL, Scopus, Web of Science, African Journals online, ClinicalTrials.gov, and the World Health Organization Global Index Medicus of peer-reviewed articles, was conducted with no date or language restrictions. Unpublished reports on mHealth interventions for treatment adherence and outcomes of care for CMD among adults living with HIV were also included in this review. Studies were included if they had at least 1 component that used an mHealth intervention to address treatment adherence or 1 or more of the stated outcomes of care for CMD among people living with HIV. Results: Our search strategy yielded 1148 unique records. In total, 10 articles met the inclusion criteria and were included in this review. Of the 10 studies, only 4 had published results. The categories of mHealth interventions ranged from short messaging, telephone calls, and wearable devices to smartphone and desktop web-based mobile apps. Across the different categories of interventions, there were no clear patterns in terms of consistency in the use of a particular intervention, as most studies (9/10, 90%) assessed a combination of mHealth interventions. Short messaging and telephone calls were however the most common interventions. Half of the studies (5/10, 50%) reported on outcomes that were indirectly linked to CMD, and none of them provided reliable evidence for evaluating the effectiveness of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. Conclusions: Due to the limited number of studies and the heterogeneity of interventions and outcome measures in the studies, no definitive conclusions could be drawn on the patterns of use and effects of mHealth interventions for treatment adherence and outcomes of care for CMD among people living with HIV. We therefore recommend that future trials should focus on standardized outcomes for CMD. We also suggest that future studies should consider having a longer follow-up period in order to determine the long-term effects of mHealth interventions on CMD outcomes for people living with HIV. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018086940; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018086940 
%M 34106075
%R 10.2196/20330
%U https://mhealth.jmir.org/2021/6/e20330
%U https://doi.org/10.2196/20330
%U http://www.ncbi.nlm.nih.gov/pubmed/34106075

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 9
%N 6
%P e29242
%T Informing Developmental Milestone Achievement for Children With Autism: Machine Learning Approach
%A Haque,Munirul M
%A Rabbani,Masud
%A Dipal,Dipranjan Das
%A Zarif,Md Ishrak Islam
%A Iqbal,Anik
%A Schwichtenberg,Amy
%A Bansal,Naveen
%A Soron,Tanjir Rashid
%A Ahmed,Syed Ishtiaque
%A Ahamed,Sheikh Iqbal
%+ Ubicomp Lab, Department of Computer Science, Marquette University, 1422 W Kilbourn Ave, 102, Milwaukee, WI, 53233-1784, United States, 1 4143267769, masud.rabbani@marquette.edu
%K autism spectrum disorders
%K machine learning
%K digital health
%K mobile health
%K mhealth
%K predictive modeling
%K milestone parameters
%K Autism and Developmental Disabilities Monitoring (ADDM)
%K early intervention
%D 2021

%7 8.6.2021
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: Care for children with autism spectrum disorder (ASD) can be challenging for families and medical care systems. This is especially true in low- and- middle-income countries such as Bangladesh. To improve family–practitioner communication and developmental monitoring of children with ASD, mCARE (Mobile-Based Care for Children with Autism Spectrum Disorder Using Remote Experience Sampling Method) was developed. Within this study, mCARE was used to track child milestone achievement and family sociodemographic assets to inform mCARE feasibility/scalability and family asset–informed practitioner recommendations. Objective: The objectives of this paper are threefold. First, it documents how mCARE can be used to monitor child milestone achievement. Second, it demonstrates how advanced machine learning models can inform our understanding of milestone achievement in children with ASD. Third, it describes family/child sociodemographic factors that are associated with earlier milestone achievement in children with ASD (across 5 machine learning models). Methods: Using mCARE-collected data, this study assessed milestone achievement in 300 children with ASD from Bangladesh. In this study, we used 4 supervised machine learning algorithms (decision tree, logistic regression, K-nearest neighbor [KNN], and artificial neural network [ANN]) and 1 unsupervised machine learning algorithm (K-means clustering) to build models of milestone achievement based on family/child sociodemographic details. For analyses, the sample was randomly divided in half to train the machine learning models and then their accuracy was estimated based on the other half of the sample. Each model was specified for the following milestones: Brushes teeth, Asks to use the toilet, Urinates in the toilet or potty, and Buttons large buttons. Results: This study aimed to find a suitable machine learning algorithm for milestone prediction/achievement for children with ASD using family/child sociodemographic characteristics. For Brushes teeth, the 3 supervised machine learning models met or exceeded an accuracy of 95% with logistic regression, KNN, and ANN as the most robust sociodemographic predictors. For Asks to use toilet, 84.00% accuracy was achieved with the KNN and ANN models. For these models, the family sociodemographic predictors of “family expenditure” and “parents’ age” accounted for most of the model variability. The last 2 parameters, Urinates in toilet or potty and Buttons large buttons, had an accuracy of 91.00% and 76.00%, respectively, in ANN. Overall, the ANN had a higher accuracy (above ~80% on average) among the other algorithms for all the parameters. Across the models and milestones, “family expenditure,” “family size/type,” “living places,” and “parent’s age and occupation” were the most influential family/child sociodemographic factors. Conclusions: mCARE was successfully deployed in a low- and middle-income country (ie, Bangladesh), providing parents and care practitioners a mechanism to share detailed information on child milestones achievement. Using advanced modeling techniques this study demonstrates how family/child sociodemographic elements can inform child milestone achievement. Specifically, families with fewer sociodemographic resources reported later milestone attainment. Developmental science theories highlight how family/systems can directly influence child development and this study provides a clear link between family resources and child developmental progress. Clinical implications for this work could include supporting the larger family system to improve child milestone achievement. 
%M 33984830
%R 10.2196/29242
%U https://medinform.jmir.org/2021/6/e29242
%U https://doi.org/10.2196/29242
%U http://www.ncbi.nlm.nih.gov/pubmed/33984830

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 6
%P e25687
%T 
        Racial Discrimination, Sedentary Time, and Physical Activity in African Americans: Quantitative Study Combining Ecological Momentary Assessment and Accelerometers
        
        
        
%A Nam,Soohyun
%A Jeon,Sangchoon
%A Ash,Garrett
%A Whittemore,Robin
%A Vlahov,David
%+ School of Nursing, Yale University, 400 West Campus Dr, West Haven, CT, 06516, United States, 1 203 737 2822, soohyun.nam@yale.edu
%K racial discrimination
%K physical activity
%K ecological momentary assessment
%K African American
%K pilot study
%K mobile phone
%D 2021

%7 7.6.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: A growing number of studies indicate that exposure to social stress, such as perceived racial discrimination, may contribute to poor health, health behaviors, and health disparities. Increased physical activity (PA) may buffer the impact of social stress resulting from racial discrimination. However, to date, data on the relationship between racial discrimination and PA have been mixed. Part of the reason is that the effect of perceived racial discrimination on PA has primarily been examined in cross-sectional studies that captured retrospective measures of perceived racial discrimination associated with individuals’ current PA outcomes. The association between real-time perceived racial discrimination and PA among African Americans remains unclear. Objective: The purpose of this study is to examine the relationship among demographic, anthropometric and clinical, and psychological factors with lifetime racial discrimination and examine the within- and between-person associations between daily real-time racial discrimination and PA outcomes (total energy expenditure, sedentary time, and moderate-to-vigorous PA patterns) measured by ecological momentary assessment (EMA) and accelerometers in healthy African Americans. Methods: This pilot study used an intensive, observational, case-crossover design of African Americans (n=12) recruited from the community. After participants completed baseline surveys, they were asked to wear an accelerometer for 7 days to measure their PA levels. EMA was sent to participants 5 times per day for 7 days to assess daily real-time racial discrimination. Multilevel models were used to examine the within- and between-person associations of daily racial discrimination on PA. Results: More EMA-reported daily racial discrimination was associated with younger age (r=0.75; P=.02). Daily EMA-reported microaggression was associated with depressive symptoms (r=0.66; P=.05), past race-related events (r=0.82; P=.004), and lifetime discrimination (r=0.78; P=.01). In the within-person analyses, the day-level association of racial discrimination and sedentary time was significant (β=.30, SE 0.14; P=.03), indicating that on occasions when participants reported more racial discrimination than usual, more sedentary time was observed. Between-person associations of racial discrimination (β=−.30, SE 0.28; P=.29) or microaggression (β=−.34, SE 0.36; P=.34) with total energy expenditure were suggestive but inconclusive. Conclusions: Concurrent use of EMA and accelerometers is a feasible method to examine the relationship between racial discrimination and PA in real time. Examining daily processes at the within-person level has the potential to elucidate the mechanisms of which racial discrimination may have on health and health behaviors and to guide the development of personalized interventions for increasing PA in racial ethnic minorities. Future studies with a precision health approach, incorporating within- and between-person associations, are warranted to further elucidate the effects of racial discrimination and PA. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22068 
%M 34096870
%R 10.2196/25687
%U https://formative.jmir.org/2021/6/e25687
%U https://doi.org/10.2196/25687
%U http://www.ncbi.nlm.nih.gov/pubmed/34096870

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 4
%N 2
%P e24156
%T Perceptions and Acceptability of a Smartphone App Intervention (ChildSafe) in Malaysia: Qualitative Exploratory Study
%A Yong,Teresa Sui Mien
%A Perialathan,Komathi
%A Ahmad,Masitah
%A Juatan,Nurashma
%A Abdul Majid,Liana
%A Johari,Mohammad Zabri
%+ Institute for Health Behavioural Research, National Institutes of Health, Ministry of Health Malaysia, Block B3, No 1, Jalan Setia Murni U13/52, Section U13, Shah Alam, 40170, Malaysia, 60 333627600 ext 8612, teresa_yong@yahoo.co.uk
%K child safety
%K unintentional injuries
%K consolidated framework for implementation research (CFIR)
%K characteristics of individuals
%K Mobile App Rating Scale (MARS)
%D 2021

%7 1.6.2021
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Home is a vulnerable place for accidental child injuries. Unintentional injuries are a leading cause of death, hospitalization, and disabilities. These injuries are considered preventable and if not tackled, they will continue to be a persisting problem. Smartphones have become increasingly important in our everyday life and is an important tool not only for communication but also for other purposes—they have apps that can be used for various purposes. Therefore, an app-based intervention (ChildSafe) was developed to assess and reduce child injury at home. Objective: This study aimed to evaluate the acceptance of the ChildSafe smartphone app intervention by parents/guardians. Methods: This study was conducted using a qualitative exploratory approach on selected participants of the ChildSafe intervention app study. A total of 27 semistructured in-depth interviews were carried out among parents or guardians who have at least one child between the age of 0 and 59 months in the area of Sungai Buloh, Selangor, between November 2017 and March 2018. Interview questions were developed from the consolidated framework for implementation research (CFIR). Interviews were recorded, transcribed verbatim, and data were thematically analyzed guided by CFIR. Results: The study revealed users’ perception on usability, feasibility, and acceptability toward the ChildSafe app. Three CFIR domains were identified: intervention characteristics, inner setting, and characteristics of individuals. A total of 5 constructs were revealed under intervention characteristics: evidence strength and quality, relative advantage, adaptability, trialability, and design quality and packaging; 2 under inner setting: implementation climate and readiness for implementation; and 4 under characteristics of individuals: knowledge and beliefs about the intervention, self-efficacy, individual stage of change, and other personal attributes. In general, participants felt the app is extremely useful and effective, easy to use, and purposeful in achieving home safety assessment via reminders. The app replaces the need for participants to search for information on home safety and dangers, as the app itself was designed as a tool to assess for this specific purpose. Even at the nascent stage and despite its limitations, the app has prompted users to consider and make changes around their own home. However, future versions of the app should be expanded to make it more attractive to users as it lacks interactive feedback and additional features. Conclusions: Parents/guardians are accepting the use of the ChildSafe app to prevent child injury at home. However, further expansion and improvements are needed to increase the acceptability of this app by parents/guardians. 
%M 34061039
%R 10.2196/24156
%U https://pediatrics.jmir.org/2021/2/e24156
%U https://doi.org/10.2196/24156
%U http://www.ncbi.nlm.nih.gov/pubmed/34061039

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 5
%P e23350
%T Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research
%A Rossman,Andrea H
%A Reid,Hadley W
%A Pieters,Michelle M
%A Mizelle,Cecelia
%A von Isenburg,Megan
%A Ramanujam,Nimmi
%A Huchko,Megan J
%A Vasudevan,Lavanya
%+ Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC, 27705, United States, 1 9196131423, lavanya.vasudevan@duke.edu
%K cervical cancer
%K digital health
%K mobile phones
%K low- and middle-income countries
%K colposcopy
%K uterine cervical neoplasms
%K telemedicine or mobile apps
%K cell phones
%K developing countries
%D 2021

%7 27.5.2021
%9 Review
%J J Med Internet Res
%G English
                
%X Background: Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. Objective: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. Methods: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. Results: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. Conclusions: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies. 
%M 34042592
%R 10.2196/23350
%U https://www.jmir.org/2021/5/e23350
%U https://doi.org/10.2196/23350
%U http://www.ncbi.nlm.nih.gov/pubmed/34042592

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 5
%P e28594
%T An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study
%A Akhtar,Hashaam
%A Akhtar,Samar
%A Rahman,Fazal-Ul
%A Afridi,Maham
%A Khalid,Sundas
%A Ali,Sabahat
%A Akhtar,Nasim
%A Khader,Yousef S
%A Ahmad,Hamaad
%A Khan,Muhammad Mujeeb
%+ Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road, Islamabad, 44000, Pakistan, 92 515709447, hashaamakhtar@gmail.com
%K COVID-19
%K antibiotics
%K Pakistan
%K multidrug resistant infections
%K antibiotic resistance
%K first wave
%D 2021

%7 27.5.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. Objective: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. Methods: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). Results: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). Conclusions: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19. 
%M 33945498
%R 10.2196/28594
%U https://publichealth.jmir.org/2021/5/e28594
%U https://doi.org/10.2196/28594
%U http://www.ncbi.nlm.nih.gov/pubmed/33945498

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 5
%P e14851
%T Utilizing Lean Software Methods To Improve Acceptance of Global eHealth Initiatives: Results From the Implementation of the Basic Emergency Care App
%A Rose,Christian
%A Nichols,Taylor
%A Hackner,Daniel
%A Chang,Julia
%A Straube,Steven
%A Jooste,Willem
%A Sawe,Hendry
%A Tenner,Andrea
%+ Department of Emergency Medicine, Stanford University School of Medicine, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4159159585, ccrose@stanford.edu
%K lean
%K eHealth
%K emergency
%K global health
%K app development
%K decision support
%K primary survey
%K mHealth
%K Africa
%K Tanzania
%K low- and middle income countries
%K LMIC
%D 2021

%7 26.5.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Health systems in low- and middle-income countries face considerable challenges in providing high-quality accessible care. eHealth has had mounting interest as a possible solution given the unprecedented growth in mobile phone and internet technologies in these locations; however, few apps or software programs have, as of yet, gone beyond the testing phase, most downloads are never opened, and consistent use is extremely rare. This is believed to be due to a failure to engage and meet local stakeholder needs and the high costs of software development. Objective: World Health Organization Basic Emergency Care course participants requested a mobile point-of-care adjunct to the primary course material. Our team undertook the task of developing this solution through a community-based participatory model in an effort to meet trainees’ reported needs and avoid some of the abovementioned failings. We aimed to use the well-described Lean software development strategy—given our familiarity with its elements and its ubiquitous use in medicine, global health, and software development—to complete this task efficiently and with maximal stakeholder involvement. Methods: From September 2016 through January 2017, the Basic Emergency Care app was designed and developed at the University of California San Francisco. When a prototype was complete, it was piloted in Cape Town, South Africa and Dar es Salaam, Tanzania—World Health Organization Basic Emergency Care partner sites. Feedback from this pilot shaped continuous amendments to the app before subsequent user testing and study of the effect of use of the app on trainee retention of Basic Emergency Care course material. Results: Our user-centered mobile app was developed with an iterative participatory approach with its first version available within 6 months and with high acceptance—95% of Basic Emergency Care Course participants felt that it was useful. Our solution had minimal direct costs and resulted in a robust infrastructure for subsequent assessment and maintenance and allows for efficient feedback and expansion. Conclusions: We believe that utilizing Lean software development strategies may help global health advocates and researchers build eHealth solutions with a process that is familiar and with buy-in across stakeholders that is responsive, rapid to deploy, and sustainable. 
%M 33882013
%R 10.2196/14851
%U https://formative.jmir.org/2021/5/e14851
%U https://doi.org/10.2196/14851
%U http://www.ncbi.nlm.nih.gov/pubmed/33882013

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 5
%P e25016
%T Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial
%A Diniz,Carmen Simone Grilo
%A Franzon,Ana Carolina Arruda
%A Fioretti-Foschi,Beatriz
%A Niy,Denise Yoshie
%A Pedrilio,Livia Sanches
%A Amaro Jr,Edson
%A Sato,João Ricardo
%+ Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Av Dr Arnaldo, 715, Sao Paulo, 01246-904, Brazil, 55 1130617124, denise.niy@gmail.com
%K app
%K childbirth
%K communication
%K COVID-19
%K health literacy
%K informatics
%K internet
%K intervention
%K maternal health
%K neonatal health
%K neonate public health
%K society
%K technology
%K women
%D 2021

%7 21.5.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 
%M 33945496
%R 10.2196/25016
%U https://www.researchprotocols.org/2021/5/e25016
%U https://doi.org/10.2196/25016
%U http://www.ncbi.nlm.nih.gov/pubmed/33945496

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 5
%P e24470
%T Performance of a Mobile Single-Lead Electrocardiogram Technology for Atrial Fibrillation Screening in a Semirural African Population: Insights From “The Heart of Ethiopia: Focus on Atrial Fibrillation” (TEFF-AF) Study
%A Pitman,Bradley M
%A Chew,Sok-Hui
%A Wong,Christopher X
%A Jaghoori,Amenah
%A Iwai,Shinsuke
%A Thomas,Gijo
%A Chew,Andrew
%A Sanders,Prashanthan
%A Lau,Dennis H
%+ Centre for Heart Rhythm Disorders, The University of Adelaide, 1 Port Rd, Adelaide, 5000, Australia, 61 8313 9000, dennis.h.lau@adelaide.edu.au
%K atrial fibrillation
%K screening
%K sub-Saharan Africa
%K single-lead ECG
%D 2021

%7 19.5.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Atrial fibrillation (AF) screening using mobile single-lead electrocardiogram (ECG) devices has demonstrated variable sensitivity and specificity. However, limited data exists on the use of such devices in low-resource countries. Objective: The goal of the research was to evaluate the utility of the KardiaMobile device’s (AliveCor Inc) automated algorithm for AF screening in a semirural Ethiopian population. Methods: Analysis was performed on 30-second single-lead ECG tracings obtained using the KardiaMobile device from 1500 TEFF-AF (The Heart of Ethiopia: Focus on Atrial Fibrillation) study participants. We evaluated the performance of the KardiaMobile automated algorithm against cardiologists’ interpretations of 30-second single-lead ECG for AF screening. Results: A total of 1709 single-lead ECG tracings (including repeat tracing on 209 occasions) were analyzed from 1500 Ethiopians (63.53% [953/1500] male, mean age 35 [SD 13] years) who presented for AF screening. Initial successful rhythm decision (normal or possible AF) with one single-lead ECG tracing was lower with the KardiaMobile automated algorithm versus manual verification by cardiologists (1176/1500, 78.40%, vs 1455/1500, 97.00%; P<.001). Repeat single-lead ECG tracings in 209 individuals improved overall rhythm decision, but the KardiaMobile automated algorithm remained inferior (1301/1500, 86.73%, vs 1479/1500, 98.60%; P<.001). The key reasons underlying unsuccessful KardiaMobile automated rhythm determination include poor quality/noisy tracings (214/408, 52.45%), frequent ectopy (22/408, 5.39%), and tachycardia (>100 bpm; 167/408, 40.93%). The sensitivity and specificity of rhythm decision using KardiaMobile automated algorithm were 80.27% (1168/1455) and 82.22% (37/45), respectively. Conclusions: The performance of the KardiaMobile automated algorithm was suboptimal when used for AF screening. However, the KardiaMobile single-lead ECG device remains an excellent AF screening tool with appropriate clinician input and repeat tracing. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001107112; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378057&isReview=true 
%M 34009129
%R 10.2196/24470
%U https://mhealth.jmir.org/2021/5/e24470
%U https://doi.org/10.2196/24470
%U http://www.ncbi.nlm.nih.gov/pubmed/34009129

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 5
%P e24802
%T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework
%A Karssen,Levie T
%A Vink,Jacqueline M
%A de Weerth,Carolina
%A Hermans,Roel C J
%A de Kort,Carina P M
%A Kremers,Stef PJ
%A Ruiter,Emilie L M
%A Larsen,Junilla K
%+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl
%K childhood obesity
%K preventive intervention
%K parenting practices
%K energy-balance related behavior
%K socio-economic position
%K mHealth
%K behavior change
%K mobile phone
%D 2021

%7 14.5.2021
%9 Protocol
%J JMIR Form Res
%G English
                
%X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. 
%M 33988510
%R 10.2196/24802
%U https://formative.jmir.org/2021/5/e24802
%U https://doi.org/10.2196/24802
%U http://www.ncbi.nlm.nih.gov/pubmed/33988510

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 5
%P e18984
%T Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial
%A Campos,Claudia L
%A Jones,Deanna
%A Snively,Beverly M
%A Rocco,Michael
%A Pedley,Carolyn
%A Atwater,Sara
%A Moore,Justin B
%+ Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 336713600, ccampos@wakehealth.edu
%K hypertension
%K home blood pressure monitoring
%K telehealth
%K medication adherence
%K SMS
%K health disparities
%D 2021

%7 14.5.2021
%9 Proposal
%J JMIR Res Protoc
%G English
                
%X Background: A decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown. Objective: The objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications. Methods: We will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients’ medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control. Results: Our study was funded in July 2020. As of May 2021, we have enrolled 6 participants. Conclusions: Our findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials. Trial Registration: ClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242 International Registered Report Identifier (IRRID): PRR1-10.2196/18984 
%M 33988513
%R 10.2196/18984
%U https://www.researchprotocols.org/2021/5/e18984
%U https://doi.org/10.2196/18984
%U http://www.ncbi.nlm.nih.gov/pubmed/33988513

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 5
%P e22239
%T Promoting HIV, Hepatitis B Virus, and Hepatitis C Virus Screening Among Migrants With a Language Barrier: Protocol for the Development and Evaluation of an Electronic App (Apidé)
%A Thonon,Frédérique
%A Fahmi,Saleh
%A Rousset-Torrente,Olivia
%A Bessonneau,Pascal
%A Griffith,James W
%A Brown,Carter
%A Chassany,Olivier
%A Duracinsky,Martin
%+ Patient-Reported Outcomes Unit (PROQOL), UMR 1123, Université de Paris, INSERM, F-75004, Hôpital Hôtel Dieu, 1 place du Parvis Notre Dame, Paris, 75004, France, 33 140275543, frederique.thonon@gmail.com
%K HIV
%K hepatitis B
%K hepatitis C
%K migrants
%K screening
%K language barrier
%K eHealth
%D 2021

%7 5.5.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Late diagnoses of HIV, hepatitis B, and hepatitis C are important public health problems that affect the population at large and migrants in particular. Missed opportunities of HIV and hepatitis screening are numerous, with language differences being a significant barrier to testing. Several studies have shown that migrants who do not speak the language of the health provider are less likely to get tested, due to health providers’ reluctance to offer a test and to migrants’ reluctance to accept testing. Objective: The aim of our study is to develop a multilingual electronic tool (app) that assists health providers in offering and explaining HIV and hepatitis screenings to migrants with a language barrier and to evaluate its acceptability and impact in terms of public health. Methods: The study will go through 3 stages: (1) concept development, (2) app development, and (3) app evaluation. A qualitative study has been undertaken to explore language barriers during health care encounters and their effect on communication, specifically when a screening test is offered. In parallel, a systematic review of the literature was conducted to have a comprehensive overlook of electronic tools designed to help health care providers communicate with migrants with a language barrier. To generate a list of items to be translated for inclusion in the app, we will conduct a focus group and Delphi survey. The development of the app will include translation and voice recording of items. The electronic development will also include 3 steps of user testing. The acceptability of the app will be evaluated using the System Usability Scale. Evaluation of the app’s efficacy will consist of a stepped wedge randomized controlled trial. The study will be carried out in 16 centers that treat migrants and offer them screening tests for infectious diseases. The primary outcome is the percentage of screening tests realized. The secondary outcomes are the rate of screening proposal by health professionals, acceptance rate by migrants, number of positive cases using this app, and frequency of use of the app. Results: The app evaluation study received a 3-year grant from the Agence Nationale de la Recherche contre le SIDA et les hépatites virales (ANRS) and from the Office Français de l’Immigration et Intégration (OFII). At the time of publication of this protocol, the initial qualitative study and systematic literature review were completed. Conclusions: This study will develop an app that assists health providers in offering and explaining HIV and hepatitis screenings to migrants with a language barrier and measure its acceptability and effectiveness in terms of public health. When completed, this app could be distributed to numerous professionals carrying out screening with migrant populations in various health care settings. International Registered Report Identifier (IRRID): PRR1-10.2196/22239 
%M 33949963
%R 10.2196/22239
%U https://www.researchprotocols.org/2021/5/e22239
%U https://doi.org/10.2196/22239
%U http://www.ncbi.nlm.nih.gov/pubmed/33949963

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 4
%P e25299
%T Conducting Internet-Based Visits for Onboarding Populations With Limited Digital Literacy to an mHealth Intervention: Development of a Patient-Centered Approach
%A Hernandez-Ramos,Rosa
%A Aguilera,Adrian
%A Garcia,Faviola
%A Miramontes-Gomez,Jose
%A Pathak,Laura Elizabeth
%A Figueroa,Caroline Astrid
%A Lyles,Courtney Rees
%+ Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Bldg 10, Ward 13, Box 1364, San Francisco, CA, 94110, United States, 1 628 206 6483, courtney.Lyles@ucsf.edu
%K digital literacy
%K digital divide
%K underserved
%K patient-centered
%K digital health
%K mhealth
%K intervention
%K telehealth
%K COVID-19
%D 2021

%7 29.4.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The COVID-19 pandemic has propelled patient-facing research to shift to digital and telehealth strategies. If these strategies are not adapted for minority patients of lower socioeconomic status, health inequality will further increase. Patient-centered models of care can successfully improve access and experience for minority patients. Objective: This study aims to present the development process and preliminary acceptability of altering in-person onboarding procedures into internet-based, remote procedures for a mobile health (mHealth) intervention in a population with limited digital literacy. Methods: We actively recruited safety-net patients (English- and Spanish-speaking adults with diabetes and depression who were receiving care at a public health care delivery system in San Francisco, United States) into a randomized controlled trial of text messaging support for physical activity. Because of the COVID-19 pandemic, we modified the in-person recruitment and onboarding procedures to internet-based, remote processes with human support. We conducted a preliminary evaluation of how the composition of the recruited cohort might have changed from the pre–COVID-19 period to the COVID-19 enrollment period. First, we analyzed the digital profiles of patients (n=32) who had participated in previous in-person onboarding sessions prior to the COVID-19 pandemic. Next, we documented all changes made to our onboarding processes to account for remote recruitment, especially those needed to support patients who were not very familiar with downloading apps onto their mobile phones on their own. Finally, we used the new study procedures to recruit patients (n=11) during the COVID-19 social distancing period. These patients were also asked about their experience enrolling into a fully digitized mHealth intervention. Results: Recruitment across both pre–COVID-19 and COVID-19 periods (N=43) demonstrated relatively high rates of smartphone ownership but lower self-reported digital literacy, with 32.6% (14/43) of all patients reporting they needed help with using their smartphone and installing apps. Significant changes were made to the onboarding procedures, including facilitating app download via Zoom video call and/or a standard phone call and implementing brief, one-on-one staff-patient interactions to provide technical assistance personalized to each patient’s digital literacy skills. Comparing recruitment during pre–COVID-19 and COVID-19 periods, the proportion of patients with digital literacy barriers reduced from 34.4% (11/32) in the pre–COVID-19 cohort to 27.3% (3/11) in the COVID-19 cohort. Differences in digital literacy scores between both cohorts were not significant (P=.49). Conclusions: Patients of lower socioeconomic status have high interest in using digital platforms to manage their health, but they may require additional upfront human support to gain access. One-on-one staff-patient partnerships allowed us to provide unique technical assistance personalized to each patient’s digital literacy skills, with simple strategies to troubleshoot patient barriers upfront. These additional remote onboarding strategies can mitigate but not eliminate digital barriers for patients without extensive technology experience. Trial Registration: Clinicaltrials.gov NCT0349025, https://clinicaltrials.gov/ct2/show/NCT03490253 
%M 33872184
%R 10.2196/25299
%U https://formative.jmir.org/2021/4/e25299
%U https://doi.org/10.2196/25299
%U http://www.ncbi.nlm.nih.gov/pubmed/33872184

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 4
%P e25128
%T Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study
%A Holst,Christine
%A Sukums,Felix
%A Ngowi,Bernard
%A Diep,Lien My
%A Kebede,Tewodros Aragie
%A Noll,Josef
%A Winkler,Andrea Sylvia
%+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no
%K digital health
%K eHealth
%K mHealth
%K DigI
%K Tanzania
%K digital health messages
%K digital health promotion
%K digital health education
%K HIV/AIDS
%K tuberculosis
%D 2021

%7 22.4.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Traditionally, health promotion and health education have been provided to communities in the global south in the form of leaflets or orally by health care workers. Digital health interventions (DHIs) such as digital health messages accessed by smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of health care systems. The DHI in this study focuses on disseminating digital health education regarding 3 disease complexes of high public health concern: HIV/AIDS, tuberculosis, and Taenia solium (neuro)cysticercosis or taeniasis, a parasitic zoonotic disease that requires a One Health approach. The DHI presents the participants with animated health videos (animations) and provides access to information spots (InfoSpots) with a free-of-charge digital health platform containing messages about health to rural Tanzanian communities. Objective: The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. Methods: This is a mixed methods study including a nonrandomized controlled trial and qualitative interviews conducted in rural Tanzania. A health platform containing digital health messages for the communities was developed prior to the study. The health messages consist of text, pictures, quizzes, and animations of everyday stories, aimed at disease prevention and early treatment. The baseline and immediate postintervention assessments were completed in Iringa, Tanzania in May 2019. The participants were interviewed by enumerators and completed questionnaires regarding health knowledge. Participants in the intervention group were exposed to 3 different health animations once on a tablet device. The participants’ health knowledge was assessed again immediately after the exposure. The first follow-up survey was undertaken in August 2019. The InfoSpots with the digital health platform were thereafter launched in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. Results: A total of 600 participants have been enrolled in the trial. We will assess (1) the difference in knowledge scores between baseline and the immediate postintervention assessments in the intervention group and (2) the difference in knowledge scores between the intervention and control groups at baseline, 3 and 6 months post-DHI rollout. Since a randomized design did not prove feasible, potential confounders (eg, age, gender, education, and time of exposure) may be introduced, and results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, and perspectives and experiences related to use and nonuse of the InfoSpots are being explored. Conclusions: The data have been collected, and the analysis is ongoing in this digital health study, aimed at evaluating the effects of a DHI based on relevant health messages. The publications of results can be expected this year. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR1-10.2196/25128 
%M 33885369
%R 10.2196/25128
%U https://www.researchprotocols.org/2021/4/e25128
%U https://doi.org/10.2196/25128
%U http://www.ncbi.nlm.nih.gov/pubmed/33885369

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 4
%P e25496
%T The Potential of mHealth as a Game Changer for the Management of Sickle Cell Disease in India
%A Kumar,Ravindra
%A Das,Aparup
%+ ICMR-National Institute of Research in Tribal Health, ICMR-NIRTH Campus, Nagpur Road, PO Garha, Jabalpur, 482003, India, 91 7612370800, aparupdas@nirth.res.in
%K sickle cell disease
%K drug adherence
%K mHealth
%K India
%D 2021

%7 13.4.2021
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Sickle cell disease (SCD) is a chronic genetic disease that requires lifelong therapy and monitoring. Low drug adherence and poor monitoring may lead to an increase in morbidities and low quality of life. In the era of digital technology, various mobile health (mHealth) apps are being tested for their potential in increasing drug adherence in patients with SCD. We herewith discuss the applicability and feasibility of these mHealth apps for the management of SCD in India.
%M 33847598
%R 10.2196/25496
%U https://mhealth.jmir.org/2021/4/e25496
%U https://doi.org/10.2196/25496
%U http://www.ncbi.nlm.nih.gov/pubmed/33847598

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 4
%P e23718
%T Leprosy Screening Based on Artificial Intelligence: Development of a Cross-Platform App
%A De Souza,Márcio Luís Moreira
%A Lopes,Gabriel Ayres
%A Branco,Alexandre Castelo
%A Fairley,Jessica K
%A Fraga,Lucia Alves De Oliveira
%+ Multicentre Biochemistry and Molecular Biology Program, Federal University of Juiz de Fora, R São Paulo 745 Centro, Governador Valadares-MG, Brazil, 55 33 33011000, artigoacm@gmail.com
%K leprosy
%K artificial intelligence
%K random forest
%K Python
%K R
%K apps
%K mHealth
%K shinyApp
%D 2021

%7 7.4.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: According to the World Health Organization, achieving targets for control of leprosy by 2030 will require disease elimination and interruption of transmission at the national or regional level. India and Brazil have reported the highest leprosy burden in the last few decades, revealing the need for strategies and tools to help health professionals correctly manage and control the disease. Objective: The main objective of this study was to develop a cross-platform app for leprosy screening based on artificial intelligence (AI) with the goal of increasing accessibility of an accurate method of classifying leprosy treatment for health professionals, especially for communities further away from major diagnostic centers. Toward this end, we analyzed the quality of leprosy data in Brazil on the National Notifiable Diseases Information System (SINAN). Methods: Leprosy data were extracted from the SINAN database, carefully cleaned, and used to build AI decision models based on the random forest algorithm to predict operational classification in paucibacillary or multibacillary leprosy. We used Python programming language to extract and clean the data, and R programming language to train and test the AI model via cross-validation. To allow broad access, we deployed the final random forest classification model in a web app via shinyApp using data available from the Brazilian Institute of Geography and Statistics and the Department of Informatics of the Unified Health System. Results: We mapped the dispersion of leprosy incidence in Brazil from 2014 to 2018, and found a particularly high number of cases in central Brazil in 2014 that further increased in 2018 in the state of Mato Grosso. For some municipalities, up to 80% of cases showed some data discrepancy. Of a total of 21,047 discrepancies detected, the most common was “operational classification does not match the clinical form.” After data processing, we identified a total of 77,628 cases with missing data. The sensitivity and specificity of the AI model applied for the operational classification of leprosy was 93.97% and 87.09%, respectively. Conclusions: The proposed app was able to recognize patterns in leprosy cases registered in the SINAN database and to classify new patients with paucibacillary or multibacillary leprosy, thereby reducing the probability of incorrect assignment by health centers. The collection and notification of data on leprosy in Brazil seem to lack specific validation to increase the quality of the data for implementations via AI. The AI models implemented in this work had satisfactory accuracy across Brazilian states and could be a complementary diagnosis tool, especially in remote areas with few specialist physicians. 
%M 33825685
%R 10.2196/23718
%U https://mhealth.jmir.org/2021/4/e23718
%U https://doi.org/10.2196/23718
%U http://www.ncbi.nlm.nih.gov/pubmed/33825685

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 4
%P e27381
%T Technology-Based Fall Risk Assessments for Older Adults in Low-Income Settings: Protocol for a Cross-sectional Study
%A Thiamwong,Ladda
%A Stout,Jeffrey R
%A Park,Joon-Hyuk
%A Yan,Xin
%+ College of Nursing, University of Central Florida, 12201 Research Parkway, Orlando, FL, 32826, United States, 1 4072830470, ladda.thiamwong@ucf.edu
%K body composition
%K falls
%K risk assessment
%K technology
%K wearable devices
%K accidental falls
%K fear
%D 2021

%7 7.4.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: One-third of older adults have maladaptive fall risk appraisal (FRA), a condition in which there is a discrepancy between the level of fear of falling (FOF) and physiological fall risk (balance performance). Older adults who overestimate their physiological fall risk and report a high FOF are less likely to participate in physical activity. Limited data suggest that the association among FOF, body composition, and physical activity intensity differs by fear severity.

 Objective: This study aims to examine the associations among FRA, body composition, and physical activity using assistive health technology, including the BTrackS balance system, bioelectrical impedance analysis, and activity monitoring devices. This study also aims to examine the feasibility of recruitment and acceptability of technologies and procedures for use among older adults in low-income settings.

 Methods: This cross-sectional study will be conducted in older adults’ homes or apartments in low-income settings in Central Florida, United States. Following consent, participants will be contacted, and our team will visit them twice. The first visit includes questionnaire completion (eg, sociodemographic or FOF) and balance performance test using the BTrackS balance system. The participants will be stratified by the FRA matrix. In addition, they will perform hand grip strength and dynamic balance performance tests. Participants will then be asked to wear the ActiGraph GT9X Link wireless activity monitor on the nondominant wrist for 7 consecutive days. The second visit includes body composition testing and a structured interview about the acceptability of the technologies and procedures.

 Results: Ethical approval was obtained from the institutional review board of the University of Central Florida (protocol number 2189; September 10, 2020). As of December 2020, participation enrollment is ongoing and the results are expected to be published in Summer 2022.

 Conclusions: Accurate FRA is essential for implementing physical activity programs, especially in older adults with low income. This study will provide data for developing technology-based fall risk assessments to improve participation in physical activity, thus enhancing healthy longevity among older adults in low-income settings.
 International Registered Report Identifier (IRRID): PRR1-10.2196/27381 
%M 33825688
%R 10.2196/27381
%U https://www.researchprotocols.org/2021/4/e27381
%U https://doi.org/10.2196/27381
%U http://www.ncbi.nlm.nih.gov/pubmed/33825688

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 4
%P e23280
%T Staff Perceptions of Preimplementation Barriers and Facilitators to a Mobile Health Antiretroviral Therapy Adherence Counseling Intervention in South Africa: Qualitative Study
%A McCreesh-Toselli,Siobhan
%A Torline,John
%A Gouse,Hetta
%A Robbins,Reuben N
%A Mellins,Claude A
%A Remien,Robert H
%A Rowe,Jessica
%A Peton,Neshaan
%A Rabie,Stephan
%A Joska,John A
%+ HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, J Block, Groote Schuur Hospital, Observatory, South Africa, 27 21 404 2174, john.joska@uct.ac.za
%K HIV/AIDS
%K antiretroviral treatment
%K low-resource settings
%K mHealth
%K Masivukeni
%K Consolidated Framework for Implementation Research
%K implementation research
%K lay antiretroviral therapy adherence counselors
%K mobile phone
%D 2021

%7 6.4.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: South Africa adopted a universal test and treatment program for HIV infection in 2015. The standard of care that people living with HIV receive consists of 3 sessions of readiness counseling delivered by lay counselors (LCs). In the largest antiretroviral therapy (ART) program worldwide, effective and early HIV and ART education and support are key for ensuring ART adoption, adherence, and retention in care. Having LCs to deliver readiness counseling allows for the wide task-sharing of this critical activity but carries the risks of loss of standardization, incomplete content delivery, and inadequate monitoring and supervision. Systems for ensuring that a minimum standard of readiness counseling is delivered to the growing number of people living with HIV are essential in the care cascade. In resource-constrained, high-burden settings, mobile health (mHealth) apps may potentially offer solutions to these treatment gaps by providing content structure and delivery records.  Objective: This study aims to explore, at a large Cape Town–based nonprofit HIV care organization, the staff’s perceived preimplementation barriers and facilitators of an mHealth intervention (Masivukeni) developed as a structured app for ART readiness counseling.  Methods: Masivukeni is a laptop-based app that incorporates written content, graphics, short video materials, and participant activities. In total, 20 participants were included in this study. To explore how an mHealth intervention might be adopted across different staff levels within the organization, we conducted 7 semistructured interviews (participants: 7/20, 35%) and 3 focus groups (participants in 2 focus groups: 4/20, 20%; participants in 1 focus group: 3/20, 15%) among LCs, supervisors, and their managers. In total, 20 participants were included in this study. Interviews lasted approximately 60 minutes, and focus groups ranged from 90 to 120 minutes. The Consolidated Framework for Implementation Research was used to explore the perceived implementation barriers and facilitators of the Masivukeni mHealth intervention.  Results: Several potential facilitators of Masivukeni were identified. Multimedia and visual elements were generally regarded as aids in content delivery. The interactive learning components were notably helpful, whereas facilitated updates to the adherence curriculum were important to facilitators and managers. The potential to capture administrative information regarding LC delivery and client logging was regarded as an attractive feature. Barriers to implementation included security risks and equipment costs, the high volume of clients to be counseled, and variable computer literacy among LCs. There was uncertainty about the app’s appeal to older clients.  Conclusions: mHealth apps, such as Masivukeni, were perceived as being well placed to address some of the needs of those who deliver ART adherence counseling in South Africa. However, the successful implementation of mHealth apps appeared to be dependent on overcoming certain barriers in this setting. 
%M 33821806
%R 10.2196/23280
%U https://mhealth.jmir.org/2021/4/e23280
%U https://doi.org/10.2196/23280
%U http://www.ncbi.nlm.nih.gov/pubmed/33821806

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 4
%P e21638
%T Perceived Impacts, Acceptability, and Recommendations for Ecological Momentary Assessment Among Youth Experiencing Homelessness: Qualitative Study
%A Acorda,Darlene
%A Businelle,Michael
%A Santa Maria,Diane
%+ Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX, 77030, United States, 1 832 824 1179, darlene.e.acorda@uth.tmc.edu
%K youth experiencing homelessness
%K ecological momentary assessment
%K mobile apps
%K behavior change
%D 2021

%7 6.4.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: The use of ecological momentary assessment (EMA) to study youth experiencing homelessness (YEH) behaviors is an emerging area of research. Despite high rates of participation and potential clinical utility, few studies have investigated the acceptability and recommendations for EMA from the YEH perspective. Objective: This study aimed to describe the perceived benefits, usability, acceptability, and barriers to the use of EMA from the homeless youth perspective. Methods: YEH were recruited from a larger EMA study. Semistructured exit interviews were performed using an interview guide that focused on the YEH experience with the EMA app, and included perceived barriers and recommendations for future studies. Data analyses used an inductive approach with thematic analysis to identify major themes and subthemes. Results: A total of 18 YEH aged 19-24 years participated in individual and group exit interviews. The EMA was highly acceptable to YEH and they found the app and EMA surveys easy to navigate. Perceived benefits included increased behavioral and emotional awareness with some YEH reporting a decrease in their high-risk behaviors as a result of participation. Another significant perceived benefit was the ability to use the phones for social support and make connections to family, friends, and potential employers. Barriers were primarily survey and technology related. Survey-related barriers included the redundancy of questions, the lack of customizable responses, and the timing of survey prompts. Technology-related barriers included the “freezing” of the app, battery charge, and connectivity issues. Recommendations for future studies included the need to provide real-time mental health support for symptomatic youth, to create individually customized questions, and to test the use of personalized motivational messages that respond to the EMA data in real time. Conclusions: YEH are highly receptive to the use of EMA in studies. Further studies are warranted to understand the impact of EMA on YEH behaviors. Incorporating the YEH perspective into the design and implementation of EMA studies may help minimize barriers, increase acceptability, and improve participation rates in this hard-to-reach, disconnected population. 
%M 33821805
%R 10.2196/21638
%U https://formative.jmir.org/2021/4/e21638
%U https://doi.org/10.2196/21638
%U http://www.ncbi.nlm.nih.gov/pubmed/33821805

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e25699
%T Telehealth Diabetes Prevention Intervention for the Next Generation of African American Youth: Protocol for a Pilot Trial
%A Gamble,Abigail
%A Beech,Bettina M
%A Wade,Breanna C
%A Sutton,Victor D
%A Lim,Crystal
%A Sandridge,Shanda
%A Welsch,Michael A
%+ Department of Preventive Medicine, John D Bower School of Population Health, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, United States, 1 6018159065, agamble2@umc.edu
%K prediabetic state
%K child obesity
%K telehealth
%K obesity management
%K behavioral science
%K implementation science
%K Jackson Heart Study
%K Centers for Disease Control and Prevention
%K preventive medicine
%K mobile phone
%D 2021

%7 31.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: In 1999, type 2 diabetes mellitus (T2DM) was identified as an emerging epidemic in youth, and racial and ethnic minority youth were identified with high risk. Two decades later, no gold standard T2DM prevention intervention has been established for this population. Objective: This study tests the efficacy of a telehealth diabetes prevention intervention for African American (AA) families with children with risk for T2DM. Concurrently, investigators aim to evaluate an implementation strategy for the uptake of the intervention by the University of Mississippi Medical Center’s (UMMC) pediatric weight management clinic. Methods: This single-arm trial will enroll 20 parents with overweight or obesity of children (8-11 years) with overweight or obesity, both of whom are at risk for T2DM. Parents will meet in small groups (5 parents per group) weekly for 11 weeks and then monthly for 4 monthly maintenance sessions via videoconference using Wi-Fi–enabled iPads with cellular connectivity. The intervention will be adapted from the National Diabetes Prevention Program and Power to Prevent, a diabetes prevention program tailored for AA families. The same lifestyle intervention facilitated by a racially concordant lifestyle coach trained in the Diabetes Prevention Program will be delivered to all groups (n=4). Participants will be recruited in-person during patient encounters at the UMMC’s pediatric weight management clinic. Sessions will consist of dietary and physical activity behavior change strategies facilitated using problem-solving and goal-setting skills. The implementation strategy has 2 targets: the pediatric weight management clinic site and clinical team and parents of children at risk for T2DM engaged in intensive obesity treatment to prevent T2DM. The multifaceted implementation protocol includes 4 discrete strategies: creating a new clinical team, changing the service site, intervening with families, and promoting organizational readiness for change. Results: Recruitment and enrollment began in December 2020, and the intervention is scheduled to be delivered to the first cohort of parents in March 2021. The results are expected to be submitted for publication beginning in November 2021 through 2022. The primary outcome measure for the pilot trial will include changes from baseline to 12 and 30 weeks in the child BMI z score and parent BMI. The implementation evaluation will include multiple measures of feasibility, acceptability, appropriateness, fidelity, and efficacy. This protocol was approved by the UMMC’s Institutional Review Board (#2020V0249). Conclusions: The proposed intervention approach is supported by the scientific literature and is scalable given the current and future health care subsidies for telehealth. Findings from this pilot trial will begin to address critical barriers to defining a gold standard lifestyle intervention for AA families with children at risk for T2DM. If effective, the intervention could be feasibly disseminated to treat obesity and prevent T2DM in high-risk AA pediatric populations. International Registered Report Identifier (IRRID): PRR1-10.2196/25699 
%M 33787504
%R 10.2196/25699
%U https://www.researchprotocols.org/2021/3/e25699
%U https://doi.org/10.2196/25699
%U http://www.ncbi.nlm.nih.gov/pubmed/33787504

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 3
%P e19310
%T Smartphone Medical App Use and Associated Factors Among Physicians at Referral Hospitals in Amhara Region, North Ethiopia, in 2019: Cross-sectional Study
%A Teferi,Gizaw Hailiye
%A Tilahun,Binyam Cheklu
%A Guadie,Habtamu Alganeh
%A Amare,Ashenafi Tazebew
%+ Department of Health Informatics, College of Medicine and Health Science, Debre-Markos University, PO Box: 269, Debre Markos, Ethiopia, 251 921493560, ghailiye463@gmail.com
%K application
%K medical
%K physician
%K smartphone
%K mobile phone
%D 2021

%7 26.3.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Information in health care is rapidly expanding and is updated very regularly, especially with the increasing use of technology in the sector. Due to this, health care providers require timely access to the latest scientific evidence anywhere. Smartphone medical apps are tools to access the latest reputable scientific evidence in the discipline. In addition, smartphone medical apps could lead to improved decision making, reduced numbers of medical errors, and improved communication between hospital medical staff. Objective: The aim of this study was to assess smartphone medical app use and associated factors among physicians working at referral hospitals of the Amhara region, Ethiopia. Methods: An institution-based cross-sectional study design was conducted among physicians working at 5 referral hospitals in the Amhara region, Ethiopia, from February 5 to May 27, 2019. A simple random sampling method was used to select 423 physicians. A self-administered questionnaire was used to collect the data and analyzed using SPSS, version 21 (IBM Corp). Binary and multivariable logistic regression analysis was performed to assess factors associated with smartphone medical app use among physicians. A value of P<.05, corresponding to a 95% CI, was considered statistically significant. The validity of the questionnaire was determined based on the view of experts and the reliability of it obtained by calculating the value of Cronbach alpha (α=.78) Results: In this study, most of the 417 respondents (375, 89.9%) had medical apps installed on their smartphones. Of those 375 respondents, 264 (70.4%) had used medical apps during clinical practice. The medical apps most commonly used by the respondents were UpToDate, Medscape, MedCalc, and Doximity. According to multivariable logistic regression analysis, attitude (adjusted odds ratio [AOR] 1.64, 95% CI 1.05-2.55), internet access (AOR 2.82, 95% CI 1.75-4.54), computer training (AOR 1.71, 95% CI 1.09-2.67), perceived usefulness of the app (AOR 1.64, 95% CI 1.05-2.54), information technology support staff (AOR 2.363, 95% CI 1.5-3.08), and technical skill (AOR 2.52, 95% CI 1.50-4.25) were significantly associated with smartphone medical app use. Conclusions: Most respondents have a smartphone medical app and have used it in clinical practice. Attitude, internet access, computer training, perceived usefulness of the app, information technology support staff, and technical skill are the most notable factors that are associated with smartphone medical app use by physicians.  
%M 33769303
%R 10.2196/19310
%U https://mhealth.jmir.org/2021/3/e19310
%U https://doi.org/10.2196/19310
%U http://www.ncbi.nlm.nih.gov/pubmed/33769303

%0 Journal Article
        
%@ 2369-1999
%I JMIR Publications
%V 7
%N 1
%P e24062
%T A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach
%A Morse,Robert S
%A Lambden,Kaley
%A Quinn,Erin
%A Ngoma,Twalib
%A Mushi,Beatrice
%A Ho,Yun Xian
%A Ngoma,Mamsau
%A Mahuna,Habiba
%A Sagan,Sarah B
%A Mmari,Joshua
%A Miesfeldt,Susan
%+ Maine Medical Center, Suite 111, 100 Campus Drive, Scarborough, ME, 04074, United States, 1 207 396 7787, MIESFS@mmc.org
%K mobile health
%K mHealth
%K user-centered design
%K palliative care
%K pain
%K cancer
%K sub-Saharan Africa
%K mobile phone
%D 2021

%7 23.3.2021
%9 Original Paper
%J JMIR Cancer
%G English
                
%X Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life–focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app’s effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users—patients or caregivers, LHWs, and members of the palliative care team—and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. 
%M 33755022
%R 10.2196/24062
%U https://cancer.jmir.org/2021/1/e24062
%U https://doi.org/10.2196/24062
%U http://www.ncbi.nlm.nih.gov/pubmed/33755022

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 3
%P e17170
%T A Pharmacist and Health Coach–Delivered Mobile Health Intervention for Type 2 Diabetes: Protocol for a Randomized Controlled Crossover Study
%A Sharp,Lisa Kay
%A Biggers,Alana
%A Perez,Rosanne
%A Henkins,Julia
%A Tilton,Jessica
%A Gerber,Ben S
%+ Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60611, United States, 1 3123553569, sharpl@uic.edu
%K mHealth
%K type 2 diabetes mellitus
%K community health workers
%K clinical pharmacists
%D 2021

%7 10.3.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Aggressive management of blood glucose, blood pressure, and cholesterol through medication and lifestyle adherence is necessary to minimize the adverse health outcomes of type 2 diabetes. However, numerous psychosocial and environmental barriers to adherence prevent low-income, urban, and ethnic minority populations from achieving their management goals, resulting in diabetes complications. Health coaches working with clinical pharmacists represent a promising strategy for addressing common diabetes management barriers. Mobile health (mHealth) tools may further enhance their ability to support vulnerable minority populations in diabetes management. Objective: The aim of this study is to evaluate the impact of an mHealth clinical pharmacist and health coach–delivered intervention on hemoglobin A1c (HbA1c, primary outcome), blood pressure, and low-density lipoprotein (secondary outcomes) in African-Americans and Latinos with poorly controlled type 2 diabetes. Methods: A 2-year, randomized controlled crossover study will evaluate the effectiveness of an mHealth diabetes intervention delivered by a health coach and clinical pharmacist team compared with usual care. All patients will receive 1 year of team intervention, including lifestyle and medication support delivered in the home with videoconferencing and text messages. All patients will also receive 1 year of usual care without team intervention and no home visits. The order of the conditions received will be randomized. Our recruitment goal is 220 urban African-American or Latino adults with uncontrolled type 2 diabetes (HbA1c ≥8%) receiving care from a largely minority-serving, urban academic medical center. The intervention includes the following: health coaches supporting patients through home visits, phone calls, and text messaging and clinical pharmacists supporting patients through videoconferences facilitated by health coaches. Data collection includes physiologic (HbA1c, blood pressure, weight, and lipid profile) and survey measures (medication adherence, diabetes-related behaviors, and quality of life). Data collection during the second year of study will determine the maintenance of any physiological improvement among participants receiving the intervention during the first year. Results: Participant enrollment began in March 2017. We have recruited 221 patients. Intervention delivery and data collection will continue until November 2021. The results are expected to be published by May 2022. Conclusions: This is among the first trials to incorporate health coaches, clinical pharmacists, and mHealth technologies to increase access to diabetes support among urban African-Americans and Latinos to achieve therapeutic goals. International Registered Report Identifier (IRRID): DERR1-10.2196/17170 
%M 33688847
%R 10.2196/17170
%U https://www.researchprotocols.org/2021/3/e17170
%U https://doi.org/10.2196/17170
%U http://www.ncbi.nlm.nih.gov/pubmed/33688847

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 7
%N 3
%P e23154
%T Combining Wearable Devices and Mobile Surveys to Study Child and Youth Development in Malawi: Implementation Study of a Multimodal Approach
%A Leal Neto,Onicio
%A Haenni,Simon
%A Phuka,John
%A Ozella,Laura
%A Paolotti,Daniela
%A Cattuto,Ciro
%A Robles,Daniel
%A Lichand,Guilherme
%+ Department of Economics, University of Zurich, Schönberggasse 1, Zurich, 8001, Switzerland, 41 44 634 55 80, onicio@gmail.com
%K child development
%K wearables
%K participatory surveillance
%K proximity sensors
%K mobile surveying
%D 2021

%7 5.3.2021
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Multimodal approaches have been shown to be a promising way to collect data on child development at high frequency, combining different data inputs (from phone surveys to signals from noninvasive biomarkers) to understand children’s health and development outcomes more integrally from multiple perspectives. Objective: The aim of this work was to describe an implementation study using a multimodal approach combining noninvasive biomarkers, social contact patterns, mobile surveying, and face-to-face interviews in order to validate technologies that help us better understand child development in poor countries at a high frequency. Methods: We carried out a mixed study based on a transversal descriptive analysis and a longitudinal prospective analysis in Malawi. In each village, children were sampled to participate in weekly sessions in which data signals were collected through wearable devices (electrocardiography [ECG] hand pads and electroencephalography [EEG] headbands). Additionally, wearable proximity sensors to elicit the social network were deployed among children and their caregivers. Mobile surveys using interactive voice response calls were also used as an additional layer of data collection. An end-line face-to-face survey was conducted at the end of the study. Results: During the implementation, 82 EEG/ECG data entry points were collected across four villages. The sampled children for EEG/ECG were 0 to 5 years old. EEG/ECG data were collected once a week. In every session, children wore the EEG headband for 5 minutes and the ECG hand pad for 3 minutes. In total, 3531 calls were sent over 5 weeks, with 2291 participants picking up the calls and 984 of those answering the consent question. In total, 585 people completed the surveys over the course of 5 weeks. Conclusions: This study achieved its objective of demonstrating the feasibility of generating data through the unprecedented use of a multimodal approach for tracking child development in Malawi, which is one of the poorest countries in the world. Above and beyond its multiple dimensions, the dynamics of child development are complex. It is the case not only that no data stream in isolation can accurately characterize it, but also that even if combined, infrequent data might miss critical inflection points and interactions between different conditions and behaviors. In turn, combining different modes at a sufficiently high frequency allows researchers to make progress by considering contact patterns, reported symptoms and behaviors, and critical biomarkers all at once. This application showcases that even in developing countries facing multiple constraints, complementary technologies can leverage and accelerate the digitalization of health, bringing benefits to populations that lack new tools for understanding child well-being and development. 
%M 33536159
%R 10.2196/23154
%U https://publichealth.jmir.org/2021/3/e23154
%U https://doi.org/10.2196/23154
%U http://www.ncbi.nlm.nih.gov/pubmed/33536159

%0 Journal Article
        
%@ 2561-3278
%I JMIR Publications
%V 6
%N 1
%P e23527
%T Point-of-Care Quantification of Serum Alpha-Fetoprotein for Screening Birth Defects in Resource-Limited Settings: Proof-of-Concept Study
%A Srinivasan,Balaji
%A Finkelstein,Julia L
%A Erickson,David
%A Mehta,Saurabh
%+ Division of Nutritional Sciences, Cornell University, 314 Savage Hall, Ithaca, NY, 14850, United States, 1 607 255 2640, smehta@cornell.edu
%K alpha-fetoprotein
%K point-of-care testing
%K screening
%K neural tube defects
%K mobile phone
%D 2021

%7 3.3.2021
%9 Original Paper
%J JMIR Biomed Eng
%G English
                
%X Background: Maternal serum alpha-fetoprotein (MSAFP) concentration typically increases during pregnancy and is routinely measured during the second trimester as a part of screening for fetal neural tube defects and Down syndrome. However, most pregnancy screening tests are not available in the settings they are needed the most. A mobile device–enabled technology based on MSAFP for screening birth defects could enable the rapid screening and triage of high-risk pregnancies, especially where maternal serum screening and fetal ultrasound scan facilities are not easily accessible. Shifting the approach from clinic- and laboratory-dependent care to a mobile platform based on our point-of-care approach will enable translation to resource-limited settings and the global health care market. Objective: The objective of this study is to develop and perform proof-of-concept testing of a lateral flow immunoassay on a mobile platform for rapid, point-of-care quantification of serum alpha-fetoprotein (AFP) levels, from a drop of human serum, within a few minutes. Methods: The development of the immunoassay involved the selection of commercially available antibodies and optimization of their concentrations by an iterative method to achieve the required detection limits. We compared the performance of our method with that of commercially obtained human serum samples, with known AFP concentrations quantified by the Abbott ARCHITECT chemiluminescent magnetic microparticle immunoassay (CMIA). Results: We tested commercially obtained serum samples (N=20) with concentrations ranging from 2.2 to 446 ng/mL to compare the results of our point-of-care assay with results from the Abbott ARCHITECT CMIA. A correlation of 0.98 (P<.001) was observed on preliminary testing and comparison with the CMIA. The detection range of our point-of-care assay covers the range of maternal serum AFP levels observed during pregnancy. Conclusions: The preliminary test results from the AFP test on the mobile platform performed in this study represent a proof of concept that will pave the way for our future work focused on developing a mobile device–enabled quad-screen point-of-care testing with the potential to enable the screening of high-risk pregnancies in various settings. The AFP test on the mobile platform can be applied to enable screening for high-risk pregnancies, within a few minutes, at the point of care even in remote areas where maternal serum tests and fetal ultrasound scans are not easily accessible; assessment of whether clinical follow-up and diagnostic testing may be needed after a positive initial screening evaluation; and development of surveillance tools for birth defects. 
%M 34746648
%R 10.2196/23527
%U https://biomedeng.jmir.org/2021/1/e23527
%U https://doi.org/10.2196/23527
%U http://www.ncbi.nlm.nih.gov/pubmed/34746648

%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
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 3
%P e18240
%T Delivering Perinatal Health Information via a Voice Interactive App (SMILE): Mixed Methods Feasibility Study
%A Militello,Lisa
%A Sezgin,Emre
%A Huang,Yungui
%A Lin,Simon
%+ Martha S Pitzer Center for Women, Children & Youth, College of Nursing, The Ohio State University, 1585 Neil Ave, 145 Newton Hall, Columbus, OH, 43210, United States, 1 3128135007, militello.14@osu.edu
%K perinatal care
%K infant mortality
%K health education
%K mobile health
%K feasibility studies
%K family
%K mobile phone
%K webcasts as topic
%K user-computer interface
%D 2021

%7 1.3.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Perinatal health care is critically important for maternal health outcomes in infants. The United States fares considerably worse than comparable countries for maternal and infant mortality rates. As such, alternative models of care or engagement are warranted. Ubiquitous digital devices and increased use of digital health tools have the potential to extend the reach to women and infants in their everyday lives and make a positive impact on their health outcomes. As voice technology becomes more mainstream, research is prudent to establish evidence-based practice on how to best leverage voice technology to promote maternal-infant health. Objective: The aim of this study is to assess the feasibility of using voice technology to support perinatal health and infant care practices. Methods: Perinatal women were recruited from a large Midwest Children’s Hospital via hospital email announcements and word of mouth. Owing to the technical aspects of the intervention, participants were required to speak English and use an iPhone. Demographics, patterns of technology use, and technology use specific to perinatal health or self-care practices were assessed at baseline. Next, participants were onboarded and asked to use the intervention, Self-Management Intervention–Life Essentials (SMILE), over the course of 2 weeks. SMILE provided users with perinatal health content delivered through mini podcasts (ranging from 3 to 8 minutes in duration). After each podcast, SMILE prompted users to provide immediate verbal feedback to the content. An exit interview was conducted with participants to gather feedback on the intervention and further explore participants’ perceptions of voice technology as a means to support perinatal health in the future. Results: In total, 19 pregnant women (17 to 36 weeks pregnant) were consented. Themes identified as important for perinatal health information include establishing routines, expected norms, and realistic expectations and providing key takeaways. Themes identified as important for voice interaction include customization and user preferences, privacy, family and friends, and context and convenience. Qualitative analysis suggested that perinatal health promotion content delivered by voice should be accurate and succinctly delivered and highlight key takeaways. Perinatal health interventions that use voice should provide users with the ability to customize the intervention but also provide opportunities to engage family members, particularly spouses. As a number of women multitasked while the intervention was being deployed, future interventions should leverage the convenience of voice technology while also balancing the influence of user context (eg, timing or ability to listen or talk versus nonvoice interaction with the system). Conclusions: Our findings demonstrate the short-term feasibility of disseminating evidence-based perinatal support via podcasts and curate voice-captured data from perinatal women. However, key areas of improvement have been identified specifically for perinatal interventions leveraging voice technology. Findings contribute to future content, design, and delivery considerations of perinatal digital health interventions. 
%M 33646136
%R 10.2196/18240
%U https://formative.jmir.org/2021/3/e18240
%U https://doi.org/10.2196/18240
%U http://www.ncbi.nlm.nih.gov/pubmed/33646136

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 2
%P e18853
%T Rural Residents’ Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews
%A Schoenberg,Nancy
%A Dunfee,Madeline
%A Yeager,Hannah
%A Rutledge,Matthew
%A Pfammatter,Angela
%A Spring,Bonnie
%+ Department of Behavior Science, University of Kentucky, 760 Press Avenue, 372 Healthy Kentucky Research Building, Lexington, KY, 40536, United States, 1 859 323 8175, nesch@uky.edu
%K rural populations
%K technology
%K exercise
%K diet
%K community-based participatory research
%K mobile phone
%D 2021

%7 26.2.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. Objective: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program—Make Better Choices 2—consists of personalized health coaching, accelerometer use, and financial incentives. Methods: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. Results: We identified 3 main themes regarding Appalachian residents’ perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. Conclusions: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents. 
%M 33635278
%R 10.2196/18853
%U https://formative.jmir.org/2021/2/e18853
%U https://doi.org/10.2196/18853
%U http://www.ncbi.nlm.nih.gov/pubmed/33635278

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 2
%P e18224
%T Perspectives From Underserved African Americans and Their Health Care Providers on the Development of a Diabetes Self-Management Smartphone App: Qualitative Exploratory Study
%A Barber-Gumbs,Tai
%A Trolle Lagerros,Ylva
%A Sena,Laura M
%A Gittelsohn,Joel
%A Chang,Larry W
%A Zachary,Wayne W
%A Surkan,Pamela J
%+ Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe St, Room E5523, Baltimore, MD, 21205-2179, United States, 1 410 502 7396, psurkan@jhu.edu
%K diabetes
%K mHealth
%K type 2 diabetes mellitus
%K diabetes self-management
%K mobile app
%K mobile phone
%D 2021

%7 26.2.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Type 2 diabetes mellitus (T2DM) affects approximately 10% of the US population, disproportionately afflicting African Americans. Smartphone apps have emerged as promising tools to improve diabetes self-management, yet little is known about the use of this approach in low-income minority communities. Objective: The goal of the study was to explore which features of an app were prioritized for people with T2DM in a low-income African American community. Methods: Between February 2016 and May 2018, we conducted formative qualitative research with 78 participants to explore how a smartphone app could be used to improve diabetes self-management. Information was gathered on desired features, and app mock-ups were presented to receive comments and suggestions of improvements from smartphone users with prediabetes and T2DM, their friends and family members, and health care providers; data were collected from six interactive forums, one focus group, and 15 in-depth interviews. We carried out thematic data analysis using an inductive approach. Results: All three types of participants reported that difficulty with accessing health care was a main problem and suggested that an app could help address this. Participants also indicated that an app could provide information for diabetes education and self-management. Other suggestions included that the app should allow people with T2DM to log and track diabetes care–related behaviors and receive feedback on their progress in a way that would increase engagement in self-management among persons with T2DM. Conclusions: We identified educational and tracking smartphone features that can guide development of diabetes self-management apps for a low-income African American population. Considering those features in combination gives rise to opportunities for more advanced support, such as determining self-management recommendations based on data in users’ logs. 
%M 33635279
%R 10.2196/18224
%U https://formative.jmir.org/2021/2/e18224
%U https://doi.org/10.2196/18224
%U http://www.ncbi.nlm.nih.gov/pubmed/33635279

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 2
%P e17262
%T Evaluating a Mobile Phone–Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial
%A Ehlman,Daniel C
%A Magoola,Joseph
%A Tanifum,Patricia
%A Wallace,Aaron S
%A Behumbiize,Prosper
%A Mayanja,Robert
%A Luzze,Henry
%A Yukich,Joshua
%A Daniels,Danni
%A Mugenyi,Kevin
%A Baryarama,Fulgentius
%A Ayebazibwe,Nicholas
%A Conklin,Laura
%+ Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, United States, 1 4046398224, dehlman@cdc.gov
%K immunization
%K vaccination
%K reminder system
%K mHealth
%K short message service
%K text messages
%K cell phone
%K mobile phone
%K vaccination dropout
%K vaccination timeliness
%D 2021

%7 24.2.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective: This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods: A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results: Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions: Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration: ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID): DERR1-10.2196/17262 
%M 33625372
%R 10.2196/17262
%U https://www.researchprotocols.org/2021/2/e17262
%U https://doi.org/10.2196/17262
%U http://www.ncbi.nlm.nih.gov/pubmed/33625372

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 2
%P e23737
%T Implementation of a Newborn Clinical Decision Support Software (NoviGuide) in a Rural District Hospital in Eastern Uganda: Feasibility and Acceptability Study
%A Muhindo,Mary
%A Bress,Joshua
%A Kalanda,Rogers
%A Armas,Jean
%A Danziger,Elon
%A Kamya,Moses R
%A Butler,Lisa M
%A Ruel,Theodore
%+ UCSF Preterm Birth Initiative, University of California San Francisco School of Medicine, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States, 1 788551502, marymkakuru@gmail.com
%K clinical decision support
%K neonatology
%K neonatal mortality
%K mHealth
%K mobile phone
%D 2021

%7 19.2.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Lack of trained health care workers and nonadherence to national guidelines are key barriers to achieving high-quality newborn care in health care facilities in low- and middle-income countries. Traditional didactic approaches addressing these barriers fail to account for high staff turnover rates and result in temporary behavior change. NoviGuide, a clinical decision support software designed to standardize neonatal care through point-of-care assessments, has the potential to align bedside practice to national guidelines in settings lacking subspecialty neonatal providers. Objective: This study aims to determine the adaptation, adoption, feasibility, acceptability, and sustainability of NoviGuide and its impact on nurse-midwives’ knowledge in a rural hospital in eastern Uganda. Methods: This mixed methods observational study was guided by the Proctor framework. Experts reviewed the clinical content of NoviGuide to ensure fidelity to Uganda guidelines. We enrolled nurses and midwives providing newborn care at Tororo District Hospital, trained them on NoviGuide use, and followed them for 12 months. We assessed adoption, feasibility, acceptability, and sustainability by analyzing NoviGuide use data, comparing it with maternity registry data and administering the System Usability Scale (SUS) and the Center for Health Care Evaluation Provider Satisfaction Questionnaire. We compared the mean knowledge assessment score at baseline, 6 months, and 12 months using a two-tailed t test. Results: Five Ugandan experts suggested two minor changes to NoviGuide: the inclusion of an unsterile birth environment as an indication for empiric antibiotics and the addition of a reminder to follow-up with newborns with temperatures between 37.7°C and 37.9°C. Of the 19 nurse-midwives enrolled in February 2017, 74% (n=14) completed the follow-up in March 2018. The participants entered a total of 1705 assessments of varying newborn characteristics into NoviGuide throughout the day, evening, and night nursing shifts. The SUS score at the end of the study was very high (93.5, above the average of 68). Participants had a positive perception about NoviGuide, reporting that NoviGuide saved time (mean 5, SD 0) and prevented mistakes (mean 5, SD 0), and that they felt more confident in taking care of newborns when they used NoviGuide (mean 5, SD 0). Participants were highly satisfied with NoviGuide (mean 4.86, SD 0.36), although they lacked medical supplies and materials needed to follow NoviGuide recommendations (mean 3.3, SD 1.22). The participants’ knowledge scores improved by a mean change of 3.7 (95% CI 2.6-4.8) at 6 months and 6.7 (95% CI 4.6-8.2) at 12 months (P<.001). Conclusions: NoviGuide was easily adapted to the Uganda guidelines. Nurse-midwives used NoviGuide frequently and reported high levels of satisfaction despite challenges with medical supplies and high staff turnover. NoviGuide improved knowledge and confidence in newborn care without in-person didactic training. NoviGuide use has the potential to scale up quality newborn care by facilitating adherence to national guidelines. 
%M 33605886
%R 10.2196/23737
%U http://mhealth.jmir.org/2021/2/e23737/
%U https://doi.org/10.2196/23737
%U http://www.ncbi.nlm.nih.gov/pubmed/33605886

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 2
%P e22229
%T An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial
%A Byonanebye,Dathan Mirembe
%A Nabaggala,Maria S
%A Naggirinya,Agnes Bwanika
%A Lamorde,Mohammed
%A Oseku,Elizabeth
%A King,Rachel
%A Owarwo,Noela
%A Laker,Eva
%A Orama,Richard
%A Castelnuovo,Barbara
%A Kiragga,Agnes
%A Parkes-Ratanshi,Rosalind
%+ Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom, 44 7817739450, rp549@medschl.cam.ac.uk
%K mHealth
%K HIV
%K quality of life
%K interactive voice response
%K mobile health
%K digital health
%D 2021

%7 11.2.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings. Objective: The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively. Methods: Within the Call for Life study, ART-experienced and ART-naïve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4. Results: Overall, 600 participants (413 female, 68.8%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3%) opted for IVR and 2 (0.7%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4%) active participants had picked up at least 50% of the calls. In the active intervention participants, high users (received >75% of reminders) had overall higher QoL compared to low users (received <25% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51%-75%) had better viral suppression at 12 months (80/94, 85% versus 11/19, 58%, P=.006). Conclusions: Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic. Trial Registration: ClinicalTrials.gov NCT02953080; https://clinicaltrials.gov/ct2/show/NCT02953080 
%M 33570497
%R 10.2196/22229
%U https://mhealth.jmir.org/2021/2/e22229
%U https://doi.org/10.2196/22229
%U http://www.ncbi.nlm.nih.gov/pubmed/33570497

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 5
%N 2
%P e19243
%T Attitudes Toward a Proposed GPS-Based Location Tracking Smartphone App for Improving Engagement in HIV Care Among Pregnant and Postpartum Women in South Africa: Focus Group and Interview Study
%A Clouse,Kate
%A Phillips,Tamsin K
%A Mogoba,Phepo
%A Ndlovu,Linda
%A Bassett,Jean
%A Myer,Landon
%+ Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN, 37240, United States, 1 (615) 343 5351, kate.clouse@vanderbilt.edu
%K HIV/AIDS
%K South Africa
%K smartphone
%K mobile health
%K pregnancy
%K GPS tracking
%D 2021

%7 8.2.2021
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Peripartum women living with HIV in South Africa are at high risk of dropping out of care and are also a particularly mobile population, which may impact their engagement in HIV care. With the rise in mobile phone use worldwide, there is an opportunity to use smartphones and GPS location software to characterize mobility in real time. Objective: The aim of this study was to propose a smartphone app that could collect individual GPS locations to improve engagement in HIV care and to assess potential users’ attitudes toward the proposed app. Methods: We conducted 50 in-depth interviews (IDIs) with pregnant women living with HIV in Cape Town and Johannesburg, South Africa, and 6 focus group discussions (FGDs) with 27 postpartum women living with HIV in Cape Town. Through an open-ended question in the IDIs, we categorized “positive,” “neutral,” or “negative” reactions to the proposed app and identified key quotations. For the FGD data, we grouped the text into themes, then analyzed it for patterns, concepts, and associations and selected illustrative quotations. Results: In the IDIs, the majority of participants (76%, 38/50) responded favorably to the proposed app. Favorable comments were related to the convenience of facilitated continued care, a sense of helpfulness on the part of the researchers and facilities, and the difficulties of trying to maintain care while traveling. Among the 4/50 participants (8%) who responded negatively, their comments were primarily related to the individual’s responsibility for their own health care. The FGDs revealed four themes: facilitating connection to care, informed choice, disclosure (intentional or unintentional), and trust in researchers. Conclusions: Women living with HIV were overwhelmingly positive about the idea of a GPS-based smartphone app to improve engagement in HIV care. Participants reported that they would welcome a tool to facilitate connection to care when traveling and expressed trust in researchers and health care facilities. Within the context of the rapid increase of smartphone use in South Africa, these early results warrant further exploration and critical evaluation following real-world experience with the app. 
%M 33555261
%R 10.2196/19243
%U https://formative.jmir.org/2021/2/e19243
%U https://doi.org/10.2196/19243
%U http://www.ncbi.nlm.nih.gov/pubmed/33555261

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 2
%P e25443
%T mHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial
%A Desrosiers,Alethea
%A Schafer,Carolyn
%A Esliker,Rebecca
%A Jambai,Musu
%A Betancourt,Theresa S
%+ Boston College, School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 01778, United States, 1 617 552 8398, alethea.desrosiers@bc.edu
%K mHealth
%K caregiver mental health
%K family functioning
%K early childhood development
%K community health workers
%D 2021

%7 2.2.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Past trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes. Objective: This study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care. Methods: We will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care. Results: Funding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020. Conclusions: This study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC. Trial Registration: ClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399. International Registered Report Identifier (IRRID): PRR1-10.2196/25443 
%M 33528371
%R 10.2196/25443
%U https://www.researchprotocols.org/2021/2/e25443
%U https://doi.org/10.2196/25443
%U http://www.ncbi.nlm.nih.gov/pubmed/33528371

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 23
%N 2
%P e17837
%T The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV
%A Kreniske,Philip
%A Basmajian,Alyssa
%A Nakyanjo,Neema
%A Ddaaki,William
%A Isabirye,Dauda
%A Ssekyewa,Charles
%A Nakubulwa,Rosette
%A Hirsch,Jennifer S
%A Deisher,Andrea
%A Nalugoda,Fred
%A Chang,Larry W
%A Santelli,John S
%+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, New York, NY, New York, United States, 1 646 774 6947, pk2361@columbia.edu
%K adolescence
%K youth
%K mobile phones
%K cell phones
%K mobility
%K HIV
%K East Africa
%D 2021

%7 2.2.2021
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. 
%M 33528375
%R 10.2196/17837
%U https://www.jmir.org/2021/2/e17837
%U https://doi.org/10.2196/17837
%U http://www.ncbi.nlm.nih.gov/pubmed/33528375

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 2
%P e26192
%T Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other)
%A Logie,Carmen
%A Okumu,Moses
%A Hakiza,Robert
%A Kibuuka Musoke,Daniel
%A Berry,Isha
%A Mwima,Simon
%A Kyambadde,Peter
%A Kiera,Uwase Mimy
%A Loutet,Miranda
%A Neema,Stella
%A Newby,Katie
%A McNamee,Clara
%A Baral,Stefan D
%A Lester,Richard
%A Musinguzi,Joshua
%A Mbuagbaw,Lawrence
%+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, , Canada, 1 (416) 978 6314, carmen.logie@utoronto.ca
%K adolescents and youth
%K implementation research
%K HIV testing
%K mobile health
%K refugee
%K Uganda
%D 2021

%7 2.2.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. Trial Registration: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. International Registered Report Identifier (IRRID): DERR1-10.2196/26192 
%M 33528378
%R 10.2196/26192
%U https://www.researchprotocols.org/2021/2/e26192
%U https://doi.org/10.2196/26192
%U http://www.ncbi.nlm.nih.gov/pubmed/33528378

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 1
%P e21585
%T Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials
%A van 't Hof,Edith
%A Heim,Eva
%A Abi Ramia,Jinane
%A Burchert,Sebastian
%A Cornelisz,Ilja
%A Cuijpers,Pim
%A El Chammay,Rabih
%A Harper Shehadeh,Melissa
%A Noun,Philip
%A Smit,Filip
%A van Klaveren,Chris
%A van Ommeren,Mark
%A Zoghbi,Edwina
%A Carswell,Kenneth
%+ Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 31 641692545, edithvanhof@gmail.com
%K e-mental health
%K psychological interventions
%K guided-self-help
%K global mental health
%K adversity
%K Lebanon
%K Syrians
%D 2021

%7 28.1.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression. Objective: This study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2). Methods: This Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week. Results: The trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020. Conclusions: The Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world. Trial Registration: ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID): DERR1-10.2196/21585 
%M 33507158
%R 10.2196/21585
%U http://www.researchprotocols.org/2021/1/e21585/
%U https://doi.org/10.2196/21585
%U http://www.ncbi.nlm.nih.gov/pubmed/33507158

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 1
%P e22061
%T Implementation of an Interactive Voice Response System for Cancer Awareness in Uganda: Mixed Methods Study
%A Kabukye,Johnblack K
%A Ilozumba,Onaedo
%A Broerse,Jacqueline E W
%A de Keizer,Nicolette
%A Cornet,Ronald
%+ Uganda Cancer Institute, Upper Mulago Hill Road, Kampala, PO Box 3935, Kampa, Uganda, 256 700447351, jkabukye@gmail.com
%K telemedicine
%K medical oncology
%K health promotion
%K low-and-middle-income countries
%K participatory research
%K mobile phone
%D 2021

%7 26.1.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Cancer awareness is crucial for cancer care and prevention. However, cancer awareness in Uganda is low, and access to cancer information is limited. Objective: This study aims to (1) understand the cancer awareness situation in Uganda (perceptions, beliefs, information needs, and challenges to accessing cancer information) and opinions about interactive voice response (IVR) systems; (2) develop cancer awareness messages and implement them in an IVR system; and (3) evaluate user acceptance and use of the IVR system. Methods: A participatory design approach was adopted. To understand cancer awareness needs and challenges, 3 interviews and 7 focus group discussions (FGDs) were conducted with cancer health care providers, patients with cancer, caregivers and survivors, administrators, and lay citizens (n=73). On the basis of the resulting qualitative data, audio messages addressing cancer information needs were developed and implemented in an IVR system. The system and messages were tested with users (n=12) during 2 co-design workshops before final rollout. Finally, the system was evaluated over 6 months after going live, using call records and user feedback from telephone interviews with callers (n=40). Results: The cancer information needs included general topics such as what cancer is, what causes it, cancer screening and diagnosis, cancer treatment, and practical information on what to expect during cancer care. There were also myths and misconceptions that need to be addressed, such as that cancer is due to witchcraft and has no treatment. Information on COVID-19 was also sought after following the outbreak. We developed 20 audio cancer messages (approximately 2 minutes each) in English and Luganda, along with 14 IVR navigation instructions. These were implemented in an IVR system with 24/7 availability from all over Uganda via a toll-free multi-channel telephone number. The total number of calls made to the IVR system 6 months after going live was 3820. Of these, 2437 (63.8%) lasted at least 30 seconds and were made from 1230 unique telephone numbers. There were 191 voice messages and 760 calls to live agents, most of which (681/951, 71.6%) were in Luganda. Call volumes peaked following advertisement of the system and lockdowns due to COVID-19. Participants were generally familiar with IVR technology, and caller feedback was largely positive. Cited benefits included convenience, toll-free access, and detailed information. Recommendations for improvement of the system included adding live agents and marketing of the system to target users. Conclusions: IVR technology provides an acceptable and accessible method for providing cancer information to patients and the general public in Uganda. However, a need remains for health system reforms to provide additional cancer information sources and improve cancer care services in general. 
%M 33496672
%R 10.2196/22061
%U http://mhealth.jmir.org/2021/1/e22061/
%U https://doi.org/10.2196/22061
%U http://www.ncbi.nlm.nih.gov/pubmed/33496672

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 1
%P e25424
%T Mobile Health Intervention to Close the Guidelines-To-Practice Gap in Hypertension Treatment: Protocol for the mGlide Randomized Controlled Trial
%A Lakshminarayan,Kamakshi
%A Murray,Thomas A
%A Westberg,Sarah M
%A Connett,John
%A Overton,Val
%A Nyman,John A
%A Culhane-Pera,Kathleen A
%A Pergament,Shannon L
%A Drawz,Paul
%A Vollbrecht,Emily
%A Xiong,Txia
%A Everson-Rose,Susan A
%+ Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S 2nd Street, Suite 300, Minneapolis, MN, 55415, United States, 1 6126249492, laksh004@umn.edu
%K hypertension
%K mobile health technology
%K health disparities
%K randomized controlled trial
%D 2021

%7 25.1.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Suboptimal treatment of hypertension remains a widespread problem, particularly among minorities and socioeconomically disadvantaged groups. We present a health system–based intervention with diverse patient populations using readily available smartphone technology. This intervention is designed to empower patients and create partnerships between patients and their provider team to promote hypertension control. Objective: The mGlide randomized controlled trial is a National Institutes of Health–funded study, evaluating whether a mobile health (mHealth)-based intervention that is an active partnership between interprofessional health care teams and patients results in better hypertension control rates than a state-of-clinical care comparison. Methods: We are recruiting 450 participants including stroke survivors and primary care patients with elevated cardiovascular disease risk from diverse health systems. These systems include an acute stroke service (n=100), an academic medical center (n=150), and community medical centers including Federally Qualified Health Centers serving low-income and minority (Latino, Hmong, African American, Somali) patients (n=200). The primary aim tests the clinical effectiveness of the 6-month mHealth intervention versus standard of care. Secondary aims evaluate sustained hypertension control rates at 12 months; describe provider experiences of system usability and satisfaction; examine patient experiences, including medication adherence and medication use self-efficacy, self-rated health and quality of life, and adverse event rates; and complete a cost-effectiveness analysis. Results: To date, we have randomized 107 participants (54 intervention, 53 control). Conclusions: This study will provide evidence for whether a readily available mHealth care model is better than state-of-clinical care for bridging the guideline-to-practice gap in hypertension treatment in health systems serving diverse patient populations. Trial Registration: Clinicaltrials.gov NCT03612271; https://clinicaltrials.gov/ct2/show/NCT03612271 International Registered Report Identifier (IRRID): DERR1-10.2196/25424 
%M 33492231
%R 10.2196/25424
%U http://www.researchprotocols.org/2021/1/e25424/
%U https://doi.org/10.2196/25424
%U http://www.ncbi.nlm.nih.gov/pubmed/33492231

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 1
%P e19109
%T Young People’s Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study
%A Mwaisaka,Jefferson
%A Gonsalves,Lianne
%A Thiongo,Mary
%A Waithaka,Michael
%A Sidha,Hellen
%A Alfred,Otieno
%A Mukiira,Carol
%A Gichangi,Peter
%+ International Centre for Reproductive Health, Kenya, Tom Mboya Street, Mombasa, Kenya, 254 723 206 132, jeffmwaisaka@gmail.com
%K mHealth
%K mobile phones
%K sexual and reproductive health
%K Kenya
%D 2021

%7 15.1.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people’s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. Objective: The objective of this study was to explore young people’s experiences using an on-demand SRH mHealth platform in Kenya. Methods: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). Results: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. Conclusions: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience. 
%M 33448930
%R 10.2196/19109
%U http://mhealth.jmir.org/2021/1/e19109/
%U https://doi.org/10.2196/19109
%U http://www.ncbi.nlm.nih.gov/pubmed/33448930

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 9
%N 1
%P e21244
%T Mobile Phone Access and Implications for Digital Health Interventions Among Adolescents and Young Adults in Zimbabwe: Cross-Sectional Survey
%A Doyle,Aoife M
%A Bandason,Tsitsi
%A Dauya,Ethel
%A McHugh,Grace
%A Grundy,Chris
%A Dringus,Stefanie
%A Dziva Chikwari,Chido
%A Ferrand,Rashida A
%+ MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E7HT, United Kingdom, 44 207 927 2041, aoife.doyle@lshtm.ac.uk
%K adolescent
%K young adult
%K young person
%K young people
%K cross-sectional studies
%K humans
%K female
%K male
%K mobile phone
%K smartphone
%K cell phones
%K technology
%K internet
%K safety
%K health-related internet use
%K Zimbabwe
%D 2021

%7 13.1.2021
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile phones may help young people (YP) access health information and support health service engagement. However, in low-income settings there is limited knowledge on YP’s phone and internet access to inform the feasibility of implementing digital health interventions. Objective: We investigated access to information and communication technologies among adolescents and young adults in Zimbabwe. Methods: A cross-sectional population-based survey was conducted from October to December 2018 among YP aged 13-24 years in 5 communities in urban and peri-urban Harare and Mashonaland East, Zimbabwe. Consenting YP completed a self-completed tablet-based questionnaire on mobile phone ownership and use, and use of the internet. The primary outcome was the proportion who reported owning a mobile phone. Secondary outcomes included phone and internet access and use behavior, and ownership and use of other technological devices. Multivariable logistic regression was used to investigate factors associated with mobile phone ownership and with internet access, with adjustment for the one-stage cluster sampling design. A priori exploratory variables were age, sex, marital status, and urban/peri-urban residence. Results: A total of 634/719 (88.2%) eligible YP, mean age 18.0 years (SD 3.3) and 62.6% (397/634) females, participated. Of the YP interviewed, 62.6% (396/633; 95% CI 58.5-66.5) reported owning a phone and a further 4.3% (27/633) reported having access to a shared phone. Phone ownership increased with age: 27.0% (43/159) of 13-15-year olds, 61.0% (72/118) of 16-17-year olds, 71.5% (103/144) of 18-19-year olds, and 84.7% (171/202) of 20-24-year olds (odds ratio [OR] 1.4, 95% CI 1.3-1.5) per year increase. Ownership was similar among females and males: 61.0% (236/387; 95% CI 55.6-66.1) versus 64.8% (153/236; 95% CI 57.8-71.2), age-adjusted OR 0.7 (95% CI 0.5-1.1); higher in those with secondary level education compared to primary or no education: 67.1% (346/516; 95% CI 62.6-71.2) versus 26% (21/82; 95% CI 16.4-37.7), age-adjusted OR 2.3 (95% CI 1.1-4.8); and similar across other sociodemographic factors. YP reported that 85.3% (361/423) of phones, either owned or shared, were smartphones. Among phone owners, the most commonly used phone app was WhatsApp (71.2%, 282/396), and 16.4% (65/396) reported having ever used their phone to track their health. A total of 407/631 (64.5%; 95% CI 60.3-68.5) currently had access to the internet (used in last 3 months on any device) with access increasing with age (OR 1.2, 95% CI 1.2-1.3 per year increase). In age-adjusted analysis, internet access was higher among males, the unmarried, those with a higher level of education, phone owners, and those who had lived in the community for more than 1 year. The aspect of the internet that YP most disliked was unwanted sexual (29.2%, 136/465) and violent (13.1%, 61/465) content. Conclusions: Mobile phone–based interventions may be feasible in this population; however, such interventions could increase inequity, especially if they require access to the internet. Internet-based interventions should consider potential risks for participants and incorporate skill-building sessions on safe internet and phone use. 
%M 33439136
%R 10.2196/21244
%U https://mhealth.jmir.org/2021/1/e21244
%U https://doi.org/10.2196/21244
%U http://www.ncbi.nlm.nih.gov/pubmed/33439136

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 10
%N 1
%P e18029
%T Using a Mobile Health Intervention (DOT Selfie) With Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda: Protocol for a Randomized Controlled Trial
%A Sekandi,Juliet Nabbuye
%A Onuoha,Nicole Amara
%A Buregyeya,Esther
%A Zalwango,Sarah
%A Kaggwa,Patrick Evans
%A Nakkonde,Damalie
%A Kakaire,Robert
%A Atuyambe,Lynn
%A Whalen,Christopher C
%A Dobbin,Kevin K
%+ Global Health Institute, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30606, United States, 1 706 542 5257, jsekandi@uga.edu
%K tuberculosis
%K mHealth
%K digital health
%K eHealth
%K directly observed therapy
%K video observed therapy
%K DOT Selfie
%K treatment adherence
%K Africa
%D 2021

%7 5.1.2021
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The World Health Organization’s End TB Strategy envisions a world free of tuberculosis (TB)—free of deaths, disease, and suffering due to TB—by 2035. Nonadherence reduces cure rates, prolongs infectiousness, and contributes to the emergence of multidrug-resistant TB (MDR-TB). Moreover, MDR-TB is a growing, complex, and costly problem that presents a major obstacle to TB control. Directly observed therapy (DOT) for treatment adherence monitoring is the recommended standard; however, it is challenging to implement at scale because it is labor-intensive. Mobile health interventions can facilitate remote adherence monitoring and minimize the costs and inconveniences associated with standard DOT. Objective: The study aims to evaluate the effectiveness of using video directly observed therapy (VDOT) plus incentives to improve medication adherence in TB treatment versus usual-care DOT in an African context. Methods: The DOT Selfie study is an open-label, randomized controlled trial (RCT) with 2 parallel groups, in which 144 adult patients with TB aged 18-65 years will be randomly assigned to receive the usual-care DOT monitoring or VDOT as the intervention. The intervention will consist of a smartphone app, a weekly internet subscription, translated text message reminders, and incentives for those who adhere. The participant will use a smartphone to record and send time-stamped encrypted videos showing their daily medication ingestion. This video component will directly substitute the need for daily face-to-face meetings between the health provider and patients. We hypothesize that the VDOT intervention will be more effective because it allows patients to swallow their pills anywhere, anytime. Moreover, patients will receive mobile-phone–based “social bundle” incentives to motivate adherence to continued daily submission of videos to the health system. The health providers will log into a secured computer system to verify treatment adherence, document missed doses, investigate the reasons for missed doses, and follow prespecified protocol measures to re-establish medication adherence. The primary endpoint is the adherence level as measured by the fraction of expected doses observed over the treatment period. The main secondary outcome will be time-to-treatment completion in both groups. Results: This study was funded in 2019. Enrollment began in July and is expected to be completed by November 2020. Data collection and follow-up are expected to be completed by June 2021. Results from the analyses based on the primary endpoint are expected to be submitted for publication by December 2021. Conclusions: This random control trial will be among the first to evaluate the effectiveness of VDOT within an African setting. The results will provide robust scientific evidence on the implementation and adoption of mobile health (mHealth) tools, coupled with incentives to motivate TB medication adherence. If successful, VDOT will apply to other low-income settings and a range of chronic diseases with lifelong treatment, such as HIV/AIDs. Trial Registration: ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689 International Registered Report Identifier (IRRID): DERR1-10.2196/18029 
%M 32990629
%R 10.2196/18029
%U https://www.researchprotocols.org/2021/1/e18029
%U https://doi.org/10.2196/18029
%U http://www.ncbi.nlm.nih.gov/pubmed/32990629

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 12
%P e22478
%T Mobile Health Strategies to Tackle Skin Neglected Tropical Diseases With Recommendations From Innovative Experiences: Systematic Review
%A Carrion,Carme
%A Robles,Noemí
%A Sola-Morales,Oriol
%A Aymerich,Marta
%A Ruiz Postigo,Jose Antonio
%+ eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Rambla Poble Nou 156, Barcelona, 08035, Spain, 34 1 416 340 3200, mcarrionr@uoc.edu
%K mHealth
%K mobile health
%K neglected tropical diseases
%K skin neglected tropical diseases
%K apps
%K SMS text messaging
%K low- and middle-income countries
%D 2020

%7 31.12.2020
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Neglected tropical diseases (NTDs) represent a diverse group of 20 communicable diseases that occur in tropical and subtropical areas in 149 countries, affecting over 1 billion people and costing developing economies billions of dollars every year. Within these diseases, those that present lesions on the skin surface are classified as skin NTDs (sNTDs). Mobile health interventions are currently being used worldwide to manage skin diseases and can be a good strategy in the epidemiological and clinical management of sNTDs. Objective: We aimed to analyze existing evidence about mobile health interventions to control and manage sNTDs in low- and middle-income countries (LMICs) and make recommendations for what should be considered in future interventions. Methods: A systematic review was conducted of the MEDLINE, Embase, and Scopus databases over 10 years up to April 30, 2020. All types of clinical studies were considered. Data were synthesized into evidence tables. Apps were selected through a comprehensive systematic search in the Google Play Store and Apple App Store conducted between March 20 and April 15, 2020. Results: From 133 potentially relevant publications, 13 studies met our criteria (9.8%). These analyzed eight different interventions (three SMS text messaging interventions and five app interventions). Six of the 13 (46%) studies were community-based cross-sectional studies intended to epidemiologically map a specific disease, mainly lymphatic filariasis, but also cutaneous leishmaniasis, leprosy, and NTDs, as well as sNTDs in general. Most of the studies were considered to have a high (5/13, 39%) or moderate (4/13, 31%) risk of bias. Fifteen apps were identified in the Google Play Store, of which three were also in the Apple App Store. Most of the apps (11/15, 73%) were targeted at health care professionals, with only four targeted at patients. The apps focused on scabies (3/15, 20%), lymphatic filariasis (3/15, 20%), cutaneous leishmaniasis (1/15, 7%), leprosy (1/15, 7%), yaws and Buruli ulcer (1/15, 7%), tropical diseases including more than one sNTDs (3/15, 20%), and NTDs including sNTDs (2/15, 13%). Only 1 (7%) app focused on the clinical management of sNTDs. Conclusions: All mobile health interventions that were identified face technological, legal, final user, and organizational issues. There was a remarkable heterogeneity among studies, and the majority had methodological limitations that leave considerable room for improvement. Based on existing evidence, eight recommendations have been made for future interventions. 
%M 33382382
%R 10.2196/22478
%U http://mhealth.jmir.org/2020/12/e22478/
%U https://doi.org/10.2196/22478
%U http://www.ncbi.nlm.nih.gov/pubmed/33382382

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 9
%N 4
%P e19023
%T Using Friendship Ties to Understand the Prevalence of, and Factors Associated With, Intimate Partner Violence Among Adolescents and Young Adults in Kenya: Cross-Sectional, Respondent-Driven Survey Study
%A Memiah,Peter
%A Kamau,Anne
%A Opanga,Yvonne
%A Muhula,Samuel
%A Nyakeriga,Emmanuel
%A Humwa,Felix
%A Cook,Courtney
%A Kingori,Caroline
%A Muriithi,Job
%+ University of Maryland School of Medicine, 725 West Lombard Street, Baltimore, MD, 21201, United States, 1 4107966283, pmemiah@ihv.umaryland.edu
%K intimate partner violence
%K adolescents
%K young adults
%K bullying
%K physical abuse
%K abuse
%K Africa
%K prevalence
%K risk
%D 2020

%7 31.12.2020
%9 Original Paper
%J Interact J Med Res
%G English
                
%X Background: Optimization of innovative approaches is required for estimating the intimate partner violence (IPV) burden among adolescents and young adults (AYA). Further investigation is required to identify risk and protective factors associated with IPV among AYA. There remain significant gaps in understanding these factors among this vulnerable population. Objective: The goal of our study was to determine the prevalence of IPV among an urban population of AYA and to identify factors associated with IPV among AYA. Methods: A cross-sectional study design utilizing respondent-driven sampling was adopted. The study was conducted among 887 AYA, aged 15 to 24 years, residing in Nairobi, Kenya.  Data were collected through a phone-based survey using the REACH (Reaching, Engaging Adolescents and Young Adults for Care Continuum in Health)-AYA app. Questions on behavioral and psychosocial factors were adopted from different standardized questionnaires. Descriptive, bivariate, and multivariable statistics were used to describe the characteristics of the study sample. Results: Of the 887 participants, a higher proportion were male (540/887, 60.9%) compared to female (347/887, 39.1%). The prevalence of IPV was 22.3% (124/556). IPV was associated with being unsure if it was okay for a boy to hit his girlfriend, living in a home with physical violence or abuse, and being bullied (P=.005). The likelihood of experiencing IPV was higher among respondents whose friends and family members used alcohol (odds ratio [OR] 1.80, 95% CI 1.09-2.98) and among those who had repeated a class at school in the past two years (OR 1.90, 95% CI 1.11-3.23). Respondents who visited a health facility or doctor for reproductive health services were 2 times more likely to experience IPV (OR 2.23, 95% CI 1.40-3.70).  Respondents who had used illicit drugs were 2 times more likely to experience IPV  (OR 4.31, 95% CI 2.64-7.04). The probability of experiencing IPV decreased by 63% (OR 0.37, 95% CI 0.16-0.85) among respondents who refused to have sex with someone who was not prepared to use a condom. Conclusions: IPV remains a significant public health priority because of its impact to society. Our results are in congruence with other similar studies. Efforts toward incorporating appropriate IPV core measures into the comprehensive care package for every AYA seeking health services should be explored. Programs need to address constellations of risk and protective factors linked to IPV in an effort to prevent its occurrence. 
%M 33382380
%R 10.2196/19023
%U http://www.i-jmr.org/2020/4/e19023/
%U https://doi.org/10.2196/19023
%U http://www.ncbi.nlm.nih.gov/pubmed/33382380

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 12
%P e19137
%T Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial
%A Jahan,Yasmin
%A Rahman,Md Moshiur
%A Faruque,Abu S G
%A Chisti,Mohammod Jobayer
%A Kazawa,Kana
%A Matsuyama,Ryota
%A Moriyama,Michiko
%+ Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Minami-ku, Kasumi-cho, Hiroshima-shi, Hiroshima, 7340046, Japan, 81 0822575365, dr.yasminjahan@gmail.com
%K mobile health
%K hypertension
%K behavior changes
%K awareness development
%K lifestyle
%K Bangladesh
%D 2020

%7 7.12.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. Objective: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). Methods: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). Results: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). Conclusions: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members. Trial Registration: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo International Registered Report Identifier (IRRID): RR2-10.2196/15523 
%M 33284129
%R 10.2196/19137
%U https://www.jmir.org/2020/12/e19137
%U https://doi.org/10.2196/19137
%U http://www.ncbi.nlm.nih.gov/pubmed/33284129

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 9
%N 12
%P e22996
%T An Artificial Intelligence–Based, Personalized Smartphone App to Improve Childhood Immunization Coverage and Timelines Among Children in Pakistan: Protocol for a Randomized Controlled Trial
%A Kazi,Abdul Momin
%A Qazi,Saad Ahmed
%A Khawaja,Sadori
%A Ahsan,Nazia
%A Ahmed,Rao Moueed
%A Sameen,Fareeha
%A Khan Mughal,Muhammad Ayub
%A Saqib,Muhammad
%A Ali,Sikander
%A Kaleemuddin,Hussain
%A Rauf,Yasir
%A Raza,Mehreen
%A Jamal,Saima
%A Abbasi,Munir
%A Stergioulas,Lampros K
%+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan, 92 2134864232, momin.kazi@aku.edu
%K artificial intelligence
%K AI
%K routine childhood immunization
%K EPI
%K LMICs
%K mHealth
%K Pakistan
%K personalized messages
%K routine immunization
%K smartphone apps
%K vaccine-preventable illnesses
%D 2020

%7 4.12.2020
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The immunization uptake rates in Pakistan are much lower than desired. Major reasons include lack of awareness, parental forgetfulness regarding schedules, and misinformation regarding vaccines. In light of the COVID-19 pandemic and distancing measures, routine childhood immunization (RCI) coverage has been adversely affected, as caregivers avoid tertiary care hospitals or primary health centers. Innovative and cost-effective measures must be taken to understand and deal with the issue of low immunization rates. However, only a few smartphone-based interventions have been carried out in low- and middle-income countries (LMICs) to improve RCI. Objective: The primary objectives of this study are to evaluate whether a personalized mobile app can improve children’s on-time visits at 10 and 14 weeks of age for RCI as compared with standard care and to determine whether an artificial intelligence model can be incorporated into the app. Secondary objectives are to determine the perceptions and attitudes of caregivers regarding childhood vaccinations and to understand the factors that might influence the effect of a mobile phone–based app on vaccination improvement. Methods: A mixed methods randomized controlled trial was designed with intervention and control arms. The study will be conducted at the Aga Khan University Hospital vaccination center. Caregivers of newborns or infants visiting the center for their children’s 6-week vaccination will be recruited. The intervention arm will have access to a smartphone app with text, voice, video, and pictorial messages regarding RCI. This app will be developed based on the findings of the pretrial qualitative component of the study, in addition to no-show study findings, which will explore caregivers’ perceptions about RCI and a mobile phone–based app in improving RCI coverage. Results: Pretrial qualitative in-depth interviews were conducted in February 2020. Enrollment of study participants for the randomized controlled trial is in process. Study exit interviews will be conducted at the 14-week immunization visits, provided the caregivers visit the immunization facility at that time, or over the phone when the children are 18 weeks of age. Conclusions: This study will generate useful insights into the feasibility, acceptability, and usability of an Android-based smartphone app for improving RCI in Pakistan and in LMICs. Trial Registration: ClinicalTrials.gov NCT04449107; https://clinicaltrials.gov/ct2/show/NCT04449107 International Registered Report Identifier (IRRID): DERR1-10.2196/22996 
%M 33274726
%R 10.2196/22996
%U https://www.researchprotocols.org/2020/12/e22996
%U https://doi.org/10.2196/22996
%U http://www.ncbi.nlm.nih.gov/pubmed/33274726

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 12
%P e21671
%T User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study
%A Tweheyo,Raymond
%A Selig,Hannah
%A Gibson,Dustin G
%A Pariyo,George William
%A Rutebemberwa,Elizeus
%+ Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, P O Box, 7072, Kampala, 256, Uganda, 256 772466695, rtweheyo@musph.ac.ug
%K interactive voice response
%K noncommunicable diseases
%K qualitative
%K Uganda
%D 2020

%7 3.12.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective: This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods: A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant’s perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results: Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller’s identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions: Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual. 
%M 33270037
%R 10.2196/21671
%U https://formative.jmir.org/2020/12/e21671
%U https://doi.org/10.2196/21671
%U http://www.ncbi.nlm.nih.gov/pubmed/33270037

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 6
%N 4
%P e18950
%T Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study
%A Ticha,Johnson Muluh
%A Akpan,Godwin Ubong
%A Paige,Lara MF
%A Senouci,Kamel
%A Stein,Andrew
%A Briand,Patrick
%A Tuma,Jude
%A Oyaole,Daniel Rasheed
%A Ngofa,Reuben
%A Maleghemi,Sylvester
%A Touray,Kebba
%A Salihu,Abdullahi Ahmed
%A Diallo,Mamadou
%A Tegegne,Sisay Gashu
%A Bello,Isah Mohammed
%A Idris,Umar Kabo
%A Maduka,Omosivie
%A Manengu,Casimir
%A Shuaib,Faisal
%A Galway,Michael
%A Mkanda,Pascal
%+ World Health Organization Regional Office for Africa, Cite Du Djoue, Brazzaville, 500101, Congo, 242 055736476, akpang@who.int
%K Auto-Visual Acute Flaccid Paralysis Detection and Reporting
%K surveillance
%K informants
%K acute flaccid paralysis
%K smartphones
%K polio
%D 2020

%7 2.12.2020
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. Objective: This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. Methods: This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. Results: Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. Conclusions: This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification. 
%M 33263550
%R 10.2196/18950
%U http://publichealth.jmir.org/2020/4/e18950/
%U https://doi.org/10.2196/18950
%U http://www.ncbi.nlm.nih.gov/pubmed/33263550

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 11
%P e15978
%T Using Mobile Health Technology to Deliver a Community-Based Closed-Loop Management System for Chronic Obstructive Pulmonary Disease Patients in Remote Areas of China: Development and Prospective Observational Study
%A Deng,Ning
%A Chen,Juan
%A Liu,Yiyuan
%A Wei,Shuoshuo
%A Sheng,Leiyi
%A Lu,Rong
%A Wang,Zheyu
%A Zhu,Jiarong
%A An,Jiye
%A Wang,Bei
%A Lin,Hui
%A Wang,Xiuyan
%A Zhou,Yumin
%A Duan,Huilong
%A Ran,Pixin
%+ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, 195 Dongfeng Xi Road, Guangzhou, , China, 86 020 3710 3001, pxran@gzhmu.edu.cn
%K COPD
%K mobile health technology
%K closed-loop care pathway
%K chronic disease management
%K exacerbations
%D 2020

%7 25.11.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) technology is an increasingly recognized and effective method for disease management and has the potential to intervene in pulmonary function, exacerbation risk, and psychological status of patients with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to investigate the feasibility of an mHealth-based COPD management system designed for Chinese remote areas with many potential COPD patients but limited medical resources. Methods: The system was implemented based on a tailored closed-loop care pathway that breaks the heavy management tasks into detailed pieces to be quantified and executed by computers. Low-cost COPD evaluation and questionnaire-based psychological intervention are the 2 main characteristics of the pathway. A 6-month prospective observational study at the community level was performed to evaluate the effect of the system. Primary outcomes included changes in peak expiratory flow values, quality of life measured using the COPD assessment test scale, and psychological condition. Acute exacerbations, compliance, and adverse events were also measured during the study. Compliance was defined as the ratio of the actual frequency of self-monitoring records to the prescribed number. Results: A total of 56 patients was enrolled; 39 patients completed the 6-month study. There was no significant difference in the mean peak expiratory flow value before and after the 6-month period (366.1, SD 106.7 versus 313.1, SD 116.6; P=.11). Psychological condition significantly improved after 6 months, especially for depression, as measured using the Patient Health Questionnaire-9 scale (median 6.0, IQR 3.0-9.0 versus median 4.0, IQR 0.0-6.0; P=.001). The COPD assessment test score after 6 months of intervention was also lower than that at the baseline, and the difference was significant (median 4.0, IQR 1.0-6.0 versus median 3.0, IQR 0.0-6.0; P=.003). The median overall compliance was 91.1% (IQR 67%-100%). In terms of acute exacerbation, 110 exacerbations were detected and confirmed by health care providers (per 6 months, median 2.0, IQR 1.0-5.0). Moreover, 72 adverse events occurred during the study, including 1 death, 19 hospitalizations, and 52 clinic visits due to persistent respiratory symptoms. Conclusions: We designed and validated a feasible mHealth-based method to manage COPD in remote Chinese areas with limited medical resources. The proposed closed-loop care pathway was effective at the community level. Proper education and frequent communication with health care providers may encourage patients’ acceptance and use of smartphones to support COPD self-management. In addition, WeChat might play an important role in improving patient compliance and psychological distress. Further research might explore the effect of such systems on a larger scale and at a higher evidence level. 
%M 33237036
%R 10.2196/15978
%U http://mhealth.jmir.org/2020/11/e15978/
%U https://doi.org/10.2196/15978
%U http://www.ncbi.nlm.nih.gov/pubmed/33237036

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 11
%P e17549
%T Development and Acceptability of a Tablet-Based App to Support Men to Link to HIV Care: Mixed Methods Approach
%A Mathenjwa,Thulile
%A Adeagbo,Oluwafemi
%A Zuma,Thembelihle
%A Dikgale,Keabetswe
%A Zeitlin,Anya
%A Matthews,Philippa
%A Seeley,Janet
%A Wyke,Sally
%A Tanser,Frank
%A Shahmanesh,Maryam
%A Blandford,Ann
%+ Africa Health Research Institute, KwaZulu Natal, Somkhele, Africa Centre Building, Via R618 to Hlabisa, Mtubatuba, 4001, South Africa, 27 355507500, thulile.mathenjwa@ahri.org
%K HIV
%K linkage to HIV care
%K digital technologies
%K men
%K mobile phone
%D 2020

%7 24.11.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The poor engagement of men with HIV care is attributed to a number of factors: fear of stigma, masculine representations, concerns related to confidentiality, and the time commitment needed to visit public health clinics. Digital technologies are emerging as an approach to support the engagement of men with care. Objective: This study aims to deliver a usable and engaging tablet-based app, called EPIC-HIV 2 (Empowering People through Informed Choices for HIV 2), to support men in making informed decisions about engaging with HIV care in rural KwaZulu Natal, South Africa. Methods: We employed a mixed methods, iterative, and three-phased design that was guided by self-determination theory (SDT), a person-based approach, and human-computer interaction techniques. We reviewed related literature and conducted secondary analyses of existing data to identify barriers and facilitators to linkage to care and inform content development and design principles and used focus group discussions with members of the community advisory board and general community to evaluate a PowerPoint prototype of the app; used observations and guided questions with a convenience sample of potential users from the intervention community to iteratively test and refine a functioning interactive app; and conducted qualitative interviews and satisfaction surveys with actual users to evaluate acceptability. Results: Phase 1 identified supply- and demand-side barriers to linkage to care. Specifically, clinics were feminized spaces unattractive to men with high social costs of attendance. Men did not feel vulnerable to HIV, preferred traditional medicine, and were afraid of the consequences of being HIV positive. Thus, the app needed to allow men to identify the long-term health benefits to themselves and their families of starting antiretroviral therapy early and remaining on it, and these benefits typically outweigh the social costs of attending and being seen at a clinic. SDT led to content design that emphasized long-term benefits but at the same time supported the need for autonomy, competence, and relatedness and informed decision making. Phase 2 indicated that we needed to use simpler text and more images to help users understand and navigate the app. Phase 3 indicated that the app was acceptable and likely to encourage men to link to care. Conclusions: We found that iteratively developing the app with potential users using local narratives ensured that EPIC-HIV 2 is usable, engaging, and acceptable. Although the app encouraged men to link to HIV care, it was insufficient as a stand-alone intervention for men in our sample to exercise their full autonomy to link to HIV care without other factors such as it being convenient to initiate treatment, individual experiences of HIV, and support. Combining tailored digital interventions with other interventions to address a range of barriers to HIV care, especially supply-side barriers, should be considered in the future to close the present linkage gap in the HIV treatment cascade. 
%M 33231558
%R 10.2196/17549
%U http://mhealth.jmir.org/2020/11/e17549/
%U https://doi.org/10.2196/17549
%U http://www.ncbi.nlm.nih.gov/pubmed/33231558

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 10
%P e16485
%T Admissions to a Low-Resource Neonatal Unit in Malawi Using a Mobile App: Digital Perinatal Outcome Audit
%A Crehan,Caroline
%A Kesler,Erin
%A Chikomoni,Indira Angela
%A Sun,Kristi
%A Dube,Queen
%A Lakhanpaul,Monica
%A Heys,Michelle
%+ UCL-Great Ormond Street Hospital Institute of Child Health, University College London, 30 Guilford Street, Holborn, London, WC1N 1EH, United Kingdom, 44 (0)2079052212, m.heys@ucl.ac.uk
%K infant, newborn
%K mHealth
%K data collection
%K clinical audit
%K digital health
%K low income population
%K mobile phone
%D 2020

%7 21.10.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) is showing increasing potential to address health outcomes in underresourced settings as smartphone coverage increases. The NeoTree is an mHealth app codeveloped in Malawi to improve the quality of newborn care at the point of admission to neonatal units. When collecting vital demographic and clinical data, this interactive platform provides clinical decision support and training for the end users (health care professionals [HCPs]), according to evidence-based national and international guidelines. Objective: This study aims to examine 1 month’s data collected using NeoTree in an outcome audit of babies admitted to a district-level neonatal nursery in Malawi and to demonstrate proof of concept of digital outcome audit data in this setting. Methods: Using a phased approach over 1 month (November 21-December 19, 2016), frontline HCPs were trained and supported to use NeoTree to admit newborns. Discharge data were collected by the research team using a discharge form within NeoTree, called NeoDischarge. We conducted a descriptive analysis of the exported pseudoanonymized data and presented it to the newborn care department as a digital outcome audit. Results: Of 191 total admissions, 134 (70.2%) admissions were completed using NeoTree, and 129 (67.5%) were exported and analyzed. Of 121 patients for whom outcome data were available, 102 (84.3%) were discharged alive. The overall case fatality rate was 93 per 1000 admitted babies. Prematurity with respiratory distress syndrome, birth asphyxia, and neonatal sepsis contributed to 25% (3/12), 58% (7/12), and 8% (1/12) of deaths, respectively. Data were more than 90% complete for all fields. Deaths may have been underreported because of phased implementation and some families of babies with imminent deaths self-discharging home. Detailed characterization of the data enabled departmental discussion of modifiable factors for quality improvement, for example, improved thermoregulation of infants. Conclusions: This digital outcome audit demonstrates that data can be captured digitally at the bedside by HCPs in underresourced newborn facilities, and these data can contribute to a meaningful review of the quality of care, outcomes, and potential modifiable factors. Coverage may be improved during future implementation by streamlining the admission process to be solely via digital format. Our results present a new methodology for newborn audits in low-resource settings and are a proof of concept for a novel newborn data system in these settings. 
%M 33084581
%R 10.2196/16485
%U https://mhealth.jmir.org/2020/10/e16485
%U https://doi.org/10.2196/16485
%U http://www.ncbi.nlm.nih.gov/pubmed/33084581

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 10
%P e17066
%T Costing and Cost-Effectiveness of a Mobile Health Intervention (ImTeCHO) in Improving Infant Mortality in Tribal Areas of Gujarat, India: Cluster Randomized Controlled Trial
%A Modi,Dhiren
%A Saha,Somen
%A Vaghela,Prakash
%A Dave,Kapilkumar
%A Anand,Ankit
%A Desai,Shrey
%A Shah,Pankaj
%+ Indian Institute of Public Health Gandhinagar, NH-147, Palaj Village, opp. New Air Force Station HQ, Gandhinagar, 382042, India, 91 9687207549, ssaha@iiphg.org
%K mHealth, cost-effectiveness
%K life-years saved
%K India, ASHA
%D 2020

%7 14.10.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: During 2013, a mobile health (mHealth) program, Innovative Mobile Technology for Community Health Operation (ImTeCHO), was launched in predominantly tribal and rural communities of Gujarat, India. ImTeCHO was developed as a job aid for Accredited Social Health Activists (ASHAs) and staff of primary health centers to increase coverage of maternal, neonatal, and child health care. Objective: In this study, we assessed the incremental cost per life-years saved as a result of the ImTeCHO intervention as compared to routine maternal, neonatal, and child health care  programs. Methods: A two-arm, parallel, stratified cluster randomized trial with 11 clusters (primary health centers) randomly allocated to the intervention (280 ASHAs, n=2,34,134) and control (281 ASHAs, n=2,42,809) arms was initiated in 2015 in a predominantly tribal and rural community of Gujarat. A system of surveillance assessed all live births and infant deaths in the intervention and control areas. All costs, including those required during the start-up and implementation phases, were estimated from a program perspective. Incremental cost-effectiveness ratios were estimated by dividing the incremental cost of the intervention with the number of deaths averted to estimate the cost per infant death averted. This was further analyzed to estimate the cost per life-years saved for the purpose of comparability. Sensitivity analysis was undertaken to account for parameter uncertainties. Results: Out of a total of 5754 live births (3014 in the intervention arm, 2740 in the control arm) reported in the study area, per protocol analysis showed that the implementation of ImTeCHO resulted in saving 11 infant deaths per 1000 live births in the study area at an annual incremental cost of US $163,841, which is equivalent to US $54,360 per 1000 live births. Overall, ImTeCHO is a cost-effective intervention from a program perspective at an incremental cost of US $74 per life-years saved or US $5057 per death averted. In a realistic environment with district scale-up, the program is expected to become even more cost-effective. Conclusions: Overall, the findings of our study strongly suggest that the mHealth intervention as part of the ImTeCHO program is cost-effective and should be considered for replication elsewhere in India. Trial Registration: Clinical Trials Registry of India CTRI/2015/06/005847; http://www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=11820&EncHid=&modid=&compid=%27,%2711820det%27 
%M 33052122
%R 10.2196/17066
%U https://mhealth.jmir.org/2020/10/e17066
%U https://doi.org/10.2196/17066
%U http://www.ncbi.nlm.nih.gov/pubmed/33052122

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 10
%P e17895
%T Expanding Access to Perinatal Depression Treatment in Kenya Through Automated Psychological Support: Development and Usability Study
%A Green,Eric P
%A Lai,Yihuan
%A Pearson,Nicholas
%A Rajasekharan,Sathyanath
%A Rauws,Michiel
%A Joerin,Angela
%A Kwobah,Edith
%A Musyimi,Christine
%A Jones,Rachel M
%A Bhat,Chaya
%A Mulinge,Antonia
%A Puffer,Eve S
%+ Duke Global Health Institute, Box 90519, Durham, NC, 27708, United States, 1 9196817289, eric.green@duke.edu
%K telemedicine
%K mental health
%K depression
%K artificial intelligence
%K Kenya
%K text messaging
%K mobile phone
%D 2020

%7 5.10.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Depression during pregnancy and in the postpartum period is associated with poor outcomes for women and their children. Although effective interventions exist for common mental disorders that occur during pregnancy and the postpartum period, most cases in low- and middle-income countries go untreated because of a lack of trained professionals. Task-sharing models such as the Thinking Healthy Program have shown potential in feasibility and efficacy trials as a strategy for expanding access to treatment in low-resource settings; however, there are significant barriers to scale-up. We address this gap by adapting Thinking Healthy for automated delivery via a mobile phone. This new intervention, Healthy Moms, uses an existing artificial intelligence system called Tess (Zuri in Kenya) to drive conversations with users. Objective: This prepilot study aims to gather preliminary data on the Healthy Moms perinatal depression intervention to learn how to build and test a more robust service. Methods: We conducted a single-case experimental design with pregnant women and new mothers recruited from public hospitals outside of Nairobi, Kenya. We invited these women to complete a brief, automated screening delivered via text messages to determine their eligibility. Enrolled participants were randomized to a 1- or 2-week baseline period and then invited to begin using Zuri. We prompted participants to rate their mood via SMS text messaging every 3 days during the baseline and intervention periods, and we used these preliminary repeated measures data to fit a linear mixed-effects model of response to treatment. We also reviewed system logs and conducted in-depth interviews with participants to study engagement with the intervention, feasibility, and acceptability. Results: We invited 647 women to learn more about Zuri: 86 completed our automated SMS screening and 41 enrolled in the study. Most of the enrolled women submitted at least 3 mood ratings (31/41, 76%) and sent at least 1 message to Zuri (27/41, 66%). A third of the sample engaged beyond registration (14/41, 34%). On average, women who engaged post registration started 3.4 (SD 3.2) Healthy Moms sessions and completed 3.1 (SD 2.9) of the sessions they started. Most interviewees who tried Zuri reported having a positive attitude toward the service and expressed trust in Zuri. They also attributed positive life changes to the intervention. We estimated that using this alpha version of Zuri may have led to a 7% improvement in mood. Conclusions: Zuri is feasible to deliver via SMS and was acceptable to this sample of pregnant women and new mothers. The results of this prepilot study will serve as a baseline for future studies in terms of recruitment, data collection, and outcomes. International Registered Report Identifier (IRRID): RR2-10.2196/11800 
%M 33016883
%R 10.2196/17895
%U https://formative.jmir.org/2020/10/e17895
%U https://doi.org/10.2196/17895
%U http://www.ncbi.nlm.nih.gov/pubmed/33016883

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 9
%P e19138
%T Phone Calls to Retain Research Participants and Determinants of Reachability in an African Setting: Observational Study
%A Draaijer,Melvin
%A Lalla-Edward,Samanta Tresha
%A Venter,Willem Daniel Francois
%A Vos,Alinda
%+ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, , Netherlands, 31 0887577136, A.G.Vos-8@umcutrecht.nl
%K retention
%K loss to follow-up
%K phone
%K mobile phones
%K HIV
%K ART
%K South Africa
%D 2020

%7 30.9.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Long-term retention of research participants in studies is challenging. In research in sub-Saharan Africa, phone calls are the most frequently used method to distantly engage with participants. Objective: We aimed to get insight into the effectiveness of phone calls to retain contact with participants and evaluated determinants of reachability. Methods: A cross-sectional study was performed using the databases of two randomized controlled trials investigating different kinds of antiretroviral therapy in HIV-positive patients. One trial finished in 2018 (study 1), and the other finished in 2015 (study 2). A random sample size of 200 participants per study was obtained. There were up to 3 phone numbers available per participant collected during the studies. Participants received a maximum of 3 phone calls on every available number on different days and at different times. Voicemails were left, and emails sent wherever possible. We documented how many calls were answered, who answered, as well as after how many attempts participants were reached. To further increase our understanding of reachability, we conducted a short questionnaire assessing factors contributing to reachability. The study was approved by the Research Ethics Committee of the University of Witwatersrand, Johannesburg, South Africa (reference number M1811107). Results: In our sample size of n=200 per study, study 1, with a median time of 11 months since the last visit at the research site, had a response rate of 70.5% (141/200) participants while study 2, with a median duration of 55 months since the last visit, had a response rate of 50.0% (100/200; P<.001). In study 1, 61.5% (123/200) of calls were answered directly by the participant while this was 36.0% (72/200) in study 2 (P=.003). The likelihood of reaching a participant decreased with time (odds ratio [OR] 0.73, 95% CI 0.63 to 0.84) for every year since the last face-to-face visit. Having more phone numbers per participant increased reachability (OR 2.32, 95% CI 1.24 to 4.36 for 2 phone numbers and OR 3.03, 95% CI 1.48 to 6.22 for 3 phone numbers compared with 1 number). A total of 141 of 241 reached participants responded to the questionnaire. Of the 93 participants who had changed phone numbers, 5% (50/93) had changed numbers because their phone was stolen. The most preferred method of being contacted was direct calling (128/141) with participants naming this method followed by WhatsApp (69/141). Conclusions: Time since last visit and the number of phone numbers listed were the only determinants of reachability. Longer follow-up time is accompanied with a decrease in reachability by phone while more listed phone numbers increases the likelihood that someone can be reached. Trial Registration: ClinicalTrials.gov NCT02671383; https://clinicaltrials.gov/ct2/show/NCT02671383 and ClinicalTrials.gov NCT02670772; https://clinicaltrials.gov/ct2/show/NCT02670772 
%M 32996891
%R 10.2196/19138
%U http://formative.jmir.org/2020/9/e19138/
%U https://doi.org/10.2196/19138
%U http://www.ncbi.nlm.nih.gov/pubmed/32996891

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 9
%P e16958
%T SMS Text Messages for Parents for the Prevention of Child Drowning in Bangladesh: Acceptability Study
%A Hossain,Md Mosharaf
%A Mani,Kulanthayan
%A Mat Min,Ruhani
%+ Safe Kids Malaysia and Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia, 60 0397692398, kulan@upm.edu.my
%K acceptability
%K SMS
%K drowning
%K parents
%D 2020

%7 23.9.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X 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. 
%M 32965224
%R 10.2196/16958
%U http://mhealth.jmir.org/2020/9/e16958/
%U https://doi.org/10.2196/16958
%U http://www.ncbi.nlm.nih.gov/pubmed/32965224

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e19923
%T Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation
%A Dang,Huyen
%A Dao,Sang
%A Carnahan,Emily
%A Kawakyu,Nami
%A Duong,Hong
%A Nguyen,Trung
%A Nguyen,Doan
%A Nguyen,Linh
%A Rivera,Maya
%A Ngo,Tuan
%A Werner,Laurie
%A Nguyen,Nga
%+ PATH, #1101, 11th Floor, Hanoi Towers, 49 Hai Bai Trung Street, Hoan Kiem District, Hanoi, , Vietnam, 84 24 3936 2216 ext 105, ntnguyen@path.org
%K immunization
%K immunization information system
%K electronic immunization registry
%K scale-up
%K digital health intervention
%K mHealth
%K eHealth
%D 2020

%7 22.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam’s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the “axes of scale,” to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. 
%M 32960184
%R 10.2196/19923
%U http://www.jmir.org/2020/9/e19923/
%U https://doi.org/10.2196/19923
%U http://www.ncbi.nlm.nih.gov/pubmed/32960184

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 9
%P e20356
%T 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
%A Johri,Mira
%A Chandra,Dinesh
%A Kone,Karna Georges
%A Sylvestre,Marie-Pierre
%A Mathur,Alok K
%A Harper,Sam
%A Nandi,Arijit
%+ Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 850, rue St-Denis, Montréal, QC, H2X0A9, Canada, 1 514 343 7318, mira.johri@umontreal.ca
%K randomized controlled trial
%K immunization programs
%K child health
%K mHealth
%K health promotion
%K health services accessibility
%K implementation science
%K pilot projects
%K developing countries
%K global health
%D 2020

%7 21.9.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X 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 
%M 32955455
%R 10.2196/20356
%U http://mhealth.jmir.org/2020/9/e20356/
%U https://doi.org/10.2196/20356
%U http://www.ncbi.nlm.nih.gov/pubmed/32955455

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e18414
%T Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study
%A Zaidi,Shehla
%A Kazi,Abdul Momin
%A Riaz,Atif
%A Ali,Ammarah
%A Najmi,Rabia
%A Jabeen,Rawshan
%A Khudadad,Umerdad
%A Sayani,Saleem
%+ Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan, 92 3062016825, shehla.zaidi@aku.edu
%K mHealth
%K community health workers
%K usability
%K usefulness
%K task-technology fit
%D 2020

%7 17.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan. Objective: Our study aimed to explore CHW perceptions on the operability of the mHealth app in a community setting, usefulness of the app in the delivery of assigned maternal and childcare functions, and the task-technology fit with monitoring information systems. Methods: The Hayat app, designed to digitalize and facilitate electronic record keeping, was evaluated to be embedded into mainstream health systems. The app had 2 components: smartphone app for data entry and web dashboard for visualization of the maternal, newborn, and child health reports. Using a qualitative exploratory study design, we conducted a total of 8 focus group discussions with purposively selected lady health workers (LHWs) and CHWs in 3 districts of Pakistan and 3 hamlets of Afghanistan, respectively. Focus group discussions were conducted in the local language, audio recorded, and converted into expanded notes for thematic analysis. Results: Although a majority of LHWs used the app with ease, some initially faced difficulties in operating it and requested a longer duration of training. Contrary to LHWs, the CHWs were able to use the app without difficulty, as they were using it only to register clients. Overall, use of the mHealth app in both countries resulted in a positive impact on health education sessions, easier communication with parents or clients, tracking of routine immunization defaulters and follow-ups, improved data validity, easily accessible vaccination schedules, and faster registration. In addition to building up their image in the community and personal development, the improved reporting and monitoring mechanisms also set the stage for the LHWs to get recognized for their hard work. CHWs in Afghanistan also reported the app provided immediate access to information when requested by their supervisor. Although the Hayat app eliminates the need to carry multiple registers and helps in recalling client information at the touch of a button, technical issues around connectivity and data inputting tabs were highlighted by the participants. Conclusions: The digitization of records not only provided CHWs support in their daily routine but also strengthened monitoring mechanisms and improved motivation. We recommend conducting end user experience studies before embedding apps into mainstream health systems as high acceptability does not always result in high uptake of digital technology. 
%M 32940612
%R 10.2196/18414
%U http://www.jmir.org/2020/9/e18414/
%U https://doi.org/10.2196/18414
%U http://www.ncbi.nlm.nih.gov/pubmed/32940612

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e21573
%T An Innovative Artificial Intelligence–Based App for the Diagnosis of Gestational Diabetes Mellitus (GDM-AI): Development Study
%A Shen,Jiayi
%A Chen,Jiebin
%A Zheng,Zequan
%A Zheng,Jiabin
%A Liu,Zherui
%A Song,Jian
%A Wong,Sum Yi
%A Wang,Xiaoling
%A Huang,Mengqi
%A Fang,Po-Han
%A Jiang,Bangsheng
%A Tsang,Winghei
%A He,Zonglin
%A Liu,Taoran
%A Akinwunmi,Babatunde
%A Wang,Chi Chiu
%A Zhang,Casper J P
%A Huang,Jian
%A Ming,Wai-Kit
%+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China, 86 14715485116, wkming@connect.hku.hk
%K AI
%K application
%K disease diagnosis
%K maternal health care
%K artificial intelligence
%K app
%K women
%K rural
%K innovation
%K diabetes
%K gestational diabetes
%K diagnosis
%D 2020

%7 15.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Gestational diabetes mellitus (GDM) can cause adverse consequences to both mothers and their newborns. However, pregnant women living in low- and middle-income areas or countries often fail to receive early clinical interventions at local medical facilities due to restricted availability of GDM diagnosis. The outstanding performance of artificial intelligence (AI) in disease diagnosis in previous studies demonstrates its promising applications in GDM diagnosis. Objective: This study aims to investigate the implementation of a well-performing AI algorithm in GDM diagnosis in a setting, which requires fewer medical equipment and staff and to establish an app based on the AI algorithm. This study also explores possible progress if our app is widely used. Methods: An AI model that included 9 algorithms was trained on 12,304 pregnant outpatients with their consent who received a test for GDM in the obstetrics and gynecology department of the First Affiliated Hospital of Jinan University, a local hospital in South China, between November 2010 and October 2017. GDM was diagnosed according to American Diabetes Association (ADA) 2011 diagnostic criteria. Age and fasting blood glucose were chosen as critical parameters.
For validation, we performed k-fold cross-validation (k=5) for the internal dataset and an external validation dataset that included 1655 cases from the Prince of Wales Hospital, the affiliated teaching hospital of the Chinese University of Hong Kong, a non-local hospital. Accuracy, sensitivity, and other criteria were calculated for each algorithm. Results: The areas under the receiver operating characteristic curve (AUROC) of external validation dataset for support vector machine (SVM), random forest, AdaBoost, k-nearest neighbors (kNN), naive Bayes (NB), decision tree, logistic regression (LR), eXtreme gradient boosting (XGBoost), and gradient boosting decision tree (GBDT) were 0.780, 0.657, 0.736, 0.669, 0.774, 0.614, 0.769, 0.742, and 0.757, respectively. SVM also retained high performance in other criteria. The specificity for SVM retained 100% in the external validation set with an accuracy of 88.7%. Conclusions: Our prospective and multicenter study is the first clinical study that supports the GDM diagnosis for pregnant women in resource-limited areas, using only fasting blood glucose value, patients’ age, and a smartphone connected to the internet. Our study proved that SVM can achieve accurate diagnosis with less operation cost and higher efficacy. Our study (referred to as GDM-AI study, ie, the study of AI-based diagnosis of GDM) also shows our app has a promising future in improving the quality of maternal health for pregnant women, precision medicine, and long-distance medical care. We recommend future work should expand the dataset scope and replicate the process to validate the performance of the AI algorithms. 
%M 32930674
%R 10.2196/21573
%U https://www.jmir.org/2020/9/e21573
%U https://doi.org/10.2196/21573
%U http://www.ncbi.nlm.nih.gov/pubmed/32930674

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e17659
%T Exploring the Use of Mobile Health to Improve Community-Based Health and Nutrition Service Utilization in the Hills of Nepal: Qualitative Study
%A Acharya,Ajay
%A Cunningham,Kenda
%A Manandhar,Shraddha
%A Shrestha,Niva
%A Chen,Mario
%A Weissman,Amy
%+ Asia Pacific Regional Office, Family Health International 360, 19th Floor, Tower 3, Sindhorn Building, 130-132 Wireless Road, Lumpini, Phatumwan, Bangkok, 10330, Thailand, 66 2 263 5200 ext 20226, aweissman@fhi360.org
%K mobile health
%K text messages
%K SMS text message
%K qualitative study
%K Nepal
%K health and nutrition services
%K health mothers’ group
%K female community health volunteers
%K mobile phone
%D 2020

%7 11.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: With mobile phone coverage and ownership expanding globally, mobile health (mHealth) interventions are increasingly being used to improve coverage and quality of health and nutrition services. However, evidence on mHealth intervention feasibility and factors to consider during program design is limited in low- and middle-income countries like Nepal. Objective: This study aimed to examine the potential of using text messages to improve health and nutrition services by exploring mobile phone ownership and sharing; mobile phone use and skills; and interest, preferences, and limitations regarding mHealth interventions. Methods: We conducted 35 in-depth interviews with 1000-day women (the period from conception to a child’s second birthday), health facility staff, and female community health volunteers (FCHVs), as well as eight focus group discussions with health facility staff, FCHVs, and 1000-day household decision-makers (ie, husbands, mothers-in-law, and fathers-in-law). We also conducted a mobile phone skills test. We employed thematic analysis using framework matrices and analytical memos. Results: The study included 70 study participants, of whom 68 (97%) had a mobile phone, and phone sharing was uncommon. Use of text messages was most commonly reported by 1000-day women and health facility staff than household decision-makers and FCHVs. More than 8 in 10 participants (54/64, 84%) could dial numbers, and the majority (28/34, 82%) of 1000-day women, health facility staff, and male decision-makers could also read and write text messages. We found that 1000-day women preferred educational and reminder messages, whereas health facility staff and FCHVs desired educational and motivational messages. Participants suggested different types of texts for 1000-day women, families, FCHVs, and health facility staff, and reported less value for texts received from unknown phone numbers. Conclusions: A text message–based mHealth intervention is acceptable in the hills of Nepal and has the potential to improve community health and nutrition service utilization, particularly by sending meeting reminders and by providing information. Our findings contribute to text message–based mHealth intervention design in under-resourced settings. 
%M 32915151
%R 10.2196/17659
%U http://www.jmir.org/2020/9/e17659/
%U https://doi.org/10.2196/17659
%U http://www.ncbi.nlm.nih.gov/pubmed/32915151

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 9
%P e17057
%T Cost-Effective Smartphone-Based Articulable Endoscope Systems for Developing Countries: Instrument Validation Study
%A Moon,Youngjin
%A Oh,Jeongmin
%A Hyun,Jaeho
%A Kim,Youngkyu
%A Choi,Jaesoon
%A Namgoong,Jeongman
%A Kim,Jun Ki
%+ Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-Gu, Seoul, , Republic of Korea, 82 23 010 8619, kim@amc.seoul.kr
%K smartphone-based endoscope
%K mobile health
%K low-resource settings
%K continuum body
%K articulable endoscope
%K low-cost medical device
%K point of care diagnostics
%D 2020

%7 10.9.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X 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 × 720 pixels) of the device was found to be acceptable for medical diagnosis. The maximum bending angle of 110° 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°, for a curvature of 0.013. The finest articulation resolution was 8.9°. 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 × 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. 
%M 32909951
%R 10.2196/17057
%U http://mhealth.jmir.org/2020/9/e17057/
%U https://doi.org/10.2196/17057
%U http://www.ncbi.nlm.nih.gov/pubmed/32909951

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 9
%P e20848
%T Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis
%A Lee,Seohyun
%A Kim,Eunji
%A Desta,Tekaligne Birhane
%+ Yonsei University, 1 Yonseidae-gil, Wonju, , Republic of Korea, 82 33 760 2357, leeesh@yonsei.ac.kr
%K team communication
%K health extension workers
%K mobile communication
%K mobile data collection
%K Ethiopia
%K health worker
%K communication
%K data
%D 2020

%7 8.9.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X 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. 
%M 32897231
%R 10.2196/20848
%U http://mhealth.jmir.org/2020/9/e20848/
%U https://doi.org/10.2196/20848
%U http://www.ncbi.nlm.nih.gov/pubmed/32897231

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 9
%P e21691
%T Current Challenges of Digital Health Interventions in Pakistan: Mixed Methods Analysis
%A Kazi,Abdul Momin
%A Qazi,Saad Ahmed
%A Ahsan,Nazia
%A Khawaja,Sadori
%A Sameen,Fareeha
%A Saqib,Muhammad
%A Khan Mughal,Muhammad Ayub
%A Wajidali,Zabin
%A Ali,Sikander
%A Ahmed,Rao Moueed
%A Kalimuddin,Hussain
%A Rauf,Yasir
%A Mahmood,Fatima
%A Zafar,Saad
%A Abbasi,Tufail Ahmad
%A Khoumbati,Khalil-Ur-Rahmen
%A Abbasi,Munir A
%A Stergioulas,Lampros K
%+ Department of Pediatrics and Child Health, Aga Khan University, Stadium Road​, P.O. Box 350​0, Karachi, 74800, Pakistan, 92 2134864232, momin.kazi@aku.edu
%K digital health
%K eHealth
%K LMICs
%K mHealth
%K Pakistan
%K SWOT
%K telehealth
%D 2020

%7 3.9.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to identify the internal and external factors that can potentially facilitate or hinder the progress of digital health in Pakistan. Methods: This study aims to evaluate digital health projects carried out in the last 5 years in Pakistan with mixed methods. The qualitative and quantitative data obtained from field surveys were categorized according to the World Health Organization’s (WHO) recommended building blocks for health systems research, and the data were analyzed using a SWOT analysis strategy. Results: Of the digital health projects carried out in the last 5 years in Pakistan, 51 are studied. Of these projects, 46% (23/51) used technology for conducting research, 30% (15/51) used technology for implementation, and 12% (6/51) used technology for app development. The health domains targeted were general health (23/51, 46%), immunization (13/51, 26%), and diagnostics (5/51, 10%). Smartphones and devices were used in 55% (28/51) of the interventions, and 59% (30/51) of projects included plans for scaling up. Artificial intelligence (AI) or machine learning (ML) was used in 31% (16/51) of projects, and 74% (38/51) of interventions were being evaluated. The barriers faced by developers during the implementation phase included the populations’ inability to use the technology or mobile phones in 21% (11/51) of projects, costs in 16% (8/51) of projects, and privacy concerns in 12% (6/51) of projects. Conclusions: We conclude that while digital health has a promising future in Pakistan, it is still in its infancy at the time of this study. However, due to the coronavirus disease  2019 (COVID-19) pandemic, there is an increase in demand for digital health and implementation of health outcomes following global social distancing protocols, especially in LMICs. Hence, there is a need for active involvement by public and private organizations to regulate, mobilize, and expand the digital health sector for the improvement of health care systems in countries. 
%M 32880584
%R 10.2196/21691
%U https://www.jmir.org/2020/9/e21691
%U https://doi.org/10.2196/21691
%U http://www.ncbi.nlm.nih.gov/pubmed/32880584

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e18413
%T Evaluating Network Readiness for mHealth Interventions Using the Beacon Mobile Phone App: Application Development and Validation Study
%A Scherr,Thomas Foster
%A Moore,Carson Paige
%A Thuma,Philip
%A Wright,David Wilson
%+ Department of Chemistry, Vanderbilt University, 7300 Stevenson Center, 1234 Stevenson Center Lane, Nashville, TN, 37235, United States, 1 615 322 5516, Thomas.f.scherr@vanderbilt.edu
%K mHealth
%K network readiness
%K network assessment
%K mobile network
%D 2020

%7 28.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) interventions have the potential to transform the global health care landscape. The processing power of mobile devices continues to increase, and growth of mobile phone use has been observed worldwide. Uncertainty remains among key stakeholders and decision makers as to whether global health interventions can successfully tap into this trend. However, when correctly implemented, mHealth can reduce geographic, financial, and social barriers to quality health care. Objective: The aim of this study was to design and test Beacon, a mobile phone–based tool for evaluating mHealth readiness in global health interventions. Here, we present the results of an application validation study designed to understand the mobile network landscape in and around Macha, Zambia, in 2019. Methods: Beacon was developed as an automated mobile phone app that continually collects spatiotemporal data and measures indicators of network performance. Beacon was used in and around Macha, Zambia, in 2019. Results were collected, even in the absence of network connectivity, and asynchronously uploaded to a database for further analysis. Results: Beacon was used to evaluate three mobile phone networks around Macha. Carriers A and B completed 6820/7034 (97.0%) and 6701/7034 (95.3%) downloads and 1349/1608 (83.9%) and 1431/1608 (89.0%) uploads, respectively, while Carrier C completed only 62/1373 (4.5%) file downloads and 0/1373 (0.0%) file uploads. File downloads generally occurred within 4 to 12 seconds, and their maximum download speeds occurred between 2 AM and 5 AM. A decrease in network performance, demonstrated by increases in upload and download durations, was observed beginning at 5 PM and continued throughout the evening. Conclusions: Beacon was able to compare the performance of different cellular networks, show times of day when cellular networks experience heavy loads and slow down, and identify geographic “dead zones” with limited or no cellular service. Beacon is a ready-to-use tool that could be used by organizations that are considering implementing mHealth interventions in low- and middle-income countries but are questioning the feasibility of the interventions, including infrastructure and cost. It could also be used by organizations that are looking to optimize the delivery of an existing mHealth intervention with improved logistics management. 
%M 32720909
%R 10.2196/18413
%U http://mhealth.jmir.org/2020/7/e18413/
%U https://doi.org/10.2196/18413
%U http://www.ncbi.nlm.nih.gov/pubmed/32720909

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e13686
%T Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial
%A Fatori,Daniel
%A Argeu,Adriana
%A Brentani,Helena
%A Chiesa,Anna
%A Fracolli,Lislaine
%A Matijasevich,Alicia
%A Miguel,Euripedes C
%A Polanczyk,Guilherme
%+ Department of Psychiatry, University of Sao Paulo Medical School, 785 R Dr Ovídio Pires de Campos, Sao Paulo, Brazil, 55 11961626183, daniel.fatori@gmail.com
%K mHealth
%K early childhood development
%K maternal care
%K randomized clinical trial
%K daily diary
%K ambulatory assessment
%D 2020

%7 28.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 
%M 32720906
%R 10.2196/13686
%U https://mhealth.jmir.org/2020/7/e13686
%U https://doi.org/10.2196/13686
%U http://www.ncbi.nlm.nih.gov/pubmed/32720906

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 7
%P e16856
%T Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy
%A Rabinovich,Lila
%A Molton,James Steven
%A Ooi,Wei Tsang
%A Paton,Nicholas Iain
%A Batra,Shelly
%A Yoong,Joanne
%+ Center for Economic and Social Research, University of Southern California, 1090 Vermont Avenue, NW, Washington, DC, 20005, United States, 1 2138210537, lilarabi@usc.edu
%K directly observed therapy
%K video recording
%K telemedicine
%K mobile health
%K mHealth
%K tuberculosis
%K low-income settings
%K developing countries
%K patient acceptance of health care
%K patient acceptability
%K Cambodia
%D 2020

%7 27.7.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally. 
%M 32716309
%R 10.2196/16856
%U https://www.jmir.org/2020/7/e16856
%U https://doi.org/10.2196/16856
%U http://www.ncbi.nlm.nih.gov/pubmed/32716309

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e16473
%T Digital Health and Inequalities in Access to Health Services in Bangladesh: Mixed Methods Study
%A Ahmed,Tanvir
%A Rizvi,Syed Jafar Raza
%A Rasheed,Sabrina
%A Iqbal,Mohammad
%A Bhuiya,Abbas
%A Standing,Hilary
%A Bloom,Gerald
%A Waldman,Linda
%+ Department of Oncology and Medicine, Faculty of Medicine, Dentistry and Health, University of Sheffield, Jessop Wing Maternity Unit, Tree Root Walk, Broomhall, Sheffield, S10 2SF, United Kingdom, 44 7931163982, tanvir79@outlook.com
%K health equity
%K eHealth
%K mHealth
%K digital health
%K health technology
%K Bangladesh
%K developing countries
%D 2020

%7 21.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Globally, the rapid growth of technology and its use as a development solution has generated much interest in digital health. In line with global trends, Bangladesh is also integrating technology into its health system to address disparities. Strong political endorsement and uptake of digital platforms by the government has influenced the rapid proliferation of such initiatives in the country. This paper aims to examine the implications of digital health on access to health care in Bangladesh, considering who uses electronic devices to access health information and services and why. Objective: This study aims to understand how access to health care and related information through electronic means (digital health) is affected by sociodemographic determinants (ie, age, gender, education, socioeconomic status, and personal and household ownership of mobile phones) in a semiurban community in Bangladesh. Methods: A cross-sectional survey of 854 households (between October 2013 and February 2014) and 20 focus group discussions (between February 2017 and March 2017) were conducted to understand (1) who owns electronic devices; (2) who, among the owners, uses these to access health information and services and why; (3) the awareness of electronic sources of health information; and (4) the role of intermediaries (family members or peers who helped to look for health information using electronic devices). Results: A total of 90.3% (771/854) of households (471/854, 55.2% of respondents) owned electronic devices, mostly mobile phones. Among these, 7.2% (34/471) used them to access health information or services. Middle-aged (35-54 years), female, less (or not) educated, and poorer people used these devices the least (α=.05, α is the level of significance). The lack of awareness, discomfort, differences with regular care-seeking habits, lack of understanding and skills, and proximity to a health facility were the main reasons for not using devices to access digital health. Conclusions: Although influenced by sociodemographic traits, access to digital health is not merely related to device ownership and technical skill. Rather, it is a combination of general health literacy, phone ownership, material resources, and technical skill as well as social recognition of health needs and inequity. This study’s findings should serve as a basis for better integrating technology within the health system and ensuring equitable access to health care. 
%M 32706736
%R 10.2196/16473
%U http://mhealth.jmir.org/2020/7/e16473/
%U https://doi.org/10.2196/16473
%U http://www.ncbi.nlm.nih.gov/pubmed/32706736

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 7
%P e17940
%T Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians
%A Peiffer-Smadja,Nathan
%A Poda,Armel
%A Ouedraogo,Abdoul-Salam
%A Guiard-Schmid,Jean-Baptiste
%A Delory,Tristan
%A Le Bel,Josselin
%A Bouvet,Elisabeth
%A Lariven,Sylvie
%A Jeanmougin,Pauline
%A Ahmad,Raheelah
%A Lescure,François-Xavier
%+ Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), UMR 1137, 16 rue Henri Huchard, Paris, 75870, France, 33 618662638, nathan.psmadja@gmail.com
%K decision support systems, clinical
%K antibiotic resistance, microbial
%K drug resistance, microbial
%K antibiotic stewardship
%K implementation science
%K Africa, Western
%K diffusion of innovation
%K medical informatics applications
%D 2020

%7 20.7.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. Objective: This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. Methods: We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. Results: Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and developing surveillance capabilities in primary care. The most frequently mentioned contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa, where antibiotics can be bought without a prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antibiotics using national guidelines where available. Participants endorsed co-design involving all stakeholders, including nurses, midwives, and pharmacists, as central to any introduction of CDSS. A phased approach was suggested by initiating and evaluating CDSS at a pilot site, followed by dissemination using professional networks and social media. The lack of widespread internet access and computers could be circumvented by a mobile app with an offline mode. Conclusions: Our study provides valuable information for the development and implementation of a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may, in turn, contribute to improving antibiotic use, clinical outcomes and decreasing AMR. 
%M 32442155
%R 10.2196/17940
%U https://www.jmir.org/2020/7/e17940
%U https://doi.org/10.2196/17940
%U http://www.ncbi.nlm.nih.gov/pubmed/32442155

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e17665
%T The Effect of Women’s Differential Access to Messages on Their Adoption of Mobile Health Services and Pregnancy Behavior  in Bangladesh: Retrospective Cross-Sectional Study
%A Alam,Mafruha
%A Banwell,Cathy
%A Lokuge,Kamalini
%+ Australian National University, 62 Mills Road, National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, ACT, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com
%K mHealth
%K inequality
%K access
%K pregnancy
%D 2020

%7 20.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Text or voice messages have been used as a popular method for improving women’s knowledge on birth preparedness and newborn health care practices worldwide. The Aponjon service in Bangladesh provides twice-weekly messages to female subscribers about their pregnancy and newborn care on mobile phones that they own or share with family members. It is important to understand whether women’s singular access to a phone affects their service satisfaction and the adoption of health messages before deploying such interventions in resource-limited settings. Objective: This study aims to evaluate the effect of women’s singular and shared access to mobile phone messages on their service utilization and perceived behavioral change around birth preparedness and pregnancy care. Methods: In 2014, Aponjon conducted a retrospective cross-sectional survey of 459 female subscribers who received text or voice messages during their pregnancy by themselves (n=253) or with family members (n=206). We performed multivariable regression analyses to investigate the association between pregnant women’s differential access to messages and other socioeconomic factors and outcomes of service satisfaction, ability to recall service short code, ability to identify danger signs of pregnancy, preference for skilled delivery, arrangement of a blood donor for delivery and pregnancy complications, maternal nutrition, use of potable drinking water, and washing hands with soap for hygiene. Results: In the multivariable analysis, women who had singular access to messages had higher odds of reporting high satisfaction (odds ratio [OR] 1.72, 95% CI 1.12-2.63; P=.01), recalling the service short code (OR 2.88, 95% CI 1.90-4.36; P<.001), consuming nutritious food 5 times a day (OR 1.58, 95% CI 1.04-2.40; P=.03), and following the instructions of Aponjon on drinking potable water (OR 1.90, 95% CI 1.17-3.09; P=.01) than women who shared access with family members. Women’s differential access to messages did not affect their knowledge of danger signs and preparedness around delivery. Adolescent women and women aged 20-24 years had lower odds of planning safe deliveries than older women (aged≥25 years). Secondary education was statistically significantly associated with women’s ability to recall the short code and pregnancy danger signs, plan safe delivery, and select blood donors for emergencies. Higher family income was associated with women’s satisfaction, recognition of danger signs, and arrangement of blood donors and nutritious diet. Women who received more than 4 antenatal care visits had higher odds of liking the service, preferring skilled delivery, recalling danger signs, and consuming nutritious food. Conclusions: The capacity of women to independently access mobile phone messages can improve their adoption of mobile health services and some pregnancy health care practices. A holistic approach and equitable support are required to improve access to resources and knowledge of delivery preparedness among low-literate and younger women in low-income households. 
%M 32706694
%R 10.2196/17665
%U https://mhealth.jmir.org/2020/7/e17665
%U https://doi.org/10.2196/17665
%U http://www.ncbi.nlm.nih.gov/pubmed/32706694

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e17535
%T Feasibility and Acceptability of an Adapted Mobile Phone Message Program and Changes in Maternal and Newborn Health Knowledge in Four Provinces of Afghanistan: Single-Group Pre-Post Assessment Study
%A Lebrun,Victoria
%A Dulli,Lisa
%A Alami,Sayed Omar
%A Sidiqi,Arzoo
%A Sultani,Ahmad Shah
%A Rastagar,Sayed Haroon
%A Halimzai,Iftikhar
%A Ahmadzai,Sharif
%A Todd,Catherine S
%+ Global Health, Population, and Nutrition, FHI 360, 359 Blackwell St #200, Durham, NC, 27701, United States, 1 9195447040 ext 11640, vlebrun@fhi360.org
%K Afghanistan
%K mobile apps
%K pregnant women
%K maternal health
%K newborn health
%K social and behavior change
%K mHealth
%K voice message
%K SMS
%D 2020

%7 20.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile phone apps for health promotion have expanded in many low- and middle-income countries. Afghanistan, with high maternal and newborn morbidity and mortality rates, a fragile health infrastructure, and high levels of mobile phone ownership, is an ideal setting to examine the utility of such programs. We adapted messages of the Mobile Alliance for Maternal Action (MAMA) program, which was designed to promote healthy behaviors during pregnancy and a newborn’s first year of life, to the Afghan context. We then piloted and assessed the program in the provinces of Kabul, Herat, Kandahar, and Balkh. Objective: The aim of this study was to assess the feasibility and acceptability of the MAMA pilot program, and to examine changes in reported maternal, newborn, and child health (MNCH) knowledge and attitudes among participants from baseline to follow up. Methods: We conducted a single-group study with data collected within 10 weeks of enrollment, and data collection was repeated approximately 6 months later. Data were collected through face-to-face interviews using structured questionnaires. Eligible participants included pregnant women who had registered to receive fully automated mobile health messages and their husbands. Assessment questionnaires queried sociodemographic details; knowledge, attitudes, and health care-seeking practices; and intervention experience and acceptability at follow up. The number of messages received by a given phone number was extracted from the program database. We descriptively analyzed the feasibility and acceptability data and compared the change in MNCH knowledge between baseline and follow-up measures using the McNemar Chi square test. Results: Overall, 895 women were enrolled in the MAMA program. Data from 453/625 women (72.5% of the pretest sample) who received voice (n=302) or text (n=151) messages, and 276/427 men (64.6% of the pretest sample) who received voice (n=185) or text (n=91) messages contributing data at both time points were analyzed. At follow up, 699/729 (95.9%) participants were still enrolled in the MAMA program; voice message and SMS text messaging subscribers received 43 and 69 messages on average over the 6-month period, respectively. Participants who were voice message subscribers and female participants more commonly reported missing messages compared with the text message subscribers and men; predominant reasons for missed messages were the subscribers being busy with chores or not having their shared phone with them. Over 90% of men and women reported experiencing benefits from the program, mainly increased knowledge, and 226/453 (49.9%) of the female participants reported referring someone else to the program. Most of the participants (377/453, 83.2% women and 258/276, 93.5% men) believed it was beneficial to include husbands in the program. Joint decision making regarding maternal and child health care increased overall. The proportions of participants with correct knowledge significantly increased for all but one MNCH measure at follow up. Conclusions: This assessment indicates that the pilot MAMA program is feasible and acceptable in the Afghan context. Further research should be conducted to determine whether program participation leads to improved MNCH knowledge, health practices, and health service utilization in this fragile setting prior to larger scale up. 
%M 32706690
%R 10.2196/17535
%U https://mhealth.jmir.org/2020/7/e17535
%U https://doi.org/10.2196/17535
%U http://www.ncbi.nlm.nih.gov/pubmed/32706690

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e17891
%T Automated and Interviewer-Administered Mobile Phone Surveys in Burkina Faso: Sociodemographic Differences Among Female Mobile Phone Survey Respondents and Nonrespondents
%A Greenleaf,Abigail R
%A Gadiaga,Aliou
%A Choi,Yoonjoung
%A Guiella,Georges
%A Turke,Shani
%A Battle,Noelle
%A Ahmed,Saifuddin
%A Moreau,Caroline
%+ ICAP at Columbia University, 722 W 168th St, New York, NY, 10032, United States, 1 4439553694, arg2177@cumc.columbia.edu
%K cell phone
%K mHealth
%K Africa South of the Sahara
%K Burkina Faso
%K methodology, survey, nonrespondents, survey methods, interviews, telephone
%D 2020

%7 14.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The remarkable growth of cell phone ownership in low- and middle-income countries has generated significant interest in using cell phones for conducting surveys through computer-assisted telephone interviews, live interviewer-administered surveys, or automated surveys (ie, interactive voice response). Objective: This study aimed to compare, by mode, the sociodemographic characteristics of cell phone owners who completed a follow-up phone survey with those who did not complete the survey. Methods: The study was based on a nationally representative sample of women aged 15 to 49 years who reported cell phone ownership during a household survey in Burkina Faso in 2016. Female cell phone owners were randomized to participate in a computer-assisted telephone interview or hybrid interactive voice response follow-up phone survey 11 months after baseline interviews. Completion of the phone survey was defined as participants responding to more than 50% of questions in the phone survey. We investigated sociodemographic characteristics associated with cell phone survey completion using multivariable logistic regression models, stratifying the analysis by survey mode and by directly comparing computer-assisted telephone interview and hybrid interactive voice response respondents. Results: A total of 1766 women were called for the phone survey between November 5 and 17, 2017. In both the computer-assisted telephone interview and hybrid interactive voice response samples, women in urban communities and women with secondary education or higher were more likely to complete the survey than their rural and less-educated counterparts. Compared directly, women who completed the hybrid interactive voice response survey had higher odds of having a secondary education than those who completed computer-assisted telephone interviews (odds ratio 1.7, 95% CI 1.1-2.6). Conclusions: In Burkina Faso, computer-assisted telephone interviews are the preferred method of conducting cell phone surveys owing to less sample distortion and a higher response rate compared with a hybrid interactive voice response survey. 
%M 32673250
%R 10.2196/17891
%U https://mhealth.jmir.org/2020/7/e17891
%U https://doi.org/10.2196/17891
%U http://www.ncbi.nlm.nih.gov/pubmed/32673250

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e18226
%T A One-Step, Streamlined Children’s Vision Screening Solution Based on Smartphone Imaging for Resource-Limited Areas: Design and Preliminary Field Evaluation
%A Ma,Shuoxin
%A Guan,Yongqing
%A Yuan,Yazhen
%A Tai,Yuan
%A Wang,Tan
%+ TerryDr Infomation Technology, Room A3-701, #180 RuanJianDaDao, YuHuaTai District, Nanjing, 210000, China, 86 13813998278, shuoxinma@163.com
%K vision screening
%K resource-limited application
%K photorefraction
%K strabismus
%K myopia
%K anisometropia
%K mHealth
%K screening
%D 2020

%7 13.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Young children’s vision screening, as part of a preventative health care service, produces great value for developing regions. Besides yielding a high return on investment from forestalling surgeries using a low-cost intervention at a young age, it improves school performance and thus boosts future labor force quality. Leveraging low-skilled health care workers with smartphones and automated diagnosis to offer such programs can be a scalable model in resource-limited areas. Objective: This study aimed to develop and evaluate an effective, efficient, and comprehensive vision screening solution for school children in resource-limited areas. First, such an exam would need to cover the major risk factors of amblyopia and myopia, 2 major sources of vision impairment effectively preventable at a young age. Second, the solution must be integrated with digital patient record-keeping for long-term monitoring and popular statistical analysis. Last, it should utilize low-skilled technicians and only low-cost tools that are available in a typical school in developing regions, without compromising quality or efficiency. Methods: A workflow for the screening program was designed and a smartphone app was developed to implement it. In the standardized screening procedure, a young child went through the smartphone-based photoscreening in a dark room. The child held a smartphone in front of their forehead, displaying pre-entered personal information as a quick response code that duplexed as a reference of scale. In one 10-second procedure, the child’s personal information and interpupillary distance, relative visual axis alignment, and refractive error ranges were measured and analyzed automatically using image processing and artificial intelligence algorithms. The child’s risk for strabismus, myopia, and anisometropia was then derived and consultation given. Results: A preliminary evaluation of the solution was conducted alongside yearly physical exams in Luoyang, Henan, People’s Republic of China. It covered 20 students with suspected strabismus and 80 randomly selected students, aged evenly between 8 and 10. Each examinee took about 1 minute, and a streamlined workflow allowed 3 exams to run in parallel. The 1-shot and 2-shot measurement success rates were 87% and 100%, respectively. The sensitivity and specificity of strabismus detection were 0.80 and 0.98, respectively. The sensitivity and specificity of myopia detection were 0.83 and 1.00, respectively. The sensitivity and specificity of anisometropia detection were 0.80 and 1.00, respectively. Conclusions: The proposed vision screening program is effective, efficient, and scalable. Compared with previously published studies on utilizing a smartphone for an automated Hirschberg test and photorefraction screening, this comprehensive solution is optimized for practicality and robustness, and is thus better ready-to-deploy. Our evaluation validated the achievement of the program’s design specifications. 
%M 32673243
%R 10.2196/18226
%U http://mhealth.jmir.org/2020/7/e18226/
%U https://doi.org/10.2196/18226
%U http://www.ncbi.nlm.nih.gov/pubmed/32673243

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e19552
%T Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda
%A Meyer,Amanda J
%A Armstrong-Hough,Mari
%A Babirye,Diana
%A Mark,David
%A Turimumahoro,Patricia
%A Ayakaka,Irene
%A Haberer,Jessica E
%A Katamba,Achilles
%A Davis,J Lucian
%+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, United States, 1 203 785 3665, lucian.davis@yale.edu
%K mHealth
%K implementation
%K tuberculosis
%K consolidated framework for implementation science
%K Uganda
%K framework
%K intervention
%K app
%D 2020

%7 13.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective: We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods: We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results: We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions: mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration: Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877 
%M 32673262
%R 10.2196/19552
%U http://mhealth.jmir.org/2020/7/e19552/
%U https://doi.org/10.2196/19552
%U http://www.ncbi.nlm.nih.gov/pubmed/32673262

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 7
%P e16753
%T Need for the Development of a Specific Regulatory Framework for Evaluation of Mobile Health Apps in Peru: Systematic Search on App Stores and Content Analysis
%A Rojas Mezarina,Leonardo
%A Silva-Valencia,Javier
%A Escobar-Agreda,Stefan
%A Espinoza Herrera,Daniel Hector
%A Egoavil,Miguel S
%A Maceda Kuljich,Mirko
%A Inga-Berrospi,Fiorella
%A Ronceros,Sergio
%+ Unidad de Telesalud, School of Medicine, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, Lima, Peru, 51 978978368, javier.silva@unmsm.edu.pe
%K mhealth apps
%K mHealth
%K regulatory framework
%K Peru, eHealth
%D 2020

%7 10.7.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In Peru, there is an increase in the creation of mobile health (mHealth) apps; however, this situation could present problems related to the quality of information these apps share, data security and privacy, usability, and effectiveness, as there is no specific local regulation about their creation and use. Objective: The objective of this study was to review mHealth apps created, uploaded, or used in Peru, and perform an analysis of the national regulatory framework that could be applied to evaluate whether there is a need to develop and implement a specific regulation to these apps. Methods: A total of 3 reviews were performed. First, we reviewed information about Peruvian mHealth apps created up to May 2019 from scientific publications, news, government communications, and virtual stores, and evaluated their purpose, creator, and the available evidence of their usability and effectiveness. The second review was carried out by taking a sample of the 10 most commonly used mHealth apps in Peru (regardless of the country of creation), to evaluate the information they collect and classify them according to the possible risks that they could present in terms of security and privacy. In addition, we evaluated whether they refer to or endorse the information they provided. Finally, in the third review, we searched for Peruvian standards related to electronic health (eHealth) that involve information technology that can be applied to regulate these apps. Results: A total of 66 apps meeting our inclusion criteria were identified; of these, 47% (n=31) belonged to government agencies and 47% (n=31) were designed for administrative purposes (private and government agencies). There was no evidence about the usability or effectiveness of any of these apps. Concerning the 10 most commonly used mHealth apps in Peru, about the half of them gathered user information that could be leaked, changed, or lost, thus posing a great harm to their users or to their related patients. In addition, 6/10 (60%) of these apps did not mention the source of the information they provided. Among the Peruvian norms, the Law on the Protection of Personal Data, Law on Medical Devices, and administrative directives on standards and criteria for health information systems have some regulations that could be applied to these apps; however, these do not fully cover all aspects concerning the evaluation of security and privacy of data, quality of provided information, and evidence of an app’s usability and effectiveness. Conclusions: Because many Peruvian mHealth apps have issues related to security and privacy of data, quality of information provided, and lack of available evidence of their usability and effectiveness, there is an urgent need to develop a regulatory framework based on existing medical device and health information system norms in order to promote the evaluation and regulation of all the aforesaid aspects, including the creation of a national repository for these apps that describes all these characteristics. 
%M 32352926
%R 10.2196/16753
%U https://mhealth.jmir.org/2020/7/e16753
%U https://doi.org/10.2196/16753
%U http://www.ncbi.nlm.nih.gov/pubmed/32352926

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 7
%N 2
%P e14078
%T The Mobile Alliance for Maternal Action Text Message–Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study
%A Coleman,Jesse
%A Eriksen,Jaran
%A Black,Vivian
%A Thorson,Anna
%A Hatcher,Abigail
%+ Wits Reproductive Health & HIV Institute, School of Medicine, University of Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2001, South Africa, 27 833991066, denots@gmail.com
%K maternal health
%K text messaging
%K focus groups
%K South Africa
%K mHealth
%K reproductive health
%K limited resource settings
%K public health
%K prenatal care
%K postnatal care
%D 2020

%7 29.6.2020
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program. Objective: The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback. Methods: Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback. Results: The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family. Conclusions: These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system. 
%M 32459628
%R 10.2196/14078
%U http://humanfactors.jmir.org/2020/2/e14078/
%U https://doi.org/10.2196/14078
%U http://www.ncbi.nlm.nih.gov/pubmed/32459628

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 6
%P e15375
%T The Clinical and Cost-Effectiveness of Telerehabilitation for People With Nonspecific Chronic Low Back Pain: Randomized Controlled Trial
%A Fatoye,Francis
%A Gebrye,Tadesse
%A Fatoye,Clara
%A Mbada,Chidozie E
%A Olaoye,Mistura I
%A Odole,Adesola C
%A Dada,Olumide
%+ Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Birley Fields Campus, Bonsall Street, Manchester, M15 6GX, United Kingdom, 44 0161 247 2963, f.fatoye@mmu.ac.uk
%K cost-utility analysis
%K quality-adjusted life years
%K telerehabilitation
%K low back pain
%K mobile phone
%D 2020

%7 24.6.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Telerehabilitation can facilitate multidisciplinary management for people with nonspecific chronic low back pain (NCLBP). It provides health care access to individuals who are physically and economically disadvantaged. Objective: This study aimed to evaluate the clinical and cost-effectiveness of telerehabilitation compared with a clinic-based intervention for people with NCLBP in Nigeria. Methods: A cost-utility analysis alongside a randomized controlled trial from a health care perspective was conducted. Patients with NCLBP were assigned to either telerehabilitation-based McKenzie therapy (TBMT) or clinic-based McKenzie therapy (CBMT). Interventions were carried out 3 times weekly for a period of 8 weeks. Patients’ level of disability was measured using the Oswestry Disability Index (ODI) at baseline, week 4, and week 8. To estimate the health-related quality of life of the patients, the ODI was mapped to the short-form six dimensions instrument to generate quality-adjusted life years (QALYs). Health care resource use and costs were assessed based on the McKenzie extension protocol in Nigeria in 2019. Descriptive and inferential data analyses were also performed to assess the clinical effectiveness of the interventions. Bootstrapping was conducted to generate the point estimate of the incremental cost-effectiveness ratio (ICER). Results: A total of 47 patients (TBMT, n=21 and CBMT, n=26), with a mean age of 47 (SD 11.6) years for telerehabilitation and 50 (SD 10.7) years for the clinic-based intervention, participated in this study. The mean cost estimates of TBMT and CBMT interventions per person were 22,200 naira (US $61.7) and 38,200 naira (US $106), respectively. QALY gained was 0.085 for TBMT and 0.084 for CBMT. The TBMT arm was associated with an additional 0.001 QALY (95% CI 0.001 to 0.002) per participant compared with the CBMT arm. Thus, the ICER showed that the TBMT arm was less costly and more effective than the CBMT arm. Conclusions: The findings of the study suggested that telerehabilitation for people with NCLBP was cost saving. Given the small number of participants in this study, further examination of effects and costs of the interventions is needed within a larger sample size. In addition, future studies are required to assess the cost-effectiveness of this intervention in the long term from the patient and societal perspective. 
%M 32357128
%R 10.2196/15375
%U http://mhealth.jmir.org/2020/6/e15375/
%U https://doi.org/10.2196/15375
%U http://www.ncbi.nlm.nih.gov/pubmed/32357128

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 6
%P e14714
%T Gender and the Digital Divide Across Urban Slums of New Delhi, India: Cross-Sectional Study
%A Joshi,Ashish
%A Malhotra,Bhavya
%A Amadi,Chioma
%A Loomba,Menka
%A Misra,Archa
%A Sharma,Shruti
%A Arora,Arushi
%A Amatya,Jaya
%+ Graduate School of Public Health and Health Policy, City University of New York, 55W 125th Street, New York, NY, United States, 1 4435706018, ashish.joshi@sph.cuny.edu
%K gender
%K digital divide
%K mobile phone
%K internet access
%K text messaging
%K slums
%D 2020

%7 22.6.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Disparities in access to specific technologies within gender groups have not been investigated. Slum settings provide an ideal population to investigate the contributing factors to these disparities. Objective: This study aimed to examine gender differences in mobile phone ownership, internet access, and knowledge of SMS text messaging among males and females living in urban slum settings. Methods: A convenience sampling approach was used in sample selection from 675 unnotified slums. A total of 38 slum sites were then selected across four geographic zones. Of these, 10% of the households in each slum site was selected from each zone. One household member was interviewed based on their availability and fulfillment of the eligibility criteria. Eligible individuals included those aged 18 years and above, residing in these slums, and who provided voluntary consent to participate in the study. Individuals with mental or physical challenges were excluded from the study. Results: Our results showed that females were half as likely to own mobile phones compared with males (odds ratio [OR] 0.53, 95% CI 0.37-0.76), less likely to have internet access (OR 0.79, 95% CI 0.56-1.11), or know how to send text messages (OR 0.93, 95% CI 0.66-1.31). The predictors of mobile phone ownership, internet access, and text messaging between males and females included age, individual education, housing type, and the number of earning members in a household in the adjusted analysis. Among males, the number of earning members was a predictor of both mobile phone ownership and text messaging, whereas household education was a predictor of both internet access and text messaging. Age and individual education only predicted internet access, whereas housing type only predicted text messaging. Among females, household education was a predictor of all the technology outcomes. Age and type of toilet facility only predicted mobile phone ownership; housing type only predicted internet access whereas television ownership with satellite service and smoking behavior only predicted text messaging. Conclusions: Our study findings showing disparate access to technology within gender groups lend support for further research to examine the causal mechanisms promoting these differences to proffer significant solutions. Specifically, our study findings suggest that improving household education is crucial to address the disparate access and usage of mobile phones, the internet, and text messaging among women in slum settings. This suggestion is due to the consistency in household educational level as a predictor across all these technology indicators. In addition, the mechanisms by which the number of household earning members influences the disparate access to technology among men call for further exploration. 
%M 32343670
%R 10.2196/14714
%U https://www.jmir.org/2020/6/e14714
%U https://doi.org/10.2196/14714
%U http://www.ncbi.nlm.nih.gov/pubmed/32343670

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 6
%P e16345
%T Smartphone-Guided Algorithms for Use by Community Volunteers to Screen and Refer People With Eye Problems in Trans Nzoia County, Kenya: Development and Validation Study
%A Rono,Hillary
%A Bastawrous,Andrew
%A Macleod,David
%A Bunywera,Cosmas
%A Mamboleo,Ronald
%A Wanjala,Emmanuel
%A Burton,Matthew
%+ Clinical Research Department, International Centre for Eye Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, United Kingdom, 254 722627207, hillary.rono@lshtm.ac.uk
%K visual impairment
%K algorithms
%K mobile phone
%K screening
%K mHealth
%K sensitivity
%K specificity
%D 2020

%7 19.6.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The provision of eye care services is currently insufficient to meet the requirements of eye care. Many people remain unnecessarily visually impaired or at risk of becoming so because of treatable or preventable eye conditions. A lack of access and awareness of services is, in large part, a key barrier to handle this unmet need. Objective: This study aimed to assess whether utilizing novel smartphone-based clinical algorithms can task-shift eye screening to community volunteers (CVs) to accurately identify and refer patients to primary eye care services. In particular, we developed the Peek Community Screening app and assessed its validity in making referral decisions for patients with eye problems. Methods: We developed a smartphone-based clinical algorithm (the Peek Community Screening app) using age, distance vision, near vision, and pain as referral criteria. We then compared CVs’ referral decisions using this app with those made by an experienced ophthalmic clinical officer (OCO), which was the reference standard. The same participants were assessed by a trained CV using the app and by an OCO using standard outreach equipment. The outcome was the proportion of all decisions that were correct when compared with that of the OCO. Results: The required sensitivity and specificity for the Peek Community Screening app were achieved after seven iterations. In the seventh iteration, the OCO identified referable eye problems in 65.9% (378/574) of the participants. CVs correctly identified 344 of 378 (sensitivity 91.0%; 95% CI 87.7%-93.7%) of the cases and correctly identified 153 of 196 (specificity 78.1%; 95% CI 71.6%-83.6%) cases as not having a referable eye problem. The positive predictive value was 88.9% (95% CI 85.3%-91.8%), and the negative predictive value was 81.8% (95% CI 75.5%-87.1%). Conclusions: Development of such an algorithm is feasible; however, it requires considerable effort and resources. CVs can accurately use the Peek Community Screening app to identify and refer people with eye problems. An iterative design process is necessary to ensure validity in the local context. 
%M 32558656
%R 10.2196/16345
%U https://mhealth.jmir.org/2020/6/e16345
%U https://doi.org/10.2196/16345
%U http://www.ncbi.nlm.nih.gov/pubmed/32558656

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 9
%N 6
%P e16676
%T Achieving Optimal Gestational Weight Gain, Birth Weight, and Perinatal Outcomes Among Pregnant Women at Risk of Hypertension: Protocol for a Pilot Randomized Controlled Trial
%A Hasan,S M Tafsir
%A Ahmed,Syed Imran
%A Khan,Md Alfazal
%A Sarker,Shafiqul Alam
%A Ahmed,Tahmeed
%+ Nutrition and Clinical Services Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 1712523391, tafsir.hasan@icddrb.org
%K hypertensive disorder
%K hypertension
%K pregnancy
%K preeclampsia
%K gestational weight gain
%K continuous blood pressure monitor
%K wearable device
%K Health Gauge
%K birth weight
%K perinatal outcome
%D 2020

%7 15.6.2020
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Hypertensive disorders, including preeclampsia, complicate 10% of all pregnancies, causing maternal and fetal morbidity and mortality. In Bangladesh, 24% of all maternal deaths are directly attributed to hypertensive disorders. Conventional antenatal care practices often delay or miss detecting hypertensive disorders in pregnancy, which may allow some women to become vulnerable to the adverse consequences of the hypertensive disorders. Regular self-monitoring of blood pressure and weight gain may improve maternal and fetal outcomes among pregnant women at risk of developing hypertensive disorders during pregnancy through early diagnosis, prompt referral, and timely clinical management; however, to undertake a randomized controlled trial of an intervention to reduce adverse consequences of hypertensive disorders in pregnancy, its feasibility must first be determined. Objective: The objectives of this study are to evaluate the accuracy of a wearable blood pressure monitoring device (Health Gauge) in order to test the design and methods of a future definitive randomized controlled trial, and to examine the feasibility, acceptability, and fidelity of an intervention focusing on regular monitoring of weight gain and self-monitoring of blood pressure for pregnant women at risk of developing hypertensive disorders and their associated complications. Methods: The study is located in Matlab, Bangladesh will be conducted in two phases. First, a wearable blood pressure device (Health Gauge) will be validated in accordance with the European Society of Hypertension International Protocol (revision 2010). Second, a prospective, two-arm, parallel, and nonblinded randomized controlled external pilot trial will be conducted. In the pilot trial, 70 eligible participants will be individually randomized to the intervention arm, in which pregnant women will self-monitor their blood pressure daily using a wearable device (Health Gauge) and be evaluated monthly by trained health workers for weight gain from 20 weeks of gestation until delivery, or the control arm, in which pregnant women will be assessed for weight gain every two months from 20 weeks of gestation until delivery (1:1 intervention to control allocation ratio using a permuted block randomization method with concealment). All women will receive standard antenatal care. Results: A validation study of the wearable blood pressure device has successfully been conducted among the general adult population in Matlab, Bangladesh. As of September 2019, the pilot trial has completed enrollment of women who are pregnant (N=70; intervention: n=35; control: n=35) and follow-up of the participants is ongoing. Data analysis is expected to be completed by June 2020, and results are expected to be submitted for publication in August 2020. Conclusions: The findings of this study will help us to design a comprehensive, full-scale randomized controlled trial to test the efficacy of regular self-monitoring of blood pressure and weight gain during pregnancy, a simple and inexpensive intervention to help to achieve optimal maternal and fetal outcomes in pregnant women at risk of developing hypertensive disorders and their associated complications during pregnancy. Trial Registration: ClinicalTrials.gov NCT03858595; https://clinicaltrials.gov/ct2/show/NCT03858595 International Registered Report Identifier (IRRID): DERR1-10.2196/16676 
%M 32459639
%R 10.2196/16676
%U http://www.researchprotocols.org/2020/6/e16676/
%U https://doi.org/10.2196/16676
%U http://www.ncbi.nlm.nih.gov/pubmed/32459639

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 6
%P e16721
%T The Mediating Role of Organizational Reputation and Trust in the Intention to Use Wearable Health Devices: Cross-Country Study
%A Adebesin,Funmi
%A Mwalugha,Revingstone
%+ Department of Informatics, University of Pretoria, Corner of Lynwood and Roper Street, Hatfield, Pretoria, 0083, South Africa, 27 0124205667, funmi.adebesin@up.ac.za
%K fitness trackers
%K intention
%K Kenya
%K physical activity
%K privacy
%K South Africa
%K trust
%K regression analysis
%D 2020

%7 9.6.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The use of consumer wearable health devices for fitness tracking has seen an upward trend across the globe. Previous studies have shown that trust is an important factor in the adoption and use of new technologies. However, little is known about the influence of organizational reputation and trust on the intention to use wearable health devices. Objective: This study aimed to investigate the mediating role of organizational reputation and trust in the intention to use wearable health devices and to examine the extent to which the country of residence influenced the effect of organizational reputation on consumers’ trust in and intention to use wearable health devices. Methods: We conducted a cross-country survey with participants from Kenya and South Africa using a Google Forms questionnaire derived from previously validated items. A series of mediation regression analyses were carried out using the PROCESS macro with the bootstrap CI procedure. A one-way, between-group multivariate analysis of variance (MANOVA) was also used to determine the key factors that distinguish Kenyans and South Africans in their intention to use wearable health devices. Results: A total of 232 questionnaire responses were collected. The results revealed that organizational reputation significantly mediates the relationship between trust propensity and trust, with an indirect effect of 0.22 (95% CI 0.143-0.309). Organizational reputation also plays a significant direct role in the intention to use a wearable health device, with a direct effect of 0.32 (95% CI 0.175-0.483). This role is regardless of participants’ country of residence. Furthermore, there is a significant mediating effect of trust on the relationship between trust propensity and the intention to use a wearable health device, with an indirect effect of 0.26 (95% CI 0.172-0.349); between perceived security and the intention to use a wearable health device, with an indirect effect of 0.36 (95% CI 0.255-0.461); and between perceived privacy and the intention to use a wearable health device, with an indirect effect of 0.42 (95% CI 0.282-0.557). The MANOVA test shows statistically significant differences in all variables for both groups, with the exception of organizational reputation where there is no significant difference between the two cohorts. Conclusions: Organizational reputation has a significant direct influence on participants’ trust in and the intention to use a wearable health device irrespective of their country of residence. Even in the presence of perceived security and perceived privacy, trust has a significant mediating effect on the intention to use a wearable health device. 
%M 32348260
%R 10.2196/16721
%U http://mhealth.jmir.org/2020/6/e16721/
%U https://doi.org/10.2196/16721
%U http://www.ncbi.nlm.nih.gov/pubmed/32348260

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 6
%P e15890
%T Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study
%A Watterson,Jessica L
%A Castaneda,Diego
%A Catalani,Caricia
%+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3602014410, jessica.watterson@gmail.com
%K mHealth
%K antenatal care
%K maternal health
%K text messages
%D 2020

%7 2.6.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective: This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods: This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women’s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results: The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions: These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization. 
%M 32484446
%R 10.2196/15890
%U https://mhealth.jmir.org/2020/6/e15890
%U https://doi.org/10.2196/15890
%U http://www.ncbi.nlm.nih.gov/pubmed/32484446

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 5
%P e15096
%T A Mobile Phone–Based Sexual and Reproductive Health Intervention for Female Sex Workers in Kenya: Development and Qualitative Study
%A Ampt,Frances H
%A L'Engle,Kelly
%A Lim,Megan S C
%A Plourde,Kate F
%A Mangone,Emily
%A Mukanya,Collins Mudogo
%A Gichangi,Peter
%A Manguro,Griffins
%A Hellard,Margaret
%A Stoové,Mark
%A Chersich,Matthew F
%A Jaoko,Walter
%A Agius,Paul A
%A Temmerman,Marleen
%A Wangari,Winnie
%A Luchters,Stanley
%+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 2 9282 2111, frances.ampt@burnet.edu.au
%K sex work
%K mobile health (mHealth)
%K unintended pregnancy
%K qualitative research
%D 2020

%7 29.5.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Female sex workers (FSWs) have high rates of both unintended pregnancy and HIV, but few health promotion interventions address their contraceptive needs or other sexual and reproductive health and rights (SRHR) concerns. A broader approach integrates contraceptive promotion with HIV and sexually transmitted infection (STI) prevention and management, alcohol awareness, gender-based violence and rights, and health care utilization. The Women’s Health Intervention using SMS for Preventing Pregnancy (WHISPER) mobile phone intervention uses a participatory development approach and behavior change theory to address these high-priority concerns of FSWs in Mombasa, Kenya. Objective: This paper aimed to (1) describe the process of development of the WHISPER intervention, its theoretical framework, key content domains and strategies and (2) explore workshop participants’ responses to the proposed intervention, particularly with regard to message content, behavior change constructs, and feasibility and acceptability. Methods: The research team worked closely with FSWs in two phases of intervention development. First, we drafted content for three different types of messages based on a review of the literature and behavior change theories. Second, we piloted the intervention by conducting six workshops with 42 FSWs to test and refine message content and 12 interviews to assess the technical performance of the intervention. Workshop data were thematically analyzed using a mixed deductive and inductive approach. Results: The intervention framework specified six SRHR domains that were viewed as highly relevant by FSWs. Reactions to intervention content revealed that social cognitive strategies to improve knowledge, outcome expectations, skills, and self-efficacy resonated well with workshop participants. Participants found the content empowering, and most said they would share the messages with others. The refined intervention was a 12-month SMS program consisting of informational and motivational messages, role model stories portraying behavior change among FSWs, and on-demand contraceptive information. Conclusions: Our results highlight the need for health promotion interventions that incorporate broader components of SRHR, not only HIV prevention. Using a theory-based, participatory approach, we developed a digital health intervention that reflects the complex reality of FSWs’ lives and provides a feasible, acceptable approach for addressing SRHR concerns and needs. FSWs may benefit from health promotion interventions that provide relevant, actionable, and engaging content to support behavior change. 
%M 32469326
%R 10.2196/15096
%U https://mhealth.jmir.org/2020/5/e15096
%U https://doi.org/10.2196/15096
%U http://www.ncbi.nlm.nih.gov/pubmed/32469326

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 4
%N 5
%P e17179
%T Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study
%A Zhang,Donglan
%A Jin,Lan
%A Liang,Di
%A Geng,Ruijin
%A Liu,Yun
%A Ling,Yu
%A Jiang,Fan
%A Zhang,Yunting
%+ Child Health Advocacy Institute, National Children’s Medical Center, Shanghai Children’s Medical Center, 1678 Dongfang Road, Pudong, Shanghai, China, 86 21 3862606, zhangyunting@scmc.com.cn
%K mobile health
%K interview
%K health belief model
%K early child development
%D 2020

%7 28.5.2020
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. 
%M 32463374
%R 10.2196/17179
%U http://formative.jmir.org/2020/5/e17179/
%U https://doi.org/10.2196/17179
%U http://www.ncbi.nlm.nih.gov/pubmed/32463374

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 6
%N 2
%P e15860
%T The Surveillance Outbreak Response Management and Analysis System (SORMAS): Digital Health Global Goods Maturity Assessment
%A Tom-Aba,Daniel
%A Silenou,Bernard Chawo
%A Doerrbecker,Juliane
%A Fourie,Carl
%A Leitner,Carl
%A Wahnschaffe,Martin
%A Strysewske,Maté
%A Arinze,Chinedu Chukwujekwu
%A Krause,Gerard
%+ Helmholtz Centre for Infection Research, Department of Epidemiology, Inhoffenstrasse 7, Braunschweig, 38124, Germany, 49 01739136081, daniel.tom-aba@helmholtz-hzi.de
%K mHealth
%K eHealth
%K contact tracing
%K case management
%K epidemiology
%K Ebola Virus Disease
%K West Africa
%K infectious diseases
%D 2020

%7 29.4.2020
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Digital health is a dynamic field that has been generating a large number of tools; many of these tools do not have the level of maturity required to function in a sustainable model. It is in this context that the concept of global goods maturity is gaining importance. Digital Square developed a global good maturity model (GGMM) for digital health tools, which engages the digital health community to identify areas of investment for global goods. The Surveillance Outbreak Response Management and Analysis System (SORMAS) is an open-source mobile and web application software that we developed to enable health workers to notify health departments about new cases of epidemic-prone diseases, detect outbreaks, and simultaneously manage outbreak response. Objective: The objective of this study was to evaluate the maturity of SORMAS using Digital Square’s GGMM and to describe the applicability of the GGMM on the use case of SORMAS and identify opportunities for system improvements. Methods: We evaluated SORMAS using the GGMM version 1.0 indicators to measure its development. SORMAS was scored based on all the GGMM indicator scores. We described how we used the GGMM to guide the development of SORMAS during the study period. GGMM contains 15 subindicators grouped into the following core indicators: (1) global utility, (2) community support, and (3) software maturity. Results: The assessment of SORMAS through the GGMM from November 2017 to October 2019 resulted in full completion of all subscores (10/30, (33%) in 2017; 21/30, (70%) in 2018; and 30/30, (100%) in 2019). SORMAS reached the full score of the GGMM for digital health software tools by accomplishing all 10 points for each of the 3 indicators on global utility, community support, and software maturity. Conclusions: To our knowledge, SORMAS is the first electronic health tool for disease surveillance, and also the first outbreak response management tool, that has achieved a 100% score. Although some conceptual changes would allow for further improvements to the system, the GGMM already has a robust supportive effect on developing software toward global goods maturity. 
%M 32347809
%R 10.2196/15860
%U https://publichealth.jmir.org/2020/2/e15860
%U https://doi.org/10.2196/15860
%U http://www.ncbi.nlm.nih.gov/pubmed/32347809

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 4
%P e13536
%T Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study
%A Steinman,Lesley
%A Heang,Hen
%A van Pelt,Maurits
%A Ide,Nicole
%A Cui,Haixia
%A Rao,Mayuree
%A LoGerfo,James
%A Fitzpatrick,Annette
%+ Department of Health Services, University of Washington, 1107 NE 45th St Suite 400, Seattle, WA, 98105, United States, 1 2065439837, lesles@uw.edu
%K diabetes mellitus
%K hypertension
%K chronic disease
%K noncommunicable diseases
%K health educators
%K mHealth
%K qualitative
%K disease management
%K developing countries
%D 2020

%7 24.4.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines. Objective: This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services. Methods: We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development. Results: We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings. Conclusions: These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management. 
%M 32329737
%R 10.2196/13536
%U http://mhealth.jmir.org/2020/4/e13536/
%U https://doi.org/10.2196/13536
%U http://www.ncbi.nlm.nih.gov/pubmed/32329737

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 4
%P e17122
%T Patterns of Mobile Phone Ownership and Use Among Pregnant Women in Southern Tanzania: Cross-Sectional Survey
%A Vasudevan,Lavanya
%A Ostermann,Jan
%A Moses,Sara Marwerwe
%A Ngadaya,Esther
%A Mfinanga,Sayoki Godfrey
%+ Department of Family Medicine and Community Health, School of Medicine, Duke University, DUMC 104006, Durham, NC, 27710, United States, 1 9196131423, lavanya.vasudevan@duke.edu
%K digital health
%K mobile health
%K pregnant women
%K Tanzania
%D 2020

%7 8.4.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There is a paucity of subnational data on patterns of mobile phone ownership and use in Tanzania to inform the development of digital health interventions. Objective: The aim of this study is to assess patterns of mobile phone ownership and use in pregnant women to inform the feasibility and design of digital health interventions for promoting timely uptake of childhood vaccines in southern Tanzania. Methods: Between August and November 2017, pregnant women in their third trimester were enrolled at health facilities and from surrounding communities, and asked about their patterns of mobile phone ownership and use in an interviewer administered survey. Results: Of 406 women, only 3 had never used a phone. Most women (>98%) could make and receive phone calls. Compared to urban women, rural women reported higher mobile phone use rates but were less likely to be sole owners of phones, and less likely to send or receive SMS, transact money, browse the internet, or use social media via mobile phones. Conclusions: The findings suggest high feasibility for digital health interventions delivered via mobile phones to pregnant women in southern Tanzania. The feasibility of smartphone-based interventions or strategies relying on the use of social media or the internet is limited. 
%M 32267240
%R 10.2196/17122
%U https://mhealth.jmir.org/2020/4/e17122
%U https://doi.org/10.2196/17122
%U http://www.ncbi.nlm.nih.gov/pubmed/32267240

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 9
%N 3
%P e14405
%T Automated Respiratory Rate Counter to Assess Children for Symptoms of Pneumonia: Protocol for Cross-Sectional Usability and Acceptability Studies in Ethiopia and Nepal
%A Baker,Kevin
%A Maurel,Alice
%A Ward,Charlotte
%A Getachew,Dawit
%A Habte,Tedila
%A McWhorter,Cindy
%A LaBarre,Paul
%A Karlström,Jonas
%A Petzold,Max
%A Källander,Karin
%+ Malaria Consortium, The Green House, 224-254 Cambridge Heath Road, London, E2 9DA, United Kingdom, 44 781 126 6539, k.baker@malariaconsortium.org
%K community health worker
%K pneumonia
%K child
%K respiratory rate
%K Nepal
%K Ethiopia
%D 2020

%7 30.3.2020
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Manually counting a child’s respiratory rate (RR) for 60 seconds using an acute respiratory infection timer is the World Health Organization (WHO) recommended method for detecting fast breathing as a sign of pneumonia. However, counting the RR is challenging and misclassification of an observed rate is common, often leading to inappropriate treatment. To address this gap, the acute respiratory infection diagnostic aid (ARIDA) project was initiated in response to a call for better pneumonia diagnostic aids and aimed to identify and assess automated RR counters for classifying fast breathing pneumonia when used by front-line health workers in resource-limited community settings and health facilities. The Children’s Automated Respiration Monitor (ChARM), an automated RR diagnostic aid using accelerometer technology developed by Koninklijke Philips NV, and the Rad-G, a multimodal RR diagnostic and pulse oximeter developed by Masimo, were the two devices tested in these studies conducted in the Southern Nations, Nationalities, and Peoples’ Region in Ethiopia and in the Karnali region in Nepal. Objective: In these studies, we aimed to understand the usability of two new automated RR diagnostic aids for community health workers (CHWs; health extension workers [Ethiopia] and female community health volunteers [Nepal]) and their acceptability to CHWs in Ethiopia and Nepal, first-level health facility workers (FLHFWs) in Ethiopia only, and caregivers in both Ethiopia and Nepal. Methods: This was a prospective, cross-sectional study with a mixed methods design. CHWs and FLHFWs were trained to use both devices and provided with refresher training on all WHO requirements to assess fast breathing. Immediately after training, CHWs were observed using ARIDA on two children. Routine pneumonia case management consultations for children aged 5 years and younger and the device used for these consultations between the first and second consultations were recorded by CHWs in their patient log books. CHWs were observed a second time after 2 months. Semistructured interviews were also conducted with CHWs, FLHFWs, and caregivers. The proportion of consultations with children aged 5 years and younger where CHWs using an ARIDA and adhered to all WHO requirements to assess fast breathing and device manufacturer instructions for use after 2 months will be calculated. Qualitative data from semistructured interviews will be analyzed using a thematic framework approach. Results: The ARIDA project was funded in November 2015, and data collection was conducted between April and December 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in 2020. Conclusions: This is the first time the usability and acceptability of automated RR counters in low-resource settings have been evaluated. Outcomes will be relevant for policy makers and are important for future research of this new class of diagnostic aids for the management of children with suspected pneumonia. International Registered Report Identifier (IRRID): DERR1-10.2196/14405 
%M 32224491
%R 10.2196/14405
%U http://www.researchprotocols.org/2007/3/e14405/
%U https://doi.org/10.2196/14405
%U http://www.ncbi.nlm.nih.gov/pubmed/32224491

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 3
%P e16467
%T Quantitative Screening of Cervical Cancers for Low-Resource Settings: Pilot Study of Smartphone-Based Endoscopic Visual Inspection After Acetic Acid Using Machine Learning Techniques
%A Bae,Jung Kweon
%A Roh,Hyun-Jin
%A You,Joon S
%A Kim,Kyungbin
%A Ahn,Yujin
%A Askaruly,Sanzhar
%A Park,Kibeom
%A Yang,Hyunmo
%A Jang,Gil-Jin
%A Moon,Kyung Hyun
%A Jung,Woonggyu
%+ Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Rm#709, 110 Bldg, 50 Unist-gil, Ulsan, 44919, Republic of Korea, 82 1084640110, wgjung@unist.ac.kr
%K smartphone-based endoscope
%K smartphone VIA
%K machine learning
%K cervical cancer screening
%K low-resource settings
%D 2020

%7 11.3.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Approximately 90% of global cervical cancer (CC) is mostly found in low- and middle-income countries. In most cases, CC can be detected early through routine screening programs, including a cytology-based test. However, it is logistically difficult to offer this program in low-resource settings due to limited resources and infrastructure, and few trained experts. A visual inspection following the application of acetic acid (VIA) has been widely promoted and is routinely recommended as a viable form of CC screening in resource-constrained countries. Digital images of the cervix have been acquired during VIA procedure with better quality assurance and visualization, leading to higher diagnostic accuracy and reduction of the variability of detection rate. However, a colposcope is bulky, expensive, electricity-dependent, and needs routine maintenance, and to confirm the grade of abnormality through its images, a specialist must be present. Recently, smartphone-based imaging systems have made a significant impact on the practice of medicine by offering a cost-effective, rapid, and noninvasive method of evaluation. Furthermore, computer-aided analyses, including image processing–based methods and machine learning techniques, have also shown great potential for a high impact on medicinal evaluations. Objective: In this study, we demonstrate a new quantitative CC screening technique and implement a machine learning algorithm for smartphone-based endoscopic VIA. We also evaluated the diagnostic performance and practicability of the approach based on the results compared to the gold standard and from physicians’ interpretation. Methods: A smartphone-based endoscope system was developed and applied to the VIA screening. A total of 20 patients were recruited for this study to evaluate the system. Overall, five were healthy, and 15 were patients who had shown a low to high grade of cervical intraepithelial neoplasia (CIN) from both colposcopy and cytology tests. Endoscopic VIA images were obtained before a loop electrosurgical excision procedure for patients with abnormal tissues, and their histology tissues were collected. Endoscopic VIA images were assessed by four expert physicians relative to the gold standard of histopathology. Also, VIA features were extracted from multiple steps of image processing techniques to find the differences between abnormal (CIN2+) and normal (≤CIN1). By using the extracted features, the performance of different machine learning classifiers, such as k-nearest neighbors (KNN), support vector machine, and decision tree (DT), were compared to find the best algorithm for VIA. After determining the best performing classifying model, it was used to evaluate the screening performance of VIA. Results: An average accuracy of 78%, with a Cohen kappa of 0.571, was observed for the evaluation of the system by four physicians. Through image processing, 240 sliced images were obtained from the cervicogram at each clock position, and five features of VIA were extracted. Among the three models, KNN showed the best performance for finding VIA within holdout 10-fold cross-validation, with an accuracy of 78.3%, area under the curve of 0.807, a specificity of 80.3%, and a sensitivity of 75.0%, respectively. The trained model performed using an unprovided data set resulted in an accuracy of 80.8%, specificity of 84.1%, and sensitivity of 71.9%. Predictions were visualized with intuitive color labels, indicating the normal/abnormal tissue using a circular clock-type segmentation. Calculating the overlapped abnormal tissues between the gold standard and predicted value, the KNN model overperformed the average assessments of physicians for finding VIA. Conclusions: We explored the potential of the smartphone-based endoscopic VIA as an evaluation technique and used the cervicogram to evaluate normal/abnormal tissue using machine learning techniques. The results of this study demonstrate its potential as a screening tool in low-resource settings. 
%M 32159521
%R 10.2196/16467
%U http://mhealth.jmir.org/2020/3/e16467/
%U https://doi.org/10.2196/16467
%U http://www.ncbi.nlm.nih.gov/pubmed/32159521

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 22
%N 2
%P e15553
%T The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India
%A Maulik,Pallab K
%A Devarapalli,Siddhardha
%A Kallakuri,Sudha
%A Bhattacharya,Amritendu
%A Peiris,David
%A Patel,Anushka
%+ George Insitute for Global Health, 311-312 Elegance Tower, New Delhi, 110025, India, 91 8800493204, pmaulik@georgeinstitute.org.in
%K mental health services
%K mHealth
%K rural
%K India
%K mental disorders
%K primary health care
%D 2020

%7 27.2.2020
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective: This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods: A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results: In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions: The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial. 
%M 32130125
%R 10.2196/15553
%U http://www.jmir.org/2020/2/e15553/
%U https://doi.org/10.2196/15553
%U http://www.ncbi.nlm.nih.gov/pubmed/32130125

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 2
%P e16030
%T A Men Who Have Sex With Men–Friendly Doctor Finder Hackathon in Guangzhou, China: Development of a Mobile Health Intervention to Enhance Health Care Utilization
%A Li,Chunyan
%A Xiong,Yuan
%A Sit,Hao Fong
%A Tang,Weiming
%A Hall,Brian J
%A Muessig,Kathryn E
%A Wei,Chongyi
%A Bao,Huanyu
%A Wei,Shufang
%A Zhang,Dapeng
%A Mi,Guodong
%A Yu,Fei
%A Tucker,Joseph D
%+ Social Entrepreneurship to Spur Health Global, University of North Carolina Chapel Hill Project-China, No 2 Lujing Road, Guangzhou, 510095, China, 86 13302391532, jdtucker@med.unc.edu
%K mobile health
%K hackathon
%K crowdsourcing
%K men who have sex with men
%K MSM-friendly
%K health care utilization
%D 2020

%7 27.2.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHeath)–based HIV and sexual health promotion among men who have sex with men (MSM) is feasible in low- and middle-income settings. However, many currently available mHealth tools on the market were developed by the private sector for profit and have limited input from MSM communities. Objective: A health hackathon is an intensive contest that brings together participants from multidisciplinary backgrounds to develop a proposed solution for a specific health issue within a short period. The purpose of this paper was to describe a hackathon event that aimed to develop an mHealth tool to enhance health care (specifically HIV prevention) utilization among Chinese MSM, summarize characteristics of the final prototypes, and discuss implications for future mHealth intervention development. Methods: The hackathon took place in Guangzhou, China. An open call for hackathon participants was advertised on 3 Chinese social media platforms, including Blued, a popular social networking app among MSM. All applicants completed a Web-based survey and were then scored. The top scoring applicants were grouped into teams based on their skills and content area expertise. Each team was allowed 1 month to prepare for the hackathon. The teams then came together in person with on-site expert mentorship for a 72-hour hackathon contest to develop and present mHealth prototype solutions. The judging panel included experts in psychology, public health, computer science, social media, clinical medicine, and MSM advocacy. The final prototypes were evaluated based on innovation, usability, and feasibility. Results: We received 92 applicants, and 38 of them were selected to attend the April 2019 hackathon. A total of 8 teams were formed, including expertise in computer science, user interface design, business or marketing, clinical medicine, and public health. Moreover, 24 participants self-identified as gay, and 3 participants self-identified as bisexual. All teams successfully developed a prototype tool. A total of 4 prototypes were designed as a mini program that could be embedded within a popular Chinese social networking app, and 3 prototypes were designed as stand-alone apps. Common prototype functions included Web-based physician searching based on one’s location (8 prototypes), health education (4 prototypes), Web-based health counseling with providers or lay health volunteers (6 prototypes), appointment scheduling (8 prototypes), and between-user communication (2 prototypes). All prototypes included strategies to ensure privacy protection for MSM users, and some prototypes offered strategies to ensure privacy of physicians. The selected prototypes are undergoing pilot testing. Conclusions: This study demonstrated the feasibility and acceptability of using a hackathon to create mHealth intervention tools. This suggests a different pathway to developing mHealth interventions and could be relevant in other settings. 
%M 32130189
%R 10.2196/16030
%U http://mhealth.jmir.org/2020/2/e16030/
%U https://doi.org/10.2196/16030
%U http://www.ncbi.nlm.nih.gov/pubmed/32130189

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 2
%P e16276
%T A Mobile Phone–Based Support Intervention to Increase Use of Postabortion Family Planning in Cambodia: Cost-Effectiveness Evaluation
%A Hill,Jeremy
%A McGinn,Jourdan
%A Cairns,John
%A Free,Caroline
%A Smith,Chris
%+ Graduate School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4, Sakamoto, Nagasaki-shi, 852-8523, Japan, 81 8087105309, christopher.smith@lshtm.ac.uk
%K mHealth
%K digital health
%K cost-effectiveness
%K contraception
%K postabortion contraception
%K postabortion family planning
%K Cambodia
%D 2020

%7 25.2.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly among hard-to-reach populations, by providing interactive personalized support inexpensively wherever the person is located and whenever needed. Objective: The objective of this study was to evaluate the cost-effectiveness of mobile phone–based support added to standard postabortion family planning care in Cambodia, according to the results of the MOTIF (MObile Technology for Improved Family planning) trial. Methods: A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds. Results: The incremental cost of mobile phone–based support was estimated to be an additional US $8160.49 per 1000 clients, leading to an estimated 518 couple-years of protection (CYPs) gained per 1000 clients and 99 disability-adjusted life-years (DALYs) averted. The incremental cost-effectiveness ratio was US $15.75 per additional CYP and US $82.57 per DALY averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds from US $58 to US $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%. Conclusions: This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone assessed in the MOTIF trial lies within the estimated range of the cost-effectiveness threshold for Cambodia. When assessing value in interventions to improve the uptake and adherence of family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option by policy makers. Trial Registration: ClinicalTrials.gov NCT01823861; https://clinicaltrials.gov/ct2/show/NCT01823861 
%M 32130166
%R 10.2196/16276
%U http://mhealth.jmir.org/2020/2/e16276/
%U https://doi.org/10.2196/16276
%U http://www.ncbi.nlm.nih.gov/pubmed/32130166

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 2
%P e16426
%T Feasibility of a Mobile Health Tool for Mothers to Identify Neonatal Illness in Rural Uganda: Acceptability Study
%A Matin,Shababa B
%A Wallingford,Allison
%A Xu,Shicheng
%A Ng,Natalie
%A Ho,Anthony
%A Vanosdoll,Madison
%A Waiswa,Peter
%A Labrique,Alain B
%A Acharya,Soumyadipta
%+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, , Baltimore, MD, , United States, 1 4105167074, acharya@jhu.edu
%K newborn
%K neonatal health
%K community health workers
%K maternal behavior
%K Uganda
%K World Health Organization
%K mobile apps
%K telemedicine
%D 2020

%7 18.2.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A shortage of community health workers to triage sick neonates and poor recognition of neonatal illness by mothers contribute significantly toward neonatal deaths in low- and middle-income countries. Providing low-resource communities with the tools and knowledge to recognize signs of neonatal distress can lead to early care-seeking behavior. To empower and educate mothers to recognize signs of neonatal illness, we developed a neonatal health assessment device consisting of a smartphone app and a wearable sensor (the NeMo system). Objective: The aim of this study was to determine if mothers in rural Uganda were willing and able to use the NeMo system during the first week of their infant’s life. We also assessed mothers’ responses to the device’s recommendation to seek care. Methods: A total of 20 mothers were enrolled in the study after giving birth in the Iganga District Hospital. Each mother was trained to use the NeMo system to assess her infant for signs of illness before leaving the hospital and was given the NeMo system to use at home for 1 week. Throughout the week, the smartphone tracked the mothers’ usage of NeMo, and the study team visited twice to observe mothers’ ability to use NeMo. Each mother was interviewed at the end of 1 week to gather qualitative feedback on her experience with the NeMo system. Results: In total, 18 mothers completed the study; 2 mothers were withdrawn during the week because of extenuating health circumstances. Moreover, 1 day after enrollment and training, 75% (15/20) of mothers used NeMo properly with no mistakes. Three days after enrollment and training, only 1 mother placed the wearable sensor improperly on her infant. On the final study day, only 1 mother connected the device improperly. Mothers used NeMo an average of 11.67 (SD 5.70) times on their own at home during the 5 full study days. Although the frequency of use per day decreased from day 1 to day 5 of the study (P=.04), 72% (13/18) of mothers used NeMo at least once per day. In total, 64% (9/14) of mothers who received an alert from the NeMo system to seek care for their infants either called the health care professional working with the study team or reused the system immediately and found no danger signs. All 18 mothers agreed or strongly agreed that the NeMo system was easy to use and helped them know when to seek care for their babies. Conclusions: NeMo is a feasible and acceptable tool to aid mothers in rural Uganda to assess their infant’s health. 
%M 32130174
%R 10.2196/16426
%U https://mhealth.jmir.org/2020/2/e16426
%U https://doi.org/10.2196/16426
%U http://www.ncbi.nlm.nih.gov/pubmed/32130174

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 2
%P e16081
%T Operability, Acceptability, and Usefulness of a Mobile App to Track Routine Immunization Performance in Rural Pakistan: Interview Study Among Vaccinators and Key Informants
%A Zaidi,Shehla
%A Shaikh,Saqib Ali
%A Sayani,Saleem
%A Kazi,Abdul Momin
%A Khoja,Adeel
%A Hussain,Syed Shahzad
%A Najmi,Rabia
%+ Department of Community Health Sciences, Aga Khan University, National Stadium Road, Karachi, Pakistan, 92 2134864852, shehla.zaidi@aku.edu
%K mHealth
%K immunization
%K digital technology
%K experience
%K health workers
%D 2020

%7 13.2.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There has been a recent spate of mobile health (mHealth) app use for immunizations and other public health concerns in low- and middle-income countries. However, recent evidence has largely focused on app development or before-and-after effects on awareness or service coverage. There is little evidence on the factors that facilitate adoption of mHealth programs, which is critical to effectively embed digital technology into mainstream health systems. Objective: This study aimed to provide the qualitative experiences of frontline health staff and district managers while engaging with real-time digital technology to improve the coverage of routine childhood immunization in an underserved rural district in Pakistan. Methods: An Android-based app was iteratively developed and used for a 2-year period in 11 union councils of the Tando Muhammad Khan district, an underserved rural district with poor immunization coverage in Pakistan. We used iterative methods to examine the (1) acceptability and operability of the app, (2) validity of the collected data, and (3) use of the collected data. In addition, we collected the barriers and enablers for uptake of the mHealth app. Each of these topics was further explored related to changes in work as well as the enabling factors for and barriers to app use. In-depth interviews were conducted with the 26 vaccinators posted in the 11 union councils and 7 purposively selected key informants (government district managers) involved with the Expanded Program for Immunization. Findings were triangulated in line with the three broad research areas. Results: Digital immunization tracking was considered acceptable by vaccinators and district managers. Real-time immunization data were used to monitor vaccination volume, track children with incomplete vaccinations, develop outreach visit plans, correct existing microplans, and disburse a fuel allowance for outreach sessions. The validity of the app data was perceived to be superior to that of data from manual records. Ease of operability, satisfaction with data, personal recognition, links to field support, and a sense of empowerment served as powerful enablers. Taking twice the time to complete both manual and digital entries and outdated phones over time were considered constraints. An unintended knock-on effect was improved coordination and strengthening of Expanded Program for Immunization review platforms across district stakeholders through digitalized data. Conclusions: Embedding digital technology into mainstream health systems relies on use by both end users and district stakeholders. Ease of operability, satisfaction with data reliability, personal recognition, links to field support, and empowerment are powerful enablers, whereas improved coordination as a result of easy, transparent data access can be an important by-product of digitalization. Findings are relevant not only for wide-scale implementation of immunization tracking apps in Pakistan but also for informing the use of digital technology for results-based delivery by frontline health workers. 
%M 32053115
%R 10.2196/16081
%U https://mhealth.jmir.org/2020/2/e16081
%U https://doi.org/10.2196/16081
%U http://www.ncbi.nlm.nih.gov/pubmed/32053115

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 1
%P e12424
%T Considerations for Improved Mobile Health Evaluation: Retrospective Qualitative Investigation
%A Dick,Samantha
%A O'Connor,Yvonne
%A Thompson,Matthew J
%A O'Donoghue,John
%A Hardy,Victoria
%A Wu,Tsung-Shu Joseph
%A O'Sullivan,Timothy
%A Chirambo,Griphin Baxter
%A Heavin,Ciara
%+ Health Information Systems Research Centre, Cork University Business School, University College Cork, Cork, Ireland, 353 21 420 5576, samantha.dick@ucc.ie
%K telemedicine
%K mHealth
%K research design
%K developing countries
%D 2020

%7 22.1.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile phone use and, consequently, mobile health (mHealth) interventions have seen an exponential increase in the last decade. There is an excess of 318,000 health-related apps available free of cost for consumers to download. However, many of these interventions are not evaluated and are lacking appropriate regulations. Randomized controlled trials are often considered the gold standard study design in determining the effectiveness of interventions, but recent literature has identified limitations in the methodology when used to evaluate mHealth. Objective: The objective of this study was to investigate the system developers’ experiences of evaluating mHealth interventions in the context of a developing country. Methods: We employed a qualitative exploratory approach, conducting semistructured interviews with multidisciplinary members of an mHealth project consortium. A conventional content analysis approach was used to allow codes and themes to be identified directly from the data. Results: The findings from this study identified the system developers’ perceptions of mHealth evaluation, providing an insight into the requirements of an effective mHealth evaluation. This study identified social and technical factors which should be taken into account when evaluating an mHealth intervention. Conclusions: Contextual issues represented one of the most recurrent challenges of mHealth evaluation in the context of a developing country, highlighting the importance of a mixed method evaluation. There is a myriad of social, technical, and regulatory variables, which may impact the effectiveness of an mHealth intervention. Failure to account for these variables in an evaluation may limit the ability of the intervention to achieve long-term implementation and scale. 
%M 32012085
%R 10.2196/12424
%U https://mhealth.jmir.org/2020/1/e12424
%U https://doi.org/10.2196/12424
%U http://www.ncbi.nlm.nih.gov/pubmed/32012085

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 8
%N 1
%P e14036
%T An Ototoxicity Grading System Within a Mobile App (OtoCalc) for a Resource-Limited Setting to Guide Grading and Management of Drug-Induced Hearing Loss in Patients With Drug-Resistant Tuberculosis: Prospective, Cross-Sectional Case Series
%A Hollander,Cara
%A Joubert,Karin
%A Schellack,Natalie
%+ School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi St, Ga-Rankuwa Zone 1, Ga-Rankuwa, 0208, South Africa, 27 828158878, carahollander6@gmail.com
%K drug-resistant tuberculosis
%K ototoxicity
%K grading system
%K eHealth
%K OtoCalc
%D 2020

%7 14.1.2020
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Tuberculosis (TB) affects millions of people worldwide and is treated with medication including aminoglycosides and polypeptides. Individuals respond differently to medications as a result of their genetic inheritance. These differences in genetic inheritance can result in the underdosing or overdosing of medication, which may affect the efficacy or, in the case of aminoglycosides and polypeptides used in the treatment of all forms of TB, result in ototoxicity. When ototoxicity is detected, physicians should adjust dosages to minimize further ototoxicity and hearing loss; however, there are no suitable grading systems to define significant hearing loss. Objective: The aim of this study was to develop a standardized grading system by making use of an electronic health (eHealth) platform to ensure that a user-friendly method was available to interpret hearing test results, calculate significant hearing loss, and provide recommendations with regard to dosage adjustments and management. It further aimed to establish the sensitivity of the newly developed grading scale. Methods: This grading system was developed in South Africa based on data that were obtained from an audiology and pharmacokinetic study on patients with drug-resistant TB (DR-TB) at two DR-TB units at state-run hospitals. This feasibility study employed a prospective, cross-sectional, exploratory, descriptive case series research design, with a total of 22 participants. Participants underwent audiological and pharmacological assessments at baseline and every 2 weeks for the first 3 months of treatment. Various professionals (8 in total) were subsequently involved in the development of the eHealth system, including a software engineer, four audiologists, a pharmacist, a medical doctor, and a nurse. The app underwent 14 modifications that involved aspects of data storage, ease of usability, grades, and the risk factor checklist. Results: An ototoxicity grading system within a mobile app for use by doctors, nurses, and audiologists was developed for patients with DR-TB. The purpose of this user-friendly ototoxicity calculator, OtoCalc, is to (1) assist health professionals in assessing patients for ototoxicity, (2) establish the clinical significance of ototoxicity by calculating the grade of hearing loss, (3) monitor the progression of hearing loss, and (4) enable systematic referral and management of patients according to their needs. Conclusions: This newly developed system is more sensitive than the existing grading methods for determining ototoxicity in patients with DR-TB. This app needs to be trialed in a larger sample to establish data security, ease of use, and suitability within this population. 
%M 31934875
%R 10.2196/14036
%U https://mhealth.jmir.org/2020/1/e14036
%U https://doi.org/10.2196/14036
%U http://www.ncbi.nlm.nih.gov/pubmed/31934875

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 3
%N 4
%P e15000
%T Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study
%A Ssemugabo,Charles
%A Rutebemberwa,Elizeus
%A Kajungu,Dan
%A Pariyo,George W
%A Hyder,Adnan A
%A Gibson,Dustin G
%+ Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, New Mulago Hill Road, Kampala, Uganda, 256 779625182, cssemugabo@gmail.com
%K mobile phones
%K interactive voice response
%K surveillance
%K behavioral risk factors
%K noncommunicable diseases
%K Uganda
%D 2019

%7 3.12.2019
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective: This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods: This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results: Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions: Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors. 
%M 31793889
%R 10.2196/15000
%U http://formative.jmir.org/2019/4/e15000/
%U https://doi.org/10.2196/15000
%U http://www.ncbi.nlm.nih.gov/pubmed/31793889

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 21
%N 11
%P e15681
%T Exploring People’s Candidacy for Mobile Health–Supported HIV Testing and Care Services in Rural KwaZulu-Natal, South Africa: Qualitative Study
%A Adeagbo,Oluwafemi
%A Herbst,Carina
%A Blandford,Ann
%A McKendry,Rachel
%A Estcourt,Claudia
%A Seeley,Janet
%A Shahmanesh,Maryam
%+ Africa Health Research Institute, KwaZulu-Natal, R168 Hlabisa Road Somkhele, PO Box 198, Mtubatuba, 3935, South Africa, 27 355507695, Oluwafemi.Adeagbo@ahri.org
%K mHealth
%K antiretroviral therapy
%K HIV testing
%K South Africa
%K candidacy framework
%D 2019

%7 18.11.2019
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone–connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. Objective: The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. Methods: A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. Results: Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers’ attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone–linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider–initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. Conclusions: Mobile phone–connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand. 
%M 31738174
%R 10.2196/15681
%U https://www.jmir.org/2019/11/e15681
%U https://doi.org/10.2196/15681
%U http://www.ncbi.nlm.nih.gov/pubmed/31738174

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 11
%P e13741
%T Exploring the Patterns of Use and Acceptability of Mobile Phones Among People Living With HIV to Improve Care and Treatment: Cross-Sectional Study in Three Francophone West African Countries
%A Lepère,Phillipe
%A Touré,Yélamikan
%A Bitty-Anderson,Alexandra M
%A Boni,Simon P
%A Anago,Gildas
%A Tchounga,Boris
%A Touré,Pendadiago
%A Minga,Albert
%A Messou,Eugène
%A Kanga,Guillaume
%A Koule,Serge
%A Poda,Armel
%A Calmy,Alexandra
%A Ekouevi,Didier K
%A Coffie,Patrick A
%+ Institut de Santé Globale, Université de Genève, Suisse, 24 rue du Général-Dufour, 1205 Genève, Genève, Switzerland, 41 +33673777280, lepere.p@wanadoo.fr
%K acceptability
%K mHealth
%K PLHIV
%K West Africa
%D 2019

%7 13.11.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The use of mobile technology in health care (mobile health [mHealth]) could be an innovative way to improve health care, especially for increasing retention in HIV care and adherence to treatment. However, there is a scarcity of studies on mHealth among people living with HIV (PLHIV) in West and Central Africa. Objective: The aim of this study was to assess the acceptability of an mHealth intervention among PLHIV in three countries of West Africa. Methods: A cross-sectional study among PLHIV was conducted in 2017 in three francophone West African countries: Côte d’Ivoire, Burkina Faso, and Togo. PLHIV followed in the six preselected HIV treatment and care centers, completed a standardized questionnaire on mobile phone possession, acceptability of mobile phone for HIV care and treatment, preference of mobile phone services, and phone sharing. Descriptive statistics and logistic regression were used to describe variables and assess factors associated with mHealth acceptability. Results: A total of 1131 PLHIV—643 from Côte d’Ivoire, 239 from Togo, and 249 from Burkina Faso—participated in the study. Median age was 44 years, and 76.1% were women (n=861). Almost all participants owned a mobile phone (n=1107, 97.9%), and 12.6% (n=140) shared phones with a third party. Acceptability of mHealth was 98.8%, with the majority indicating their preference for both phone calls and text messages. Factors associated with mHealth acceptability were having a primary school education or no education (adjusted odds ratio=7.15, 95% CI 5.05-10.12; P<.001) and waiting over one hour before meeting a medical doctor on appointment day (adjusted odds ratio=1.84, 95% CI 1.30-2.62; P=.01). Conclusions: The use of mHealth in HIV treatment and care is highly acceptable among PLHIV and should be considered a viable tool to allow West and Central African countries to achieve the Joint United Nations Programme on HIV/AIDS 90-90-90 goals. 
%M 31719023
%R 10.2196/13741
%U https://mhealth.jmir.org/2019/11/e13741
%U https://doi.org/10.2196/13741
%U http://www.ncbi.nlm.nih.gov/pubmed/31719023

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 11
%P e13604
%T Iterative Adaptation of a Mobile Nutrition Video-Based Intervention Across Countries Using Human-Centered Design: Qualitative Study
%A Isler,Jasmin
%A Sawadogo,N Hélène
%A Harling,Guy
%A Bärnighausen,Till
%A Adam,Maya
%A Kagoné,Moubassira
%A Sié,Ali
%A Greuel,Merlin
%A McMahon,Shannon A
%+ Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, Heidelberg, 69120, Germany, 49 06221 565344, mcmahon@uni-heidelberg.de
%K mHealth
%K Burkina Faso
%K mothers
%K Community Health Workers
%K pregnancy
%K diet
%K dgital health
%D 2019

%7 11.11.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) video interventions are often transferred across settings. Although the outcomes of these transferred interventions are frequently published, the process of adapting such videos is less described, particularly within and across lower-income contexts. This study fills a gap in the literature by outlining experiences and priorities adapting a suite of South African maternal nutrition videos to the context of rural Burkina Faso. Objective: The objective of this study was to determine the key components in adapting a suite of maternal nutrition mHealth videos across settings. Methods: Guided by the principles of human-centered design, this qualitative study included 10 focus group discussions, 30 in-depth interviews, and 30 observations. We first used focus group discussions to capture insights on local nutrition and impressions of the original (South African) videos. After making rapid adjustments based on these focus group discussions, we used additional methods (focus group discussions, in-depth interviews, and observations) to identify challenges, essential video refinements, and preferences in terms of content delivery. All data were collected in French or Dioula, recorded, transcribed, and translated as necessary into French before being thematically coded by two authors. Results: We propose a 3-pronged Video Adaptation Framework that places the aim of video adaptation at the center of a triangle framed by end recipients, health workers, and the environment. End recipients (here, pregnant or lactating mothers) directed us to (1) align the appearance, priorities, and practices of the video’s protagonist to those of Burkinabe women; (2) be mindful of local realities whether economic, health-related, or educational; and (3) identify and routinely reiterate key points throughout videos and via reminder cards. Health workers (here, Community Health Workers and Mentor Mothers delivering the videos) guided us to (1) improve technology training, (2) simplify language and images, and (3) increase the frequency of their engagements with end recipients. In terms of the environment, respondents guided us to localize climate, vegetation, diction, and how foods are depicted. Conclusions: Design research provided valuable insights in terms of developing a framework for video adaptation across settings, which other interventionists and scholars can use to guide adaptations of similar interventions. 
%M 31710302
%R 10.2196/13604
%U http://mhealth.jmir.org/2019/11/e13604/
%U https://doi.org/10.2196/13604
%U http://www.ncbi.nlm.nih.gov/pubmed/31710302

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 10
%P e14259
%T Community-Based Chronic Disease Prevention and Management for Aboriginal People in New South Wales, Australia: Mixed Methods Evaluation of the 1 Deadly Step Program 
%A Peiris,David
%A Wright,Lachlan
%A News,Madeline
%A Corcoran,Katherine
%+ The George Institute for Global Health, UNSW Sydney, 1 King St, Newtown, 2042, Australia, 61 420969204, dpeiris@georgeinstitute.org
%K chronic disease
%K screening
%K indigenous health
%K prevention
%K primary health care
%D 2019

%7 21.10.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Chronic diseases account for over 70% of health gaps between Aboriginal people and the rest of the Australian population. The 1 Deadly Step program involves community-based events that use a sporting platform and cultural ambassadors to improve chronic disease prevention and management in New South Wales (NSW). Objective: This study aimed to evaluate the feasibility and acceptability of a community-based chronic disease screening program for Aboriginal people. Methods: In 2015, the program was enhanced to include an iPad app for screening assessments, a results portal for nominated care providers, and a reporting portal for program administrators and implemented in 9 NSW community events. A mixed methods evaluation comprising survey data, analytics obtained from iPad and Web portal usage, and key informant interviews was conducted. Results: Overall, 1046 people were screened between April 2015 and April 2016 (mean age 40.3 years, 640 (61.19%) female, 957 (91.49%) Aboriginal or Torres Strait Islander). High chronic disease rates were observed (231 [22.08%] participants at high cardiovascular disease (CVD) risk, 173 [16.54%] with diabetes, and 181 [17.30%] with albuminuria). A minority at high risk of CVD (99/231 [42.9%]) and with diabetes (73/173 [42.2%]) were meeting guideline-recommended management goals. Overall, 297 participants completed surveys (response rate 37.4%) with 85.1% reporting satisfaction with event organization and information gained and 6.1% experiencing problems with certain screening activities. Furthermore, 21 interviews were conducted. A strong local working group and processes that harnessed community social networks were key to implementation success. Although software enhancements facilitated screening and data management, some technical difficulties (eg, time delays in processing blood test results) impeded smooth processing of information. Only 51.43% of participants had a medical review recorded postevent with wide intersite variability (10.5%-85.6%). Factors associated with successful follow-up included clinic managers with overall program responsibility and availability of medical staff for immediate discussion of results on event day. The program was considered highly resource intensive to implement and support from a central coordinating body and integration with existing operational processes was essential. Conclusions: 1 Deadly Step offers an effective and acceptable strategy to engage Aboriginal communities in chronic disease screening. High rates of risk factors and management gaps were encountered, including people with no previous knowledge of these issues. Strategies to improve linkage to primary care could enhance the program’s impact on reducing chronic disease burden. 
%M 31638591
%R 10.2196/14259
%U http://mhealth.jmir.org/2019/10/e14259/
%U https://doi.org/10.2196/14259
%U http://www.ncbi.nlm.nih.gov/pubmed/31638591

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 21
%N 10
%P e14748
%T Technology Acceptance and Information System Success of a Mobile Electronic Platform for Nonphysician Clinical Students in Zambia: Prospective, Nonrandomized Intervention Study
%A Barteit,Sandra
%A Neuhann,Florian
%A Bärnighausen,Till
%A Bowa,Annel
%A Wolter,Sigrid
%A Siabwanta,Hinson
%A Jahn,Albrecht
%+ Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 06221 ext 5634030, barteit@uni-heidelberg.de
%K computers, handheld
%K tablets
%K education, medical
%K sub-Saharan Africa
%K Zambia
%K mHealth
%K evidence-based practice
%K medicine
%D 2019

%7 9.10.2019
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Zambia is still experiencing a severe shortage of health workers, which is impacting the national health care system. Very few people are trained, educational infrastructure is inadequate, and senior human resources for training are not yet sufficient to produce the number of health care workers needed, especially for currently underserved rural areas. Therefore, to strengthen the medical education program of medical licentiates, we implemented a tablet-based electronic learning platform (e-platform) with a medical decision-support component. Objective: As the primary objective, this study aimed to explore the acceptance and information system (IS) success of an e-platform focused on offline-based tablet usage for nonphysician clinical students in a low-resource context in Zambia, Africa. Furthermore, we aimed to evaluate student demographic factors and prior technological experience, as well as medical lecturers’ acceptance of technology of the e-platform. Methods: We collected data for the study before and after the intervention. Before the intervention, we collected student demographic data and prior technological experience using a questionnaire. After the intervention, we collected results of the questionnaire on technology acceptance of students and IS success of the e-platform, as well as technology acceptance of medical lecturers. We calculated statistical measures such as means, standard deviations, and correlations of investigated variables. The study report was compiled using the Consolidated Standards of Reporting Trials-Electronic Health checklist. Results: Overall, questionnaire results of students and medical lecturers indicated acceptance of the e-platform and showed higher ratings for overall net benefits and information quality (students) and perceived ease of use and perceived usefulness (medical lecturers) as compared with ratings of other categories. The lowest scores were conveyed for system use and service quality (students) and attitude and behavioral intention (medical lecturers). Conclusions: Acceptance of the e-platform as a learning technology for strengthening medical education in a low-resource context in Zambia was generally high for students and medical lecturers, but shortcomings were also identified. Results indicated low overall usage of the e-platform as a learning and teaching tool. One hindering factor was the tablets’ overall weak reliability with regard to its service life and battery life span, and another was the teachers’ low engagement with the e-platform. Next steps may include other hardware and more technology-based training for medical lecturers. The evaluation results indicated that the e-platform may open new promise for further strengthening and expanding medical education in this context, especially with more affordable and viable technologies that are available. 
%M 31599731
%R 10.2196/14748
%U http://www.jmir.org/2019/10/e14748/
%U https://doi.org/10.2196/14748
%U http://www.ncbi.nlm.nih.gov/pubmed/31599731

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 10
%P e14877
%T Mobile Health for First Nations Populations: Systematic Review
%A Hobson,Georgina R
%A Caffery,Liam J
%A Neuhaus,Maike
%A Langbecker,Danette H
%+ Centre for Online Health, Centre for Health Services Research, The University of Queensland, Ground Floor, Building 33, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia, 61 731761685, g.hobson@uq.edu.au
%K mHealth
%K mobile health
%K indigenous
%K First Nations
%K aboriginal
%K humans
%K systematic review
%D 2019

%7 7.10.2019
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The ubiquitous presence and functionality of mobile devices offers the potential for mobile health (mHealth) to create equitable health opportunities. While mHealth is used among First Nations populations to respond to health challenges, the characteristics, uptake, and effectiveness of these interventions are unclear. Objective: This review aimed to identify the characteristics of mHealth interventions (eg, study locations, health topic, and modality) evaluated with First Nations populations and to summarize the outcomes reported for intervention use, user perspectives including cultural responsiveness, and clinical effectiveness. In addition, the review sought to identify the presence of First Nations expertise in the design and evaluation of mHealth interventions with First Nations populations. Methods: The methods of this systematic review were detailed in a registered protocol with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019123276). Systematic searches of peer-reviewed, scientific papers were conducted across 7 databases in October 2018. Eligible studies had a primary focus on mHealth interventions with experimental or quasi-experimental design to respond to a health challenge with First Nations people from Canada, Australia, New Zealand, and the United States. Two authors independently screened records for eligibility and assessed risk of bias using the Joanna Briggs Institute checklists. Data were synthesized narratively owing to the mix of study designs, interventions, and outcomes. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results: Searches yielded 1053 unique records, after review and screening, 13 studies (5 randomized controlled trials and 8 quasi-experimental designs) were included in the final analysis. Studies were conducted in Australia (n=9), the United States (n=2), and New Zealand (n=2). The most common health challenge addressed was mental health and suicide (n=5). Intervention modalities included text messaging (n=5), apps (n=4), multimedia messaging (n=1), tablet software (n=1), or a combination of short messaging service (SMS) and apps (n=1). Results showed mixed engagement with the intervention (n=3); favorable user perspectives, including acceptability and cultural appropriateness (n=6); and mixed outcomes for clinical effectiveness (n=10). A diverse range of risks of bias were identified, the most common of which included a lack of clarity about allocation and blinding protocols and group treatment for randomized controlled trials and a lack of control group and single outcome measures for quasi-experimental designs. First Nations expertise informed all mHealth studies, through authorship (n=8), affiliation with First Nations bodies (n=3), participatory study design (n=5), First Nations reference groups (n=5), or a combination of these. Conclusions: mHealth modalities, including SMS and apps, appear favorable for delivery of health interventions with First Nations populations, particularly in the area of mental health and suicide prevention. Importantly, First Nations expertise was strongly embedded within the studies, augmenting favorable use and user engagement. However, evidence of efficacy is limited. 
%M 31593537
%R 10.2196/14877
%U https://mhealth.jmir.org/2019/10/e14877
%U https://doi.org/10.2196/14877
%U http://www.ncbi.nlm.nih.gov/pubmed/31593537

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 10
%P e14275
%T Investigating the Use of Mobile Health Interventions in Vulnerable Populations for Cardiovascular Disease Management: Scoping Review
%A Wali,Sahr
%A Hussain-Shamsy,Neesha
%A Ross,Heather
%A Cafazzo,Joseph
%+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, TGH/RFE Bldg, 4th Fl, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 416 340 3200, sahr.wali@mail.utoronto.ca
%K mobile health
%K health services
%K indigenous
%K low- and middle-income countries
%K cardiovascular disease
%K self-care
%D 2019

%7 7.10.2019
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Cardiovascular disease (CVD) has grown to become one of the leading causes of mortality worldwide. The advancements of CVD-related treatments have led to a decline in CVD prevalence among individuals in high-income countries (HICs). However, these improvements do not reflect the state of individuals in low- and middle-income countries (LMICs) and vulnerable subgroup populations in HICs, such as the Indigenous. To help minimize the health disparities in these populations, technology-based interventions have been offered as a potential solution, but there is concern regarding if they will be effective, or even needed, as these tools have been designed for use in HICs. Objective: The objective of this study was to explore how mobile health (mHealth) interventions currently assist individuals in Indigenous communities and LMICs with CVD management. Methods: A scoping review guided by the methods outlined by Arksey and O’Malley was conducted. A comprehensive search was completed by 2 reviewers in 5 electronic databases using keywords related to mobile health, cardiovascular disease, self-care, Indigenous communities, and LMICs. Studies were screened over 2 rounds and critically reviewed using a descriptive-analytical narrative method. Descriptive data were categorized into thematic groups reflecting the major findings related to the study objective. Results: We identified a total of 11 original articles and 11 review papers that met the criteria for this scoping review. The majority of the studies included a telemonitoring- and text messaging (short message service, SMS)–related feature associated with the intervention. The use of SMS was the most common approach to effectively promote disease management among individuals in both LMICs and Indigenous communities. However, customizing for cultural considerations within the design of the intervention was highlighted as a pivotal component to encourage CVD management. Specifically, individuals emphasized that the inclusion of collaborative partnerships with community members would strengthen the effectiveness of the intervention by ensuring it was designed with the appropriate context. Conclusions: Technology-based interventions used within Indigenous communities and LMICs have shown their potential to assist individuals with managing their condition. Although the literature available regarding this topic is limited, this review outlines key components to promote the effective use of these tools in the context of these vulnerable populations. 
%M 31593547
%R 10.2196/14275
%U https://mhealth.jmir.org/2019/10/e14275
%U https://doi.org/10.2196/14275
%U http://www.ncbi.nlm.nih.gov/pubmed/31593547

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 10
%P e13557
%T Children Immunization App (CImA) Among Syrian Refugees in Zaatari Camp, Jordan: Protocol for a Cluster Randomized Controlled Pilot Trial Intervention Study 
%A Khader,Yousef S
%A Laflamme,Lucie
%A Schmid,Daniela
%A El-Halabi,Soha
%A Abu Khdair,Mohammad
%A Sengoelge,Mathilde
%A Atkins,Salla
%A Tahtamouni,Manal
%A Derrough,Tarik
%A El-Khatib,Ziad
%+ Department of Public Health Sciences, Karolinska Institutet, Stockholm,, Sweden, 46 6643461861, ziad.khatib@gmail.com
%K mHealth
%K refugees
%K vaccines
%K Jordan
%K Syria
%D 2019

%7 7.10.2019
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There are up to 19.4 million children who are still unvaccinated and face unnecessary deaths, especially among refugees. However, growing access to smartphones, among refugees, can be a leading factor to improve vaccination rates. Objective: This study aims to determine whether a smartphone app can improve the vaccination uptake among refugees and determine the app’s effectiveness in improving the documentation of vaccination records. Methods: We developed and planned to test an app through a cluster randomized trial that will be carried out at the Zaatari refugee camp in Jordan. The study will be open to all parents who carry Android smartphones, have at least one child, and agree to participate in the study. The parents will be recruited to the study by trained volunteers at the vaccination sites around the Zaatari camp. Inclusion criteria will be the following: having at least one child of 0 to 5 years, being a local resident of the camp, and having an Android smartphone. Results: The intervention includes an app that will allow storing Jordanian vaccination records, per child, on the parents’ smartphones in Arabic and English (in an interchangeable fashion). Every record will have a set of automated reminders before the appointment of each child. The app will summarize immunization records in form of due, taken, or overdue appointments, labeled in orange, green, and red, respectively. Baseline will include the collection of our primary and secondary outcomes that are needed for the pre and postdata measurements. This includes social demographic data, any previous vaccination history, and electronic health literacy. Participants, in both study arms, will be monitored for their follow-up visits to the clinic for vaccination doses. For the study outcome measures, we will measure any differences in the uptake of vaccinations. The secondary outcome is to analyze the effect of the children immunization app on visits for follow-up doses. Conclusions: Owing to the limited evidence of effective interventions for childhood vaccination among refugees, research in this area is greatly needed. The project will have a significant impact on the health of refugees and the public health system. In Jordan and the Middle East, the vaccination level is low. Given the influx of refugees from the area, it is crucial to ensure a high vaccination level among the children. International Registered Report Identifier (IRRID): PRR1-10.2196/13557 
%M 31593549
%R 10.2196/13557
%U https://www.researchprotocols.org/2019/10/e13557
%U https://doi.org/10.2196/13557
%U http://www.ncbi.nlm.nih.gov/pubmed/31593549

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 4
%N 3
%P e12600
%T Acceptability of Mobile Health Interventions to Increase Diabetic Risk Factor Awareness Among the Commuter Population in Johannesburg: Descriptive Cross-Sectional Study
%A Fischer,Alex
%A Chadyiwa,Martha
%A Tshuma,Ndumiso
%A Nkosi,Vusumuzi
%+ Department of Environmental Health, Faculty of Health Sciences, University of Johannesburg, John Orr Building, Doornfontein Campus, Doornfontein, Johannesburg, 2094, South Africa, 27 0737762705, afischer@wrhi.ac.za
%K mHealth
%K diabetes mellitus
%K noncommunicable disease
%K South Africa
%D 2019

%7 20.09.2019
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: Developing countries are experiencing a shift from infectious diseases such as HIV and tuberculosis to noncommunicable diseases (NCDs) such as diabetes. Diabetes accounts for more disability-adjusted life years than any other NCD in South Africa, and research has identified a number of preventable risk factors; however, there is not enough evidence from lower resource settings as to how best to disseminate this information to the population. Today, 90% of the world’s population lives in mobile phone coverage areas, and this provides a unique opportunity to reach large populations with health information. Objective: This study aimed to investigate how potential mobile health (mHealth) platforms should be paired with diabetes risk factor education so that at-risk communities are empowered with information to prevent and manage diabetes. Methods: A Likert-style survey was distributed to commuters in the City of Johannesburg in July 2018 that explored participants’ background characteristics as well as their knowledge and awareness surrounding diabetic risk factors (such as exercise, smoking, and hypertension) and their comfort level with various information delivery methods (such as WhatsApp, short message service, and email). The grouped variables from diabetic risk factors and information delivery methods were described with mean Likert scores and then investigated for relationships with Spearman Rho correlation coefficients. Results: Background characteristics revealed that the self-reported prevalence of diabetes was twice as high in this studied commuter population than the national average. WhatsApp was the most favorable mHealth information delivery method and had a moderate correlation coefficient with diet and nutrition (0.338; P<.001) as well as a weaker correlation with physical activity (0.243; P<.001). Although not as robust as the WhatsApp correlations, each of the other information delivery methods also showed weaker, yet statistically significant, relationships with one or more of the risk factors. Conclusions: The elevated self-reported diabetes prevalence reinforces the need for diabetes risk factor education in the studied commuter population of Johannesburg. The most feasible mHealth intervention for diabetic risk factor education should focus on WhatsApp messaging while also offering content across other mHealth and traditional platforms to remove barriers to access and enhance the user experience. The content should emphasize diet and nutrition as well as physical activity while also incorporating information on secondary risk factors. 
%M 31586363
%R 10.2196/12600
%U http://diabetes.jmir.org/2019/3/e12600/
%U https://doi.org/10.2196/12600
%U http://www.ncbi.nlm.nih.gov/pubmed/31586363

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 8
%P e14734
%T Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal
%A Poudyal,Anubhuti
%A van Heerden,Alastair
%A Hagaman,Ashley
%A Maharjan,Sujen Man
%A Byanjankar,Prabin
%A Subba,Prasansa
%A Kohrt,Brandon A
%+ Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L Street, Suite 600, Washington, DC, 20037, United States, 1 (202) 741 2888, bkohrt@gwu.edu
%K developing countries
%K feasibility studies
%K mobile health
%K mother-child interaction
%K postpartum depression
%K psychotherapy
%D 2019

%7 11.09.2019
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression. Objective: This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment. Methods: This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives. Results: To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019. Conclusions: Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/14734 
%M 31512581
%R 10.2196/14734
%U http://www.researchprotocols.org/2019/8/e14734/
%U https://doi.org/10.2196/14734
%U http://www.ncbi.nlm.nih.gov/pubmed/31512581

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 8
%P e14668
%T The Elusive Path Toward Measuring Health Outcomes: Lessons Learned From a Pseudo-Randomized Controlled Trial of a Large-Scale Mobile Health Initiative
%A Mechael,Patricia
%A Kaonga,Nadi Nina
%A Chandrasekharan,Subhashini
%A Prakash,Muthu Perumal
%A Peter,Joanne
%A Ganju,Aakash
%A Murthy,Nirmala
%+ HealthEnabled, 4101 Albemarle St NW Apt 521, Washington, DC, 20016, United States, 1 9732228252, pmechael@gmail.com
%K India
%K mHealth
%K maternal health
%K child health
%K research
%D 2019

%7 21.08.2019
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Mobile health (mHealth) offers new opportunities to improve access to health services and health information. It also presents new challenges in evaluating its impact, particularly in linking the use of a technology intervention that aims to improve health behaviors with the health outcomes that are impacted by changed behaviors. The availability of data from a multitude of sources (paper-based and electronic) provides the conditions to facilitate making stronger connections between self-reported data and clinical outcomes. This commentary shares lessons and important considerations based on the experience of applying new research frameworks and incorporating maternal and child health records data into a pseudo-randomized controlled trial to evaluate the impact of mMitra, a stage-based voice messaging program to improve maternal, newborn, and child health outcomes in urban slums in India.
%M 31436165
%R 10.2196/14668
%U http://mhealth.jmir.org/2019/8/e14668/
%U https://doi.org/10.2196/14668
%U http://www.ncbi.nlm.nih.gov/pubmed/31436165

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 8
%P e13516
%T Analysis of Digital Documentation Speed and Sequence Using Digital Paper and Pen Technology During the Refugee Crisis in Europe: Content Analysis
%A Kehe,Kai
%A Girgensohn,Roland
%A Swoboda,Walter
%A Bieler,Dan
%A Franke,Axel
%A Helm,Matthias
%A Kulla,Martin
%A Luepke,Kerstin
%A Morwinsky,Thomas
%A Blätzinger,Markus
%A Rossmann,Katalyn
%+ Department F, Bundeswehr Medical Academy, Ingolstädter Str 240, Munich, 80939, Germany, 49 31687422, kai.kehe@lrz.uni-muenchen.de
%K digital documentation
%K digital pen
%K digital paper
%K refugee camp
%K refugee crisis
%K Europe
%K Germany
%K epidemiology
%D 2019

%7 19.08.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The Syria crisis has forced more than 4 million people to leave their homeland. As a result, in 2016, an overwhelming number of refugees reached Germany. In response to this, it was of utmost importance to set up refugee camps and to provide humanitarian aid, but a health surveillance system was also implemented in order to obtain rapid information about emerging diseases. Objective: The present study describes the effects of using digital paper and pen (DPP) technology on the speed, sequence, and behavior of epidemiological documentation in a refugee camp. Methods: DPP technology was used to examine documentation speed, sequence, and behavior. The data log of the digital pens used to fill in the documentation was analyzed, and each pen stroke in a field was recorded using a timestamp. Documentation time was the difference between first and last stroke on the paper, which includes clinical examination and translation. Results: For three months, 495 data sets were recorded. After corrections had been made, 421 data sets were considered valid and subjected to further analysis. The median documentation time was 41:41 min (interquartile range 29:54 min; mean 45:02 min; SD 22:28 min). The documentation of vital signs ended up having the strongest effect on the overall time of documentation. Furthermore, filling in the free-text field clinical findings or therapy or measures required the most time (mean 16:49 min; SD 20:32 min). Analysis of the documentation sequence revealed that the final step of coding the diagnosis was a time-consuming step that took place once the form had been completed. Conclusions: We concluded that medical documentation using DPP technology leads to both an increase in documentation speed and data quality through the compliance of the data recorders who regard the tool to be convenient in everyday routine. Further analysis of more data sets will allow optimization of the documentation form used. Thus, DPP technology is an effective tool for the medical documentation process in refugee camps. 
%M 31429420
%R 10.2196/13516
%U http://mhealth.jmir.org/2019/8/e13516/
%U https://doi.org/10.2196/13516
%U http://www.ncbi.nlm.nih.gov/pubmed/31429420

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 8
%P e13309
%T Using Telemedicine to Diagnose Surgical Site Infections in Low- and Middle-Income Countries: Systematic Review
%A Sandberg,Charlotte E J
%A Knight,Stephen R
%A Qureshi,Ahmad Uzair
%A Pathak,Samir
%+ Faculty of Health Sciences, University of Bristol, First Floor, 5 Tyndall Avenue, Bristol, BS8 1UD, United Kingdom, 44 117 928 9000, cs14961@bristol.ac.uk
%K surgical site infection
%K wound infection
%K developing country
%K low- and middle-income countries
%K telemedicine
%K postoperative
%K follow-up
%D 2019

%7 19.08.2019
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A high burden of preventable morbidity and mortality due to surgical site infections (SSIs) occurs in low- and middle-income countries (LMICs), and most of these SSIs occur following discharge. There is a high loss to follow-up due to a wide geographical spread of patients, and cost of travel can result in delayed and missed diagnoses. Objective: This review analyzes the literature surrounding the use of telemedicine and assesses the feasibility of using mobile phone technology to both diagnose SSIs remotely in LMICs and to overcome social barriers. Methods: A literature search was performed using Medline, Embase, CINAHL, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials and Google Scholar. Included were English language papers reporting the use of telemedicine for detecting SSIs in comparison to the current practice of direct clinical diagnosis. Papers were excluded if infections were not due to surgical wounds, or if SSIs were not validated with in-person diagnosis. The primary outcome of this review was to review the feasibility of telemedicine for remote SSI detection. Results: A total of 404 articles were screened and three studies were identified that reported on 2082 patients across three countries. All studies assessed the accuracy of remote diagnosis of SSIs using predetermined telephone questionnaires. In total, 44 SSIs were accurately detected using telemedicine and an additional 14 were picked up on clinical follow-up. Conclusions: The use of telemedicine has shown to be a feasible method in remote diagnosis of SSIs. Telemedicine is a useful adjunct for clinical practice in LMICs to decrease loss to postsurgical follow-up. 
%M 31429414
%R 10.2196/13309
%U http://mhealth.jmir.org/2019/8/e13309/
%U https://doi.org/10.2196/13309
%U http://www.ncbi.nlm.nih.gov/pubmed/31429414

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 8
%P e14540
%T A Novel Mobile Health Tool for Home-Based Identification of Neonatal Illness in Uganda: Formative Usability Study
%A Vanosdoll,Madison
%A Ng,Natalie
%A Ho,Anthony
%A Wallingford,Allison
%A Xu,Shicheng
%A Matin,Shababa Binte
%A Verma,Neha
%A Farzin,Azadeh
%A Golden,W Christopher
%A Yazdi,Youseph
%A Waiswa,Peter
%A Labrique,Alain
%A Acharya,Soumyadipta
%+ Center for Bioengineering Innovation and Design, Department of Biomedical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, 21218, United States, 1 4105167074, acharya@jhu.edu
%K neonatal
%K community health workers
%K maternal
%K Uganda
%K World Health Organization
%K smartphone app
%K digital health
%K mobile health
%K telemedicine
%D 2019

%7 15.08.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: While early identification of neonatal illness can impact neonatal mortality rates and reduce the burden of treatment, identifying subtle clinical signs and symptoms of possible severe illness is especially challenging in neonates. The World Health Organization and the United Nations Children’s Fund developed the Integrated Management of Neonatal Childhood Illness guidelines, an evidence-based tool highlighting seven danger signs to assess neonatal health. Currently, many mothers in low-resource settings rely on home visits from community health workers (CHWs) to determine if their baby is sick. However, CHWs visit infrequently, and illness is often detected too late to impact survival. Thus, delays in illness identification pose a significant barrier to providing expedient and effective care. Neonatal Monitoring (NeMo), a novel neonatal assessment tool, seeks to increase the frequency of neonatal screening by task-shifting identification of neonatal danger signs from CHWs to mothers. Objective: This study aimed to explore the usability and acceptability of the NeMo system among target users and volunteer CHWs by assessing ease of use and learnability. Methods: Simulated device use and semistructured interviews were conducted with 32 women in the Iganga-Mayuge districts in eastern Uganda to evaluate the usability of the NeMo system, which involves a smartphone app paired with a low cost, wearable band to aid in identification of neonatal illness. Two versions of the app were evaluated using a mixed methods approach, and version II of the app contained modifications based on observations of the first cohort’s use of the system. During the posed scenario simulations, participants were offered limited guidance from the study team in order to probe the intuitiveness of the NeMo system. The ability to complete a set of tasks with the system was tested and recorded for each participant and closed- and open-ended questions were used to elicit user feedback. Additionally, focus groups with 12 CHWs were conducted to lend additional context and insight to the usability and feasibility assessment. Results: A total of 13/22 subjects (59%) using app version I and 9/10 subjects (90%) using app version II were able to use the phone and app with no difficulty, despite varying levels of smartphone experience. Following modifications to the app’s audio instructions in version II, participants’ ability to accurately answer qualitative questions concerning neonatal danger signs improved by at least 200% for each qualitative danger sign. All participants agreed they would trust and use the NeMo system to assess the health of their babies. Furthermore, CHWs emphasized the importance of community sensitization towards the system to encourage its adoption and regular use, as well as the decision to seek care based on its recommendations. Conclusions: The NeMo system is an intuitive platform for neonatal assessment in a home setting and was found to be acceptable to women in rural Uganda. 
%M 31418428
%R 10.2196/14540
%U http://mhealth.jmir.org/2019/8/e14540/
%U https://doi.org/10.2196/14540
%U http://www.ncbi.nlm.nih.gov/pubmed/31418428

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 8
%P e12672
%T Mobile Helpline and Reversible Contraception: Lessons From a Controlled Before-and-After Study in Rural India
%A Kulathinal,Sangita
%A Joseph,Bijoy
%A Säävälä,Minna
%+ The Family Federation of Finland (Väestöliitto), Kalevankatu 16, Helsinki, 00100, Finland, 358 405736557, minna.saavala@vaestoliitto.fi
%K contraception behavior
%K family planning services
%K organizations, nonprofit
%K cell phone use
%K mobile phone
%K information seeking behavior
%K mHealth
%K call center
%K South Asia
%K India
%D 2019

%7 09.08.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Researchers and activists have expressed concerns over the lack of availability and nonuse of reversible, modern, contraceptive methods in India for decades. New attempts to increase access, availability, and acceptance of reversible contraceptives need to be developed, instead of relying solely on female sterilization. Mobile health (mHealth) initiatives may offer one way to serve underprivileged populations who face challenges in sexual and reproductive health (SRH) in countries such as India. Objective: This study aimed to examine the outcome of an mHealth intervention for enhancing knowledge of, and practices related to, reversible contraceptives in rural Western India. Methods: We implemented a nonrandomized controlled trial (before-and-after study in an intervention area and a control area) in the Indian state of Maharashtra. The intervention in this case was a mobile-based SRH helpline provided by a nongovernmental organization (NGO). Baseline and follow-up surveys were carried out in two government-run primary health center areas, one each in the intervention and control area, and 405 respondents were surveyed in the two rounds. An interview-based structured questionnaire suitable for a low-literacy environment was used to collect data. The effect of the intervention was estimated using logistic regression, adjusted for gender, by calculating robust standard errors to take into account the clustering of individuals by the area (intervention or control). In each regression model, the effect of intervention was estimated by including a term for interaction between the intervention area and the period before and after the intervention. The exponent of the regression coefficient of the interaction term corresponding to the period after the intervention, along with the 95% CI, is reported here. The odds ratio for the control village multiplied by this exponent gives the odds ratio for the intervention village. Calls received in the intervention were recorded and their topics analyzed. Results: The current use of reversible contraception (18% increase in intervention area vs 2% increase in control area; 95% CI) has seen changes. The proportion of respondents who had heard of contraception methods from an NGO rose in the intervention area by 23% whereas it decreased in the control area by 1% (95% CI). However, the general level of awareness of reversible contraception, shown by the first contraceptive method that came to respondents’ mind, did not improve. Demand for wider SRH information beyond contraception was high. Men and adolescents, in addition to married women, made use of the helpline. Conclusions: A mobile helpline that one can confidentially approach at a time most convenient to the client can help provide necessary information and support to those who need reversible contraception or other sexual health information. Services that integrate mHealth in a context-sensitive way to other face-to-face health care services add value to SRH services in rural India. 
%M 31400103
%R 10.2196/12672
%U https://mhealth.jmir.org/2019/8/e12672
%U https://doi.org/10.2196/12672
%U http://www.ncbi.nlm.nih.gov/pubmed/31400103

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 7
%P e13503
%T A Smart and Multifaceted Mobile Health System for Delivering Evidence-Based Secondary Prevention of Stroke in Rural China: Design, Development, and Feasibility Study
%A Wu,Na
%A Gong,Enying
%A Wang,Bo
%A Gu,Wanbing
%A Ding,Nan
%A Zhang,Zhuoran
%A Chen,Mengyao
%A Yan,Lijing L
%A Oldenburg,Brian
%A Xu,Li-Qun
%+ Center of Excellence for mHealth and Smart Healthcare, China Mobile Research Institute, China Mobile Communications Corporation, 32 Xuanwumen West Street, Xicheng District, Beijing, 100032, China, 86 158 0169 6688 ext 35971, xuliqun@chinamobile.com
%K stroke
%K secondary prevention
%K rural health services
%K mobile application
%K software design
%K China
%D 2019

%7 19.07.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) technologies hold great promise in improving the delivery of high-quality health care services. Yet, there has been little research so far applying mHealth technologies in the context of delivering stroke care in resource-limited rural regions. Objective: This study aimed to introduce the design and development of an mHealth system targeting primary health care providers and to ascertain its feasibility in supporting the delivery of a System-Integrated techNology-Enabled Model of cAre (SINEMA) service for strengthening secondary prevention of stroke in rural China. Methods: The SINEMA mHealth system was designed by a multidisciplinary team comprising public health researchers, neurologists, and information and communication technology experts. The iterative co-design and development of the mHealth system involved the following 5 steps: (1) assessing the needs of relevant end users through in-depth interviews of stakeholders, (2) designing the functional modules and evidence-based care content, (3) designing and building the system and user interface, (4) improving and enhancing the system through a 3-month pilot test in 4 villages, and (5) finalizing the system and deploying it in field trial, and finally, evaluating its feasibility through a survey of the dominant user group. Results: From the in-depth interviews of 49 relevant stakeholders, we found that village doctors had limited capacity in caring for village-dwelling stroke patients in rural areas. Primary health care workers demonstrated real needs in receiving appropriate training and support from the mHealth system as well as great interests in using the mHealth technologies and tools. Using these findings, we designed a multifaceted mHealth system with 7 functional modules by following the iterative user-centered design and software development approach. The mHealth system, aimed at 3 different types of users (village doctors, town physicians, and county managers), was developed and utilized in a cluster-randomized controlled trial by 25 village doctors in a resource-limited county in rural China to manage 637 stroke patients between July 2017 and July 2018. In the end, a survey on the usability and functions of the mHealth system among village doctors (the dominant group of users, response rate=96%, 24/25) revealed that most of them were satisfied with the essential functions provided (71%) and were keen to continue using it (92%) after the study. Conclusions: The mHealth system was feasible for assisting primary health care providers in rural China in delivering the SINEMA service on the secondary prevention of stroke. Further research and initiatives in scaling up the SINEMA approach and this mHealth system to other resource-limited regions in China and beyond will likely enhance the quality and accessibility of essential secondary prevention among stroke patients. ClinicalTrial: ClinicalTrials.gov NCT03185858; https://clinicaltrials.gov/ct2/show/NCT03185858 International Registered Report Identifier (IRRID): RR2-10.1016/j.ahj.2018.08.015 
%M 31325288
%R 10.2196/13503
%U http://mhealth.jmir.org/2019/7/e13503/
%U https://doi.org/10.2196/13503
%U http://www.ncbi.nlm.nih.gov/pubmed/31325288

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 8
%N 7
%P e13221
%T Text Message Reminders and Unconditional Monetary Incentives to Improve Measles Vaccination in Western Kenya: Study Protocol for the Mobile and Scalable Innovations for Measles Immunization Randomized Controlled Trial
%A Gibson,Dustin G
%A Kagucia,E Wangeci
%A Were,Joyce
%A Obor,David
%A Hayford,Kyla
%A Ochieng,Benard
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Room E8650, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu
%K measles vaccine
%K text messaging
%K Kenya
%K vaccination coverage
%D 2019

%7 09.07.2019
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Globally, 21 million children do not receive the measles vaccine each year. With high levels of mobile phone access and ownership, opportunities exist to leverage mobile health technologies to generate demand for immunization. Objective: The aim of the Mobile and Scalable Innovations for Measles Immunization trial is to determine if text message (short message service, SMS) reminders, either with or without mobile phone–based incentives, can improve measles immunization coverage and timeliness in rural western Kenya. Methods: This is a 3-arm, parallel, randomized controlled trial (RCT). Using simple randomization, caregivers in Siaya County, Kenya, will be randomized and evenly allocated to 1 of 3 study arms: (1) control, (2) SMS reminders only, and (3) SMS reminders plus a 150 Kenyan Shilling (KES) incentive. Participants assigned to the SMS group will be sent SMS reminders 3 days before and on the day before the measles immunization visit scheduled for when the child is 9 months of age. Participants in the incentive arm will, in addition to SMS reminders as above, be sent an unconditional 150 KES mobile-money incentive to their mobile phone 3 days before the child becomes 9 months of age. Children will be followed up to the age of 12 months to assess the primary outcome, a measles vaccination by 10 months of age. Log-binomial regressions will be used to calculate relative risks. Results: Enrollment was completed in March 2017. We enrolled 537 caregivers and their infants into the following groups: control (n=179), SMS reminders only (n=179), and SMS reminders plus 150 KES (n=179). Results will be made publicly available in 2020. Conclusions: Few RCTs have examined the effect of text message reminders to improve measles immunization coverage. This is the first study to assess the effect of SMS reminders with and without unconditionally provided mobile-money incentives to improve measles immunization coverage. Trial Registration: ClinicalTrials.gov NCT02904642; https://clinicaltrials.gov/ct2/show/NCT02904642 (Archived by WebCite® at http://www.webcitation.org/78r7AzD2X). International Registered Report Identifier (IRRID): RR1-10.2196/13221 
%M 31290405
%R 10.2196/13221
%U http://www.researchprotocols.org/2019/7/e13221/
%U https://doi.org/10.2196/13221
%U http://www.ncbi.nlm.nih.gov/pubmed/31290405

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 6
%P e12631
%T Understanding the Use of Smartphone Apps for Health Information Among Pregnant Chinese Women: Mixed Methods Study
%A Wang,Na
%A Deng,Zequn
%A Wen,Li Ming
%A Ding,Yan
%A He,Gengsheng
%+ Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, No. 130 Dongan Road, Shanghai, 200032, China, 86 21 54237229, gshe@shmu.edu.cn
%K mobile applications
%K pregnancy
%K consumer health information
%K health promotion
%D 2019

%7 18.06.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. Objective: The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. Methods: A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). Results: The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. Conclusions: The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women. 
%M 31215516
%R 10.2196/12631
%U http://mhealth.jmir.org/2019/6/e12631/
%U https://doi.org/10.2196/12631
%U http://www.ncbi.nlm.nih.gov/pubmed/31215516

%0 Journal Article
        
%@ 2368-7959
%I JMIR Publications
%V 6
%N 6
%P e11701
%T Addressing Depression Comorbid With Diabetes or Hypertension in Resource-Poor Settings: A Qualitative Study About User Perception of a Nurse-Supported Smartphone App in Peru
%A Brandt,Lena R
%A Hidalgo,Liliana
%A Diez-Canseco,Francisco
%A Araya,Ricardo
%A Mohr,David C
%A Menezes,Paulo R
%A Miranda,J Jaime
%+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Avenida Armendariz 497, Miraflores, Lima, Peru, 51 12416978, fdiezcanseco@gmail.com
%K mental health
%K depression
%K noncommunicable diseases
%K mHealth
%K smartphone
%K developing countries
%D 2019

%7 18.06.2019
%9 Original Paper
%J JMIR Ment Health
%G English
                
%X Background: Smartphone apps could constitute a cost-effective strategy to overcome health care system access barriers to mental health services for people in low- and middle-income countries. Objective: The aim of this paper was to explore the patients’ perspectives of CONEMO (Emotional Control, in Spanish: Control Emocional), a technology-driven, psychoeducational, and nurse-supported intervention delivered via a smartphone app aimed at reducing depressive symptoms in people with diabetes, hypertension or both who attend public health care centers, as well as the nurses’ feedback about their role and its feasibility to be scaled up. Methods: This study combines data from 2 pilot studies performed in Lima, Peru, between 2015 and 2016, to test the feasibility of CONEMO. Interviews were conducted with 29 patients with diabetes, hypertension or both with comorbid depressive symptoms who used CONEMO and 6 staff nurses who accompanied the intervention. Using a content analysis approach, interview notes from patient interviews were transferred to a digital format, coded, and categorized into 6 main domains: the perceived health benefit, usability, adherence, user satisfaction with the app, nurse’s support, and suggestions to improve the intervention. Interviews with nurses were analyzed by the same approach and categorized into 4 domains: general feedback, evaluation of training, evaluation of study activities, and feasibility of implementing this intervention within the existing structures of health system. Results: Patients perceived improvement in their emotional health because of CONEMO, whereas some also reported better physical health. Many encountered some difficulties with using CONEMO, but resolved them with time and practice. However, the interactive elements of the app, such as short message service, android notifications, and pop-up messages were mostly perceived as challenging. Satisfaction with CONEMO was high, as was the self-reported adherence. Overall, patients evaluated the nurse accompaniment positively, but they suggested improvements in the technological training and an increase in the amount of contact. Nurses reported some difficulties in completing their tasks and explained that the CONEMO intervention activities competed with their everyday work routine. Conclusions: Using a nurse-supported smartphone app to reduce depressive symptoms among people with chronic diseases is possible and mostly perceived beneficial by the patients, but it requires context-specific adaptations regarding the implementation of a task shifting approach within the public health care system. These results provide valuable information about user feedback for those building mobile health interventions for depression. 
%M 31215511
%R 10.2196/11701
%U https://mental.jmir.org/2019/6/e11701/
%U https://doi.org/10.2196/11701
%U http://www.ncbi.nlm.nih.gov/pubmed/31215511

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 5
%N 2
%P e13359
%T Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad
%A Lalaye,Didier
%A de Bruijn,Mirjam E
%A de Jong,Tom PVM
%+ Julius Global Health Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887555555, lalaye84@gmail.com
%K Schistosoma haematobium
%K prevalence
%K Chad
%K neglected tropical diseases
%K mobile health
%D 2019

%7 18.06.2019
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease. Objective: The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed. Methods: This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children. Results: Direct microscopic examination of urine found 467 positive cases (24.9% of the total sample). Of all male and female samples, 341 (34%) and 127 (14.4%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8%) from an estimated total of 25,000 children in the target group. Conclusions: The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis. 
%M 31215519
%R 10.2196/13359
%U http://publichealth.jmir.org/2019/2/e13359/
%U https://doi.org/10.2196/13359
%U http://www.ncbi.nlm.nih.gov/pubmed/31215519

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e10923
%T The Twazon Arabic Weight Loss App: App-Based Intervention for Saudi Women With Obesity
%A Alnasser,Aroub
%A Kyle,Janet
%A Aloumi,Najla
%A Al-Khalifa,Abdulrahman
%A Marais,Debbi
%+ Food Science and Nutrition Dept, King Saud University, Riyadh,, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa
%K obesity
%K weight loss
%K mobile applications
%K smartphone
%K obesity management
%K mHealth
%D 2019

%7 28.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle, and a lack of health awareness, behavioral modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities. However, neither pre nor postoperative diet and exercise are promoted. Evidence-informed mobile health (mHealth) weight loss apps and interventions may be an effective tool for delivering a culturally relevant intervention. Objective: This study aimed to determine the feasibility of a weight loss intervention that tests the effectiveness of Twazon, an originally designed Arabic weight-loss app that promotes lifestyle modification specific to Arab populations. Methods: A pre-post single‐arm pilot study was carried out among a sample of 240 overweight volunteer Saudi women residing in Riyadh, Saudi Arabia who used the Twazon app over a 4-month period. Anthropometric, diet, and physical activity measures were assessed 3 times: baseline, 2-months and 4-months; frequency of app use and system usability were evaluated during the 2 latter data collection periods. Repeated measures analysis of variance was used to identify changes over time. Results: A total of 40 participants completed the 4-month intervention with an attrition rate of 83%. An evaluation of the frequency of app use fostered 2 groups: engaged users (65%) and unengaged users (35%). At 4 months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 (SD 0.6) kg (P=.18), waist circumference (WC) was reduced by 4.9 (SD 1.1) cm (P<.001), and daily energy consumption was decreased by >600 calories (P=.002). Unengaged users experienced minor changes in body weight, WC, and reduced energy intake. Conclusions: The findings have demonstrated that engagement with the Twazon app renders positive changes in body weight, WC, and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations. 
%M 31140444
%R 10.2196/10923
%U http://mhealth.jmir.org/2019/5/e10923/
%U https://doi.org/10.2196/10923
%U http://www.ncbi.nlm.nih.gov/pubmed/31140444

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e12879
%T Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs
%A Amoakoh,Hannah Brown
%A Klipstein-Grobusch,Kerstin
%A Grobbee,Diederick E
%A Amoakoh-Coleman,Mary
%A Oduro-Mensah,Ebenezer
%A Sarpong,Charity
%A Frimpong,Edith
%A Kayode,Gbenga A
%A Agyepong,Irene Akua
%A Ansah,Evelyn K
%+ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, PO Box 85500, Utrecht, 3508 GA, Netherlands, 233 264545762, ansomaame@hotmail.com
%K mHealth
%K maternal health
%K neonatal health
%K health care systems
%K developing countries
%K decision-making
%K information retrieval systems
%D 2019

%7 24.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. Objective: This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). Methods: For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. Results: In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). Conclusions: There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health. 
%M 31127719
%R 10.2196/12879
%U http://mhealth.jmir.org/2019/5/e12879/
%U https://doi.org/10.2196/12879
%U http://www.ncbi.nlm.nih.gov/pubmed/31127719

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e13049
%T A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial
%A Sabben,Gaëlle
%A Mudhune,Victor
%A Ondeng'e,Ken
%A Odero,Isdorah
%A Ndivo,Richard
%A Akelo,Victor
%A Winskell,Kate
%+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4046833103, gaelle.sabben@emory.edu
%K HIV
%K youth
%K sub-Saharan Africa
%K Kenya
%K serious game
%K narrative
%K smartphone
%K pilot study
%K randomized controlled trial
%K acceptability
%D 2019

%7 21.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents. Objective: Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial. Methods: During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview–based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game’s appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel. Results: Adolescent participants’ survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability. Conclusions: This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents. Trial Registration: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW) 
%M 31115348
%R 10.2196/13049
%U http://mhealth.jmir.org/2019/5/e13049/
%U https://doi.org/10.2196/13049
%U http://www.ncbi.nlm.nih.gov/pubmed/31115348

%0 Journal Article
        
%@ 1929-073X
%I JMIR Publications
%V 8
%N 2
%P e12664
%T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases
%A Ponum,Mahvish
%A Hasan,Osman
%A Khan,Saadia
%+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk
%K infectious diseases
%K mHealth
%K causes of death
%D 2019

%7 14.05.2019
%9 Original Paper
%J Interact J Med Res
%G English
                
%X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. 
%M 31094329
%R 10.2196/12664
%U http://www.i-jmr.org/2019/2/e12664/
%U https://doi.org/10.2196/12664
%U http://www.ncbi.nlm.nih.gov/pubmed/31094329

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e13963
%T Development and Implementation of a Mobile Phone–Based Prevention of Mother-To-Child Transmission of HIV Cascade Analysis Tool: Usability and Feasibility Testing in Kenya and Mozambique
%A Kawakyu,Nami
%A Nduati,Ruth
%A Munguambe,Khátia
%A Coutinho,Joana
%A Mburu,Nancy
%A DeCastro,Georgina
%A Inguane,Celso
%A Zunt,Andrew
%A Abburi,Neil
%A Sherr,Kenneth
%A Gimbel,Sarah
%+ Center for Global Health Nursing, University of Washington, Box 357263, Seattle, WA, 98195, United States, 1 206 221 7477, nkawakyu@uw.edu
%K mHealth
%K quality improvement
%K engineering
%K HIV
%K mother to child transmission
%K implementation science
%D 2019

%7 13.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Prevention of mother-to-child HIV transmission (PMTCT) care cascade failures drive pediatric HIV infections in sub-Saharan Africa. As nurses’ clinical and management role in PMTCT expand, decision-support tools for nurses are needed to facilitate identification of cascade inefficiencies and solutions. The mobile phone–based PMTCT cascade analysis tool (mPCAT) provides health facility staff a quick summary of the number of patients and percentage drop-off at each step of the PMCTC care cascade, as well as how many women-infant pairs would be retained if a step was optimized. Objective: The objective of this study was to understand and improve the mPCAT’s core usability factors and assess the health workers’ experience with using the mPCAT. Methods: Overall, 2 rounds of usability testing were conducted with health workers from 4 clinics and leading experts in maternal and child health in Kenya and Mozambique using videotaped think aloud assessment techniques. Semistructured group interviews gauged the understanding of mPCAT’s core usability factors, based on the Nielsen Usability Framework, followed by development of cognitive demand tables describing the needed mPCAT updates. Post adaptation, feasibility was assessed in 3 high volume clinics over 12 weeks. Participants completed a 5-point Likert questionnaire designed to measure ease of use, convenience of integration into work, and future intention to use the mPCAT. Focus group discussions with nurse participants at each facility and in-depth interviews with nurse managers were also conducted to assess the acceptability, use, and recommendations for adaptations of the mPCAT. Results: Usability testing with software engineers enabled real-time feedback to build a tool following empathic design principles. The revised mPCAT had improved navigation and simplified data entry interface, with only 1 data entry field per page. Improvements to the results page included a data visualization feature and the ability to share results through WhatsApp. Coding was simplified to enable future revisions by nontechnical staff—critical for context-specific adaptations for scale-up. Health care workers and facility managers found the tool easy to use (mean=4.3), used the tool very often (mean=4.1), and definitely intended to continue to use the tool (mean=4.8). Ease of use was the most common theme identified, with emphasis on how the tool readily informed system improvement decision making. Conclusions: The mPCAT was well accepted by frontline health workers and facility managers. The collaborative process between software developer and user led to the development of a more user-friendly, context-specific tool that could be easily integrated into routine clinical practice and workflow. The mPCAT gave frontline health workers and facility managers an immediate, direct, and tangible way to use their clinical documentation and routinely reported data for decision making for their own clinical practice and facility-level improvements. 
%M 31094351
%R 10.2196/13963
%U http://mhealth.jmir.org/2019/5/e13963/
%U https://doi.org/10.2196/13963
%U http://www.ncbi.nlm.nih.gov/pubmed/31094351

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 5
%P e11497
%T Achieving Sustainability and Scale-Up of Mobile Health Noncommunicable Disease Interventions in Sub-Saharan Africa: Views of Policy Makers in Ghana
%A Opoku,Daniel
%A Busse,Reinhard
%A Quentin,Wilm
%+ Faculty VII Economics and Management, Institute of Technology and Management, Department of Health Care Management, Technische Universität Berlin, Straße des 17. Juni 135, Administrative office H80, Berlin, 10623, Germany, 49 3031429222, Daniel.Opoku@TU-Berlin.de
%K implementation science
%K mHealth
%K eHealth
%K noncommunicable diseases
%K disease management
%K sub-Saharan Africa
%K qualitative research
%K health policy
%D 2019

%7 03.05.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A growing body of evidence shows that mobile health (mHealth) interventions may improve treatment and care for the rapidly rising number of patients with noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA). A recent realist review developed a framework highlighting the influence of context factors, including predisposing characteristics, needs, and enabling resources (PNE), for the long-term success of mHealth interventions. The views of policy makers will ultimately determine implementation and scale-up of mHealth interventions in SSA. However, their views about necessary conditions for sustainability and scale-up remain unexplored. Objective: This study aimed to understand the views of policy makers in Ghana with regard to the most important factors for successful implementation, sustainability, and scale-up of mHealth NCD interventions. Methods: Members of the technical working group responsible for Ghana’s national NCD policy were interviewed about their knowledge of and attitude toward mHealth and about the most important factors contributing to long-term intervention success. Using qualitative methods and applying a qualitative content analysis approach, answers were categorized according to the PNE framework. Results: A total of 19 policy makers were contacted and 13 were interviewed. Interviewees had long-standing work experience of an average of 26 years and were actively involved in health policy making in Ghana. They were well-informed about the potential of mHealth, and they strongly supported mHealth expansion in the country. Guided by the PNE framework’s categories, the policy makers ascertained which critical factors would support the successful implementation of mHealth interventions in Ghana. The policy makers mentioned many factors described in the literature as important for mHealth implementation, sustainability, and scale-up, but they focused more on enabling resources than on predisposing characteristics and need. Furthermore, they mentioned several factors that have been rather unexplored in the literature. Conclusions: The study shows that the PNE framework is useful to guide policy makers toward a more systematic assessment of context factors that support intervention implementation, sustainability, and scale-up. Furthermore, the framework was refined by adding additional factors. Policy makers may benefit from using the PNE framework at the various stages of mHealth implementation. Researchers may (and should) use the framework when investigating reasons for success (or failure) of interventions. 
%M 31066706
%R 10.2196/11497
%U https://mhealth.jmir.org/2019/5/e11497/
%U https://doi.org/10.2196/11497
%U http://www.ncbi.nlm.nih.gov/pubmed/31066706

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e11957
%T Needs Analysis for a Parenting App to Prevent Unintentional Injury in Newborn Babies and Toddlers: Focus Group and Survey Study Among Chinese Caregivers
%A Ning,Peishan
%A Gao,Deyue
%A Cheng,Peixia
%A Schwebel,David C
%A Wei,Xiang
%A Tan,Liheng
%A Xiao,Wangxin
%A He,Jieyi
%A Fu,Yanhong
%A Chen,Bo
%A Yang,Yang
%A Deng,Jing
%A Wu,Yue
%A Yu,Renhe
%A Li,Shukun
%A Hu,Guoqing
%+ Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 073184805414, huguoqing009@gmail.com
%K injury
%K child
%K mobile health
%K education
%K intervention
%K parenting
%K mhealth
%D 2019

%7 30.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With the growing popularity of mobile health technology, app-based interventions delivered by smartphone have become an increasingly important strategy toward injury prevention. Objective: This study aimed to develop a framework supporting the design of an app-based intervention to prevent unintentional injury, targeted for caregivers of Chinese children aged 0 to 6 years. Methods: A theory-based mixed-method study, including focus groups and Web-based quantitative survey, was performed. Adult caregivers who care for children aged 0 to 6 years and own a smartphone were recruited into 2 sequential stages of research. First, focus groups were conducted among the caregivers at community health care centers and preschools from December 2015 to March 2016. Focus groups (8-10 participants per group) explored awareness, experiences, and opinions of caregivers toward using an app to prevent unintentional injury among children. Second, based on the focus groups findings, a Web-based quantitative survey was designed and distributed to caregivers in November 2016; it collected information on specific needs for the app-based intervention. Thematic analysis and quantitative descriptive analyses were performed. Results: In total, 12 focus groups were completed, involving 108 caregivers. Most participants expressed a strong desire to learn knowledge and skills about unintentional child injury prevention and held positive attitudes toward app-based interventions. Participants expressed multiple preferences concerning the app-based intervention, including their contents, functions, interactive styles, installation and registration logistics, and privacy protection and information security. Following the focus groups, 1505 caregivers completed a WeChat-based quantitative survey, which generated roughly similar results to those of focus groups and added numerical metrics concerning participants’ preferences on what to learn, when to learn it, and how to learn it. A detailed framework was established involving 5 components: (1) content design, (2) functional design, (3) interactive style, (4) installation and registration logistics, and (5) privacy protection and information security, and 15 specific requirements. Conclusions: We developed a framework that can be used as a guide to design app-based interventions for parents and caregivers, specifically for unintentional injury prevention of children aged 0 to 6 years. 
%M 31038465
%R 10.2196/11957
%U http://mhealth.jmir.org/2019/4/e11957/
%U https://doi.org/10.2196/11957
%U http://www.ncbi.nlm.nih.gov/pubmed/31038465

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e11842
%T Patients’ and Doctors’ Perceptions of a Mobile Phone–Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study
%A Alam,Mafruha
%A Banwell,Cathy
%A Olsen,Anna
%A Lokuge,Kamalini
%+ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, 62 Mills Road, Canberra, 2601, Australia, 61 6125 5602, mafruha.alam@gmail.com
%K mobile-based consultation
%K mHealth
%K remote diagnosis
%K referral
%D 2019

%7 22.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective: We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods: We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results: Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions: Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded. 
%M 31008716
%R 10.2196/11842
%U http://mhealth.jmir.org/2019/4/e11842/
%U https://doi.org/10.2196/11842
%U http://www.ncbi.nlm.nih.gov/pubmed/31008716

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e11687
%T Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative?
%A Kumar,Anil A
%A De Costa,Ayesha
%A Das,Arundathi
%A Srinivasa,GA
%A D'Souza,George
%A Rodrigues,Rashmi
%+ Department of Community Health, St John's Medical College, St John's National Academy of Health Sciences, Koramangala 4th Block, Bangalore, 560034, India, 91 9845389538, rashmijr@gmail.com
%K medical informatics
%K tuberculosis
%K mHealth
%K adherence
%K mobile phone
%K reminder
%K SMS
%K voice call
%K DOT
%K vDOT
%K video DOT
%D 2019

%7 03.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With the availability of low-cost mobile devices and the ease of internet access, mobile health (mHealth) is digitally revolutionizing the health sector even in resource-constrained settings. It is however necessary to assess end-user perceptions before deploying potential interventions. Objective: This study aimed to assess the mobile phone usage patterns and the acceptability of mobile phone support during care and treatment in patients with tuberculosis (TB) in South India. Methods: This exploratory study was conducted at an urban private tertiary care teaching hospital and nearby public primary-level health care facilities in Bangalore, South India. We recruited 185 patients with TB through consecutive sampling. Subsequent to written informed consent, participants responded to an interviewer-administered pretested questionnaire. The questionnaire included questions on demographics, phone usage patterns, and the benefits of using of mobile phone technology to improve health outcomes and treatment adherence. Frequency, mean, median, and SD or interquartile range were used to describe the data. Bivariate associations were assessed between demographics, clinical details, phone usage, and mHealth communication preferences using the chi-square test and odds ratios. Associations with a P value ≤.20 were included in a logistic regression model. A P value of <.05 was considered significant. Results: Of the 185 participants, 151 (81.6%) used a mobile phone, and half of them owned a smartphone. The primary use of the mobile phone was to communicate over voice calls (147/151, 97.4%). The short message service (SMS) text messaging feature was used by only 66/151 (43.7%) mobile phone users. A total of 87 of the 151 mobile phone users (57.6%) knew how to use the camera. Only 41/151 (27.2%) mobile phone users had used their mobile phones to communicate with their health care providers. Although receiving medication reminders via mobile phones was acceptable to all participants, 2 participants considered repeated reminders as an intrusion of their privacy. A majority of the participants (137/185, 74.1%) preferred health communications via voice calls. Of the total participants, 123/185 (66.5%) requested reminders to be sent only at specific times during the day, 22/185 (11.9%) suggested reminders should synchronize with their prescribed medication schedule, whereas 40/185 (21.6%) did not have any time preferences. English literacy was associated with a preference for SMS in comparison with voice calls. Most participants (142/185, 76.8%) preferred video-based directly observed treatment when compared with in-person directly observed treatment. Conclusions: Although mobile phones for supporting health and treatment adherence were acceptable to patients with TB, mHealth interventions should consider language, mode of communication, and preferred timing for communication to improve uptake. 
%M 30942696
%R 10.2196/11687
%U http://mhealth.jmir.org/2019/4/e11687/
%U https://doi.org/10.2196/11687
%U http://www.ncbi.nlm.nih.gov/pubmed/30942696

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e12745
%T A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial
%A Peiris,David
%A Wright,Lachlan
%A News,Madeline
%A Rogers,Kris
%A Redfern,Julie
%A Chow,Clara
%A Thomas,David
%+ The George Institute for Global Health, UNSW Sydney, 1 King St, Newtown,, Australia, 61 280524513, dpeiris@georgeinstitute.org
%K smoking cessation
%K oceanic ancestry group
%K mobile apps
%D 2019

%7 02.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. Objective: We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. Methods: A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results: A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. Conclusions: Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT design may not be feasible in this setting. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12616001550493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371792 (Archived by WebCite at http://www.webcitation.org/76TiV7HA6). 
%M 30938691
%R 10.2196/12745
%U https://mhealth.jmir.org/2019/4/e12745/
%U https://doi.org/10.2196/12745
%U http://www.ncbi.nlm.nih.gov/pubmed/30938691

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 4
%P e12652
%T Improving Linkage to and Retention in Care in Newly Diagnosed HIV-Positive Patients Using Smartphones in South Africa: Randomized Controlled Trial
%A Venter,Willem Daniel Francois
%A Fischer,Alex
%A Lalla-Edward,Samanta Tresha
%A Coleman,Jesse
%A Lau Chan,Vincent
%A Shubber,Zara
%A Phatsoane,Mothepane
%A Gorgens,Marelize
%A Stewart-Isherwood,Lynsey
%A Carmona,Sergio
%A Fraser-Hurt,Nicole
%+ Wits Reproductive Health and HIV Institute, University of Witwatersrand, Hillbrow Health Precinct, 22 Esselen St, Johannesburg, 2001, South Africa, 27 011 358 5500, afischer@wrhi.ac.za
%K cell phones
%K HIV
%K app
%K Africa
%K linkage to care
%K patient information
%D 2019

%7 02.04.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: South Africa provides free antiretroviral therapy for almost 5 million people living with HIV, but only 71% of the eligible people are on treatment, representing a shortfall in the care cascade, especially among men and youth. Many developing countries have expanded access to smartphones; success in health apps raises the possibility of improving this cascade. Objective: SmartLink is a health app for Android smartphones providing HIV-related laboratory results, information, support, and appointment reminders to engage and link patients to care. This study aimed to evaluate the ability of SmartLink to improve linkage to care for HIV-positive smartphone owners. Methods: This study was a multisite randomized controlled trial in Johannesburg. The intervention arm received the app (along with referral to a treatment site) and the control arm received the standard of care (referral alone). Linkage to care was confirmed by an HIV-related blood test reported on the National Health Laboratory Service database between 2 weeks and 8 months after initiation. Results: A total of 345 participants were recruited into the study; 64.9% (224/345) of the participants were female and 44.1% (152/345) were aged less than 30 years. In addition, 46.7% (161/345) were employed full time, 95.9% (331/345) had at least secondary school education, and 35.9% (124/345) were from Zimbabwe. Linkage to care between 2 weeks and 8 months was 48.6% (88/181) in the intervention arm versus 45.1% (74/164) in the control (P=.52) and increased to 64.1% (116/181) and 61.0% (100/164) (P=.55), respectively, after the initial 8-month period. Moreover, youth aged 18 to 30-years showed a statistically significant 20% increase in linkage to care for the intervention group. Conclusions: Youth aged less than 30 years have been historically difficult to reach with traditional interventions, and the SmartLink app provides a proof of concept that this population reacts to mobile health interventions that engage patients in HIV care. Trial Registration: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW) 
%M 30938681
%R 10.2196/12652
%U https://mhealth.jmir.org/2019/4/e12652/
%U https://doi.org/10.2196/12652
%U http://www.ncbi.nlm.nih.gov/pubmed/30938681

%0 Journal Article
        
%@ 2561-326X
%I JMIR Publications
%V 3
%N 1
%P e11785
%T The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results
%A Alturki,Ryan
%A Gay,Valerie
%+ School of Electrical and Data Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, 81 Broadway, Ultimo, Sydney, 2007, Australia, 61 410583330, ryan.m.alturki@student.uts.edu.au
%K weight loss
%K mobile app
%K obesity
%K physical activity
%K smartphone
%K mHealth
%K motivation
%D 2019

%7 14.03.2019
%9 Original Paper
%J JMIR Form Res
%G English
                
%X Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. 
%M 30869639
%R 10.2196/11785
%U http://formative.jmir.org/2019/1/e11785/
%U https://doi.org/10.2196/11785
%U http://www.ncbi.nlm.nih.gov/pubmed/30869639

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 3
%P e11420
%T A Mobile Health Wallet for Pregnancy-Related Health Care in Madagascar: Mixed-Methods Study on Opportunities and Challenges
%A Muller,Nadine
%A Emmrich,Peter Martin Ferdinand
%A Rajemison,Elsa Niritiana
%A De Neve,Jan-Walter
%A Bärnighausen,Till
%A Knauss,Samuel
%A Emmrich,Julius Valentin
%+ Department of Infectious Diseases and Pulmonary Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany, 49 30450665296, nadine.muller@charite.de
%K pregnancy
%K maternal health services
%K healthcare financing
%K cell phone
%K mobile applications
%K telemedicine
%K maternal mortality
%K health expenditures
%K marketing of health services
%K developing countries
%K Madagascar
%D 2019

%7 05.03.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile savings and payment systems have been widely adopted to store money and pay for a variety of services, including health care. However, the possible implications of these technologies on financing and payment for maternal health care services—which commonly require large 1-time out-of-pocket payments—have not yet been systematically assessed in low-resource settings. Objective: The aim of this study was to determine the structural, contextual, and experiential characteristics of a mobile phone–based savings and payment platform, the Mobile Health Wallet (MHW), for skilled health care during pregnancy among women in Madagascar. Methods: We used a 2-stage cluster random sampling scheme to select a representative sample of women utilizing either routine antenatal (ANC) or routine postnatal care (PNC) in public sector health facilities in 2 of 8 urban and peri-urban districts of Antananarivo, Madagascar (Atsimondrano and Renivohitra districts). In a quantitative structured survey among 412 randomly selected women attending ANC or PNC, we identified saving habits, mobile phone use, media consumptions, and perception of an MHW with both savings and payment functions. To confirm and explain the quantitative results, we used qualitative data from 6 semistructured focus group discussions (24 participants in total) in the same population. Results: 59.3% (243/410, 95% CI 54.5-64.1) saved toward the expected costs of delivery and, out of those, 64.4% (159/247, 95% CI 58.6-70.2) used household cash savings for this purpose. A total of 80.3% (331/412, 95% CI 76.5-84.1) had access to a personal or family phone and 35.7% (147/412, 95% CI 31.1-40.3) previously used Mobile Money services. Access to skilled health care during pregnancy was primarily limited because of financial obstacles such as saving difficulties or unpredictability of costs. Another key barrier was the lack of information about health benefits or availability of services. The general concept of an MHW for saving toward and payment of pregnancy-related care, including the restriction of payments, was perceived as beneficial and practicable by the majority of participants. In the discussions, several themes pointed to opportunities for ensuring the success of an MHW through design features: (1) intuitive technical ease of use, (2) clear communication and information about benefits and restrictions, and (3) availability of personal customer support. Conclusions: Financial obstacles are a major cause of limited access to skilled maternal health care in Madagascar. An MHW for skilled health care during pregnancy was perceived as a useful and desirable tool to reduce financial barriers among women in urban Madagascar. The design of this tool and the communication strategy will likely be the key to success. Particularly important dimensions of design include technical user friendliness and accessible and personal customer service. 
%M 30457972
%R 10.2196/11420
%U https://mhealth.jmir.org/2019/3/e11420/
%U https://doi.org/10.2196/11420
%U http://www.ncbi.nlm.nih.gov/pubmed/30457972

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 2
%P e10645
%T Women Using Mobile Phones for Health Communication Are More Likely to Use Prenatal and Postnatal Services in Bangladesh: Cross-Sectional Study
%A Tang,Shangfeng
%A Ghose,Bishwajit
%A Hoque,Md Rakibul
%A Hao,Gang
%A Yaya,Sanni
%+ School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N5J1, Canada, 1 6132624856, brammaputram@gmail.com
%K antenatal care
%K facility delivery services
%K postnatal care
%K mHealth
%K Bangladesh
%D 2019

%7 28.02.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The public health system in Bangladesh has been struggling to provide coverage and utilization of basic maternal health care services in pursuit of achieving maternal and child mortality-related goals. Interestingly, the rapid popularization of mobile technology in the country is transforming the landscape of health care access and delivery. However, little is known regarding the use of mobile phones from the perspective of maternal health care service utilization. Objective: In this study, we aimed to investigate the prevalence and sociodemographic pattern of mobile phone use for health services among women and relationship between the use of mobile phone use and the uptake of essential maternal health services (MHSs). Methods: Cross-sectional data from the Bangladesh Demographic and Health Survey on 4494 mothers aged between 15 and 39 years were used in the analysis. Using mobile phones to get health services or advice was hypothesized to have a positive association with the uptake of basic MHSs (antenatal care, ANC, facility delivery services, postnatal care) and postnatal care for the newborn. Data were analyzed using bivariate and multivariable techniques. Results: More than a quarter (1276/4494, 28.4%; 95% CI 26.8-30.3) of the women aged 15-39 years reported using mobile phones to get health services with significant sociodemographic variations in the use of mobile phones. Analysis of the specific purposes revealed that, in most cases, mobile phones were used to contact service providers and consult with the same about what to do, whereas a smaller proportion reported using mobile phone for the purposes of arranging money and transportation. Multivariable analysis showed that compared with respondents who reported not using mobile phones for health care services, those who used them had higher odds of making 3+ ANC visits and delivering at a health facility. The odds were slightly higher for rural residents than for those in the urban areas. Conclusions: The findings of this study conclude that women who use mobile phones are more likely to use ANC and professional delivery services than those who do not. More in-depth studies are necessary to understand the mechanism through which mobile phone-based services enhance the uptake of maternal health care. 
%M 30816850
%R 10.2196/10645
%U http://mhealth.jmir.org/2019/2/e10645/
%U https://doi.org/10.2196/10645
%U http://www.ncbi.nlm.nih.gov/pubmed/30816850

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 2
%P e12692
%T Use of Weight-Management Mobile Phone Apps in Saudi Arabia: A Web-Based Survey
%A Aljuraiban,Ghadeer S
%+ Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Turki Alawwal, Riyadh, 145111, Saudi Arabia, 966 14651122, galjuraiban@ksu.edu.sa
%K lifestyle
%K mobile app
%K weight loss
%K mobile phone
%D 2019

%7 22.02.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In recent years, the use of mobile phone weight-management apps has increased significantly. Weight-management apps have been found effective in promoting health and managing weight. However, data on user perception and on barriers to app usage are scarce. Objective: This study aimed to investigate the use of weight-management apps and barriers to use as well as reasons for discontinuing use in a sample of mobile phone users in Saudi Arabia. Methods: Mobile phone users aged 18 years and above from the general public in Saudi Arabia completed a Web-based survey. The survey included questions on weight-management app usage patterns, user perceptions concerning weight management, efficacy of weight-management apps, and reasons for discontinuing use. Participants were classified into normal weight (body mass index [BMI]: 18.5 to 24.9 kg/m2) and overweight or obese (BMI: ≥25.0 kg/m2). Results: The survey included 1191 participants; 513 of them used weight-management apps. More overweight or obese respondents used these apps compared with normal weight respondents (319/513, 62.2% vs 194/513, 37.8%, respectively). App features that overweight or obese users were most interested in were mainly the possibility to be monitored by a specialist and barcode identification of calorie content, whereas normal weight users mostly preferred availability of nutrition information of food items. Reasons for discontinuing use among overweight or obese respondents were mainly that monitoring by a specialist was not offered (80/236, 33.9%) and the app was not in the local language (48/236, 20.3%). Among normal weight users, the main reason for noncontinuance was the app language (45/144, 31.3%) and difficulty of use (30/144, 20.8%). Conclusions: To better address the needs of both normal weight and overweight or obese adults, improved app designs that offer monitoring by a specialist are needed. Developers may consider ways of overcoming barriers to use, such as language, by developing local language apps, which can improve the efficacy of such apps and help spread their use. 
%M 30794205
%R 10.2196/12692
%U http://mhealth.jmir.org/2019/2/e12692/
%U https://doi.org/10.2196/12692
%U http://www.ncbi.nlm.nih.gov/pubmed/30794205

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 2
%P e12385
%T Toward Developing a Standardized Core Set of Outcome Measures in Mobile Health Interventions for Tuberculosis Management: Systematic Review
%A Lee,Seohyun
%A Lee,Youngji
%A Lee,Sangmi
%A Islam,Sheikh Mohammed Shariful
%A Kim,Sun-Young
%+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2768, sykim22@snu.ac.kr
%K mHealth
%K tuberculosis
%K outcome measures
%K evidence synthesis
%K low-and middle-income countries
%D 2019

%7 19.02.2019
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Tuberculosis (TB) management can be challenging in low- and middle-income countries (LMICs) not only because of its high burden but also the prolonged treatment period involving multiple drugs. With rapid development in mobile technology, mobile health (mHealth) interventions or using a mobile device for TB management has gained popularity. Despite the potential usefulness of mHealth interventions for TB, few studies have quantitatively synthesized evidence on its effectiveness, presumably because of variability in outcome measures reported in the literature. Objective: The aim of this systematic review was to evaluate the outcome measures reported in TB mHealth literature in LMICs. Methods: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews were searched to identify mHealth intervention studies for TB (published up to May 2018) that reported any type of outcome measures. The extracted information included the study setting, types of mHealth technology used, target population, study design, and categories of outcome measures. Outcomes were classified into 13 categories including treatment outcome, adherence, process measure, perception, technical outcome, and so on. The qualitative synthesis of evidence focused on the categories of outcome measures reported by the type of mHealth interventions. Results: A total of 27 studies were included for the qualitative synthesis of evidence. The study designs varied widely, ranging from randomized controlled trials to economic evaluations. A total of 12 studies adopted short message service (SMS), whereas 5 studies used SMS in combination with additional technologies or mobile apps. The study populations were also diverse, including patients with TB, patients with TB/HIV, health care workers, and general patients attending a clinic. There was a wide range of variations in the definition of outcome measures across the studies. Among the diverse categories of outcome measures, treatment outcomes have been reported in 14 studies, but only 6 of them measured the outcome according to the standard TB treatment definitions by the World Health Organization. Conclusions: This critical evaluation of outcomes reported in mHealth studies for TB management suggests that substantial variability exists in reporting outcome measures. To overcome the challenges in evidence synthesis for mHealth interventions, this study can provide insights into the development of a core set of outcome measures by intervention type and study design. 
%M 30777847
%R 10.2196/12385
%U http://mhealth.jmir.org/2019/2/e12385/
%U https://doi.org/10.2196/12385
%U http://www.ncbi.nlm.nih.gov/pubmed/30777847

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 2
%P e11644
%T The MomConnect Nurses and Midwives Support Platform (NurseConnect): A Qualitative Process Evaluation
%A Fischer,Alex Emilio
%A Sebidi,Jane
%A Barron,Peter
%A Lalla-Edward,Samanta Tresha
%+ Wits Reproductive Health and HIV Institute, University of Witwatersrand, Hillbrow Health Precinct, 22 Esselen Street, HIllbrow, Johannesburg, 2001, South Africa, 27 073 776 2705, afischer@wrhi.ac.za
%K evaluation
%K mHealth
%K mobile phone
%K MomConnect
%K NurseConnect
%K South Africa
%D 2019

%7 13.02.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Over the past decade, mobile health has steadily increased in low-income and middle-income countries. However, few platforms have been able to sustainably scale up like the MomConnect program in South Africa. NurseConnect was created as a capacity building component of MomConnect, aimed at supporting nurses and midwives in maternal and child health. The National Department of Health has committed to expanding NurseConnect to all nurses across the country, and an evaluation of the current user experience was conducted to inform a successful scale up. Objective: This study aims to evaluate the perception and use of NurseConnect by nurses and midwives to produce feedback that can be used to optimize the user experience as the platform continues to scale up. Methods: We conducted focus group discussions and in-depth interviews with 110 nurses and midwives from 18 randomly selected health care facilities across South Africa. Questions focused on mobile phone use, access to medical information and their experience with NurseConnect registration, as well as the content and different platforms. Results: All participants had mobile phones and communication through calls and messaging was the main use in both personal and work settings. Of 110 participants, 108 (98.2%) had data-enabled phones, and the internet, Google, and apps (South African National Department of Health Guidelines, iTriage, Drugs.com) were commonly used, especially to find information in the work setting. Of 110 participants, 62 (56.4%) were registered NurseConnect users and liked the message content, especially listeriosis and motivational messages, which created behavioral change in some instances. The mobisite and helpdesk, however, were underutilized because of a lack of information surrounding these platforms. Some participants did not trust medical information from websites and had more confidence in apps, while others associated a “helpdesk” with a call-in service, not a messaging one. Many of the unregistered participants had not heard of NurseConnect, and some cited data and time constraints as barriers to both registration and uptake. Conclusions: Mobile and smartphone penetration was very high, and participants often used their phone to find medical information. The NurseConnect messages were well-liked by all registered participants; however, the mobisite and helpdesk were underutilized owing to a lack of information and training around these platforms. Enhanced marketing and training initiatives that optimize existing social networks, as well as the provision of data and Wi-Fi, should be explored to ensure that registration improves, and that users are active across all platforms. 
%M 30758298
%R 10.2196/11644
%U http://mhealth.jmir.org/2019/2/e11644/
%U https://doi.org/10.2196/11644
%U http://www.ncbi.nlm.nih.gov/pubmed/30758298

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 2
%P e10995
%T Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation
%A Zeleke,Atinkut Alamirrew
%A Worku,Abebaw Gebeyehu
%A Demissie,Adina
%A Otto-Sobotka,Fabian
%A Wilken,Marc
%A Lipprandt,Myriam
%A Tilahun,Binyam
%A Röhrig,Rainer
%+ Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Building V04-1-133, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, 49 1732587251, atinkut.alamirrew.zeleke@uni-oldenburg.de
%K public health
%K maternal health
%K surveillance
%K survey
%K data collection
%K data quality
%K tablet computer
%K mHealth
%K Ethiopia
%D 2019

%7 11.02.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. Objective: This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. Methods: A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit–based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. Results: From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. Conclusions: EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site. 
%M 30741642
%R 10.2196/10995
%U http://mhealth.jmir.org/2019/2/e10995/
%U https://doi.org/10.2196/10995
%U http://www.ncbi.nlm.nih.gov/pubmed/30741642

%0 Journal Article
        
%@ 2561-6722
%I JMIR Publications
%V 2
%N 1
%P e12366
%T Procedures to Select Digital Sensing Technologies for Passive Data Collection With Children and Their Caregivers: Qualitative Cultural Assessment in South Africa and Nepal
%A Kohrt,Brandon A
%A Rai,Sauharda
%A Vilakazi,Khanya
%A Thapa,Kiran
%A Bhardwaj,Anvita
%A van Heerden,Alastair
%+ Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, George Washington School of Medicine and Health Sciences, 2120 L Street NW, Suite 600, Washington, DC, 20037, United States, 1 4048951643, bkohrt@gwu.edu
%K child development
%K confidentiality
%K culturally competent care
%K developing countries
%K global health
%K mental health
%K mobile phones
%K wireless technology
%D 2019

%7 16.01.2019
%9 Original Paper
%J JMIR Pediatr Parent
%G English
                
%X Background: Populations in low-resource settings with high childhood morbidity and mortality increasingly are being selected as beneficiaries for interventions using passive sensing data collection through digital technologies. However, these populations often have limited familiarity with the processes and implications of passive data collection. Therefore, methods are needed to identify cultural norms and family preferences influencing the uptake of new technologies. Objective: Before introducing a new device or a passive data collection approach, it is important to determine what will be culturally acceptable and feasible. The objective of this study was to develop a systematic approach to determine acceptability and perceived utility of potential passive data collection technologies to inform selection and piloting of a device. To achieve this, we developed the Qualitative Cultural Assessment of Passive Data collection Technology (QualCAPDT). This approach is built upon structured elicitation tasks used in cultural anthropology. Methods: We piloted QualCAPDT using focus group discussions (FGDs), video demonstrations of simulated technology use, attribute rating with anchoring vignettes, and card ranking procedures. The procedure was used to select passive sensing technologies to evaluate child development and caregiver mental health in KwaZulu-Natal, South Africa, and Kathmandu, Nepal. Videos were produced in South Africa and Nepal to demonstrate the technologies and their potential local application. Structured elicitation tasks were administered in FGDs after showing the videos. Using QualCAPDT, we evaluated the following 5 technologies: home-based video recording, mobile device capture of audio, a wearable time-lapse camera attached to the child, proximity detection through a wearable passive Bluetooth beacon attached to the child, and an indoor environmental sensor measuring air quality. Results: In South Africa, 38 community health workers, health organization leaders, and caregivers participated in interviews and FGDs with structured elicitation tasks. We refined the procedure after South Africa to make the process more accessible for low-literacy populations in Nepal. In addition, the refined procedure reduced misconceptions about the tools being evaluated. In Nepal, 69 community health workers and caregivers participated in a refined QualCAPDT. In both countries, the child’s wearable time-lapse camera achieved many of the target attributes. Participants in Nepal also highly ranked a home-based environmental sensor and a proximity beacon worn by the child. Conclusions: The QualCAPDT procedure can be used to identify community norms and preferences to facilitate the selection of potential passive data collection strategies and devices. QualCAPDT is an important first step before selecting devices and piloting passive data collection in a community. It is especially important for work with caregivers and young children for whom cultural beliefs and shared family environments strongly determine behavior and potential uptake of new technology. 
%M 31518316
%R 10.2196/12366
%U https://pediatrics.jmir.org/2019/1/e12366/
%U https://doi.org/10.2196/12366
%U http://www.ncbi.nlm.nih.gov/pubmed/31518316

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 7
%N 1
%P e12637
%T Perspectives of Nonphysician Clinical Students and Medical Lecturers on Tablet-Based Health Care Practice Support for Medical Education in Zambia, Africa: Qualitative Study
%A Barteit,Sandra
%A Neuhann,Florian
%A Bärnighausen,Till
%A Bowa,Annel
%A Lüders,Sigrid
%A Malunga,Gregory
%A Chileshe,Geoffrey
%A Marimo,Clemence
%A Jahn,Albrecht
%+ Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 06221 ext 5634030, barteit@uni-heidelberg.de
%K educational technology
%K computers, handheld
%K computer-assisted decision making
%K mobile apps
%K information dissemination
%K education
%K allied health occupations
%K Africa, Southern
%K Zambia
%D 2019

%7 15.1.2019
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Zambia is faced with a severe shortage of health workers and challenges in national health financing. This burdens the medical licentiate practitioner (MLP) program for training nonphysician clinical students in Zambia because of the shortage of qualified medical lecturers and learning resources at training sites. To address this shortage and strengthen the MLP program, a self-directed electronic health (eHealth) platform was introduced, comprising technology-supported learning (e-learning) for medical education and support for health care practice. MLP students were provided with tablets that were preloaded with content for offline access. Objective: This study aimed to explore MLP students’ and medical lecturers’ perceptions of the self-directed eHealth platform with an offline-based tablet as a training and health care practice support tool during the first year of full implementation. Methods: We conducted in-depth qualitative interviews with 8 MLP students and 5 lecturers and 2 focus group discussions with 16 students to gain insights on perceptions of the usefulness, ease of use, and adequacy of self-directed e-learning and health care practice support accessible through the offline-based tablet. Participants were purposively sampled. Verbatim transcripts were analyzed following hypothesis coding. Results: The eHealth platform (e-platform), comprising e-learning for medical education and health care practice support, was positively received by students and medical lecturers and was seen as a step toward modernizing the MLP program. Tablets enabled equal access to offline learning contents, thus bridging the gap of slow or no internet connections. The study results indicated that the e-platform appears adequate to strengthen medical education within this low-resource setting. However, student self-reported usage was low, and medical lecturer usage was even lower. One stated reason was the lack of training in tablet usage and another was the quality of the tablets. The mediocre quality and quantity of most e-learning contents were perceived as a primary concern as materials were reported to be outdated, missing multimedia features, and addressing only part of the curriculum. Medical lecturers were noted to have little commitment to updating or creating new learning materials. Suggestions for improving the e-platform were given. Conclusions: To address identified major challenges, we plan to (1) introduce half-day training sessions at the beginning of each study year to better prepare users for tablet usage, (2) further update and expand e-learning content by fostering collaborations with MLP program stakeholders and nominating an e-platform coordinator, (3) set up an e-platform steering committee including medical lecturers, (4) incorporate e-learning and e-based health care practice support across the curriculum, as well as (5) implement processes to promote user-generated content. With these measures, we aim to sustainably strengthen the MLP program by implementing the tablet-based e-platform as a serious learning technology for medical education and health care practice support. 
%R 10.2196/12637
%U http://mhealth.jmir.org/2019/1/e12637/
%U https://doi.org/10.2196/12637

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 12
%P e11468
%T Unveiling the Black Box of Diagnostic and Clinical Decision Support Systems for Antenatal Care: Realist Evaluation
%A Abejirinde,Ibukun-Oluwa Omolade
%A Zweekhorst,Marjolein
%A Bardají,Azucena
%A Abugnaba-Abanga,Rudolf
%A Apentibadek,Norbert
%A De Brouwere,Vincent
%A van Roosmalen,Jos
%A Marchal,Bruno
%+ Athena Institute, Faculty of Science, Vrije Universiteit, WN Building, S-544, De Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 205983143, i.o.abejirinde@vu.nl
%K systems analysis
%K Ghana
%K clinical decision support
%K antenatal care
%K mHealth
%K program evaluation
%D 2018

%7 21.12.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Digital innovations have shown promise for improving maternal health service delivery. However, low- and middle-income countries are still at the adoption-utilization stage. Evidence on mobile health has been described as a black box, with gaps in theoretical explanations that account for the ecosystem of health care and their effect on adoption mechanisms. Bliss4Midwives, a modular integrated diagnostic kit to support antenatal care service delivery, was piloted for 1 year in Northern Ghana. Although both users and beneficiaries valued Bliss4Midwives, results from the pilot showed wide variations in usage behavior and duration of use across project sites. Objective: To strengthen the design and implementation of an improved prototype, the study objectives were two-fold: to identify causal factors underlying the variation in Bliss4Midwives usage behavior and understand how to overcome or leverage these in subsequent implementation cycles. Methods: Using a multiple case study design, a realist evaluation of Bliss4Midwives was conducted. A total of 3 candidate program theories were developed and empirically tested in 6 health facilities grouped into low and moderate usage clusters. Quantitative and qualitative data were collected and analyzed using realist thinking to build configurations that link intervention, context, actors, and mechanisms to program outcomes, by employing inductive and deductive reasoning. Nonparametric t test was used to compare the perceived usefulness and perceived ease of use of Bliss4Midwives between usage clusters. Results: We found no statistically significant differences between the 2 usage clusters. Low to moderate adoption of Bliss4Midwives was better explained by fear, enthusiasm, and high expectations for service delivery, especially in the absence of alternatives. Recognition from pregnant women, peers, supervisors, and the program itself was a crucial mechanism for device utilization. Other supportive mechanisms included ownership, empowerment, motivation, and adaptive responses to the device, such as realignment and negotiation. Champion users displayed high adoption-utilization behavior in contexts of participative or authoritative supervision, yet used the device inconsistently. Intervention-related (technical challenges, device rotation, lack of performance feedback, and refresher training), context-related (staff turnover, competing priorities, and workload), and individual factors (low technological self-efficacy, baseline knowledge, and internal motivation) suppressed utilization mechanisms. Conclusions: This study shed light on optimal conditions necessary for Bliss4Midwives to thrive in a complex social and organizational setting. Beyond usability and viability studies, advocates of innovative technologies for maternal care need to consider how implementation strategies and contextual factors, such as existing collaborations and supervision styles, trigger mechanisms that influence program outcomes. In addition to informing scale-up of the Bliss4Midwives prototype, our results highlight the need for interventions that are guided by research methods that account for complexity. 
%M 30578177
%R 10.2196/11468
%U http://mhealth.jmir.org/2018/12/e11468/
%U https://doi.org/10.2196/11468
%U http://www.ncbi.nlm.nih.gov/pubmed/30578177

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 12
%P e11213
%T The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial
%A Xie,Ri-Hua
%A Tan,Hongzhuan
%A Taljaard,Monica
%A Liao,Yan
%A Krewski,Daniel
%A Du,Qingfeng
%A Wen,Shi Wu
%+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Road, Ottawa, ON, ON K1H 8L6, Canada, 1 6137378899 ext 73912, swwen@ohri.ca
%K maternal education
%K text messaging
%K maternal health
%K infant health
%K cluster trial
%D 2018

%7 19.12.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. Objective: This study aimed to explore the impact of a maternal education program through text messaging. Methods: We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. Results: A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. Conclusions: Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. Trial Registration: ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo) 
%M 30567693
%R 10.2196/11213
%U http://mhealth.jmir.org/2018/12/e11213/
%U https://doi.org/10.2196/11213
%U http://www.ncbi.nlm.nih.gov/pubmed/30567693

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 11
%P e10239
%T Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation
%A Meyer,Amanda J
%A Babirye,Diana
%A Armstrong-Hough,Mari
%A Mark,David
%A Ayakaka,Irene
%A Katamba,Achilles
%A Haberer,Jessica E
%A Davis,J Lucian
%+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven, CT, 06520, United States, 1 203 785 3665, lucian.davis@yale.edu
%K Africa
%K fidelity
%K implementation
%K intervention
%K short message service
%K tuberculosis
%D 2018

%7 20.11.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Previous studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or “fidelity,” of implementation may explain study results. Objective: The aim of this study was to determine the fidelity of a one-time text messaging (SMS) intervention to promote the uptake of tuberculosis evaluation services among household contacts of index patients with tuberculosis. Methods: From February to June 2017, we nested a process evaluation of text message (SMS) delivery within the intervention arm of a randomized controlled trial of tuberculosis contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household tuberculosis contacts to confirm the receipt of a one-time tuberculosis-related text message (SMS) by sending a text message (SMS) reply through a toll-free “short code.” Two weeks later, a research officer followed up by telephone to confirm the receipt of the one-time text message (SMS) and administer a survey. We considered participants lost to follow-up after 3 unsuccessful call attempts on 3 separate days over a 1-week period. Results: Of 206 consecutive household contacts, 119 had a text message (SMS) initiated from the server. While 33% (39/119) were children aged 5-14 years, including 20% (24/119) girls and 13% (15/119) boys, 18 % (21/119) were adolescents or young adults, including 12% (14/119) young women and 6% (7/119) young men. 50% (59/119) were adults, including 26% (31/119) women and 24% (28/119) men. Of 107 (90%) participants for whom we could ascertain text message (SMS) receipt status, 67% (72/107) confirmed text message (SMS) receipt, including 22% (24/107) by reply text message (SMS) and 45% (48/107) during the follow-up telephone survey. No significant clinical or demographic differences were observed between those who did and did not report receiving the text message (SMS). Furthermore, 52% (56/107) reported ever reading the SMS. The cumulative likelihood of a text message (SMS) reaching its target and being read and retained by a participant was 19%. Conclusions: The fidelity of a one-time text message (SMS) intervention to increase the uptake of household tuberculosis contact investigation and linkage to care was extremely low, a fact only discoverable through detailed process evaluation. This study suggests the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions using mobile communications to improve health. 
%M 30459147
%R 10.2196/10239
%U http://mhealth.jmir.org/2018/11/e10239/
%U https://doi.org/10.2196/10239
%U http://www.ncbi.nlm.nih.gov/pubmed/30459147

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 11
%P e183
%T An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context
%A Leluțiu-Weinberger,Corina
%A Manu,Monica
%A Ionescu,Florentina
%A Dogaru,Bogdan
%A Kovacs,Tudor
%A Dorobănțescu,Cristian
%A Predescu,Mioara
%A Surace,Anthony
%A Pachankis,John E
%+ François-Xavier Bagnoud Center, School of Nursing, Rutgers Biomedical and Health Sciences, 65 Bergen Street, 8th Floor, Newark, NJ, 07101, United States, 1 9739722093, cl1148@sn.rutgers.edu
%K alcohol use
%K young gay and bisexual men
%K HIV risk
%K mental health
%K mHealth intervention
%D 2018

%7 14.11.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Young gay and bisexual men (YGBM) in some Eastern European countries, such as Romania, face high stigma and discrimination, including in health care. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. Objective: This study aimed to adapt and pilot test, in Romania, a preliminarily efficacious mobile health (mHealth) HIV-prevention intervention, created in the United States, to reduce HIV risk among YGBM. Methods: After an intervention formative phase, we enrolled 43 YGBM, mean age 23.2 (SD 3.6) years, who reported condomless sex with a male partner and at least 5 days of heavy drinking in the past 3 months. These YGBM completed up to eight 60-minute text-based counseling sessions grounded in motivational interviewing and cognitive behavioral skills training with trained counselors on a private study mobile platform. We conducted one-group pre-post intervention assessments of sexual (eg, HIV-risk behavior), behavioral (eg, alcohol use), and mental health (eg, depression) outcomes to evaluate the intervention impact. Results: From baseline to follow-up, participants reported significant (1) increases in HIV-related knowledge (mean 4.6 vs mean 4.8; P=.001) and recent HIV testing (mean 2.8 vs mean 3.3; P=.05); (2) reductions in the number of days of heavy alcohol consumption (mean 12.8 vs mean 6.9; P=.005), and (3) increases in the self-efficacy of condom use (mean 3.3 vs mean 4.0; P=.01). Participants reported significant reductions in anxiety (mean 1.4 vs mean 1.0; P=.02) and depression (mean 1.5 vs mean 1.0; P=.003). The intervention yielded high acceptability and feasibility: 86% (38/44) of participants who began the intervention completed the minimum dose of 5 sessions, with an average of 7.1 sessions completed; evaluation interviews indicated that participation was rewarding and an “eye-opener” about HIV risk reduction, healthy identity development, and partner communication. Conclusions: This first mHealth HIV risk-reduction pilot intervention for YGBM in Eastern Europe indicates preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination across various similar settings pending future efficacy testing in a large trial, especially in contexts where stigma keeps YGBM out of reach of affirmative health interventions. 
%M 30429117
%R 10.2196/mhealth.9283
%U https://mhealth.jmir.org/2018/11/e183/
%U https://doi.org/10.2196/mhealth.9283
%U http://www.ncbi.nlm.nih.gov/pubmed/30429117

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 11
%P e10190
%T Insights From a Text Messaging–Based Sexual and Reproductive Health Information Program in Tanzania (m4RH): Retrospective Analysis
%A Olsen,Patrick S
%A Plourde,Kate F
%A Lasway,Christine
%A van Praag,Eric
%+ Health Services Research, Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11713, polsen@fhi360.org
%K data analysis
%K mobile phone
%K mHealth
%K short message service
%K user engagement
%D 2018

%7 01.11.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Many mobile health (mHealth) interventions have the potential to generate and store vast amounts of system-generated participant interaction data that could provide insight into user engagement, programmatic strengths, and areas that need improvement to maximize efficacy. However, despite the popularity of mHealth interventions, there is little documentation on how to use these data to monitor and improve programming or to evaluate impact. Objective: This study aimed to better understand how users of the Mobile for Reproductive Health (m4RH) mHealth intervention engaged with the program in Tanzania from September 2013 to August 2016. Methods: We conducted secondary data analysis of longitudinal data captured by system logs of participant interactions with the m4RH program from 127 districts in Tanzania from September 2013 to August 2016. Data cleaning and analysis was conducted using Stata 13. The data were examined for completeness and “correctness.” No missing data was imputed; respondents with missing or incorrect values were dropped from the analyses. Results: The total population for analysis included 3,673,702 queries among 409,768 unique visitors. New users represented roughly 11.15% (409,768/3,673,702) of all queries. Among all system queries for new users, 46.10% (188,904/409,768) users accessed the m4RH main menu. Among these users, 89.58% (169,218/188,904) accessed specific m4RH content on family planning, contraceptive methods, adolescent-specific and youth-specific information, and clinic locations after first accessing the m4RH main menu. The majority of these users (216,422/409,768, 52.82%) requested information on contraceptive methods; fewer users (23,236/409,768, 5.67%) requested information on clinic location. The conversion rate was highest during the first and second years of the program when nearly all users (11,246/11,470, 98.05%, and 33,551/34,830, 96.33%, respectively) who accessed m4RH continued on to query more specific content from the system. The rate of users that accessed m4RH and became active users declined slightly from 98.05% (11,246/11,470) in 2013 to 87.54% (56,696/64,765) in 2016. Overall, slightly more than one-third of all new users accessing m4RH sent queries at least once per month for 2 or more months, and 67.86% (278,088/409,768) of new and returning users requested information multiple times per month. Promotional periods were present for 15 of 36 months during the study period. Conclusions: The analysis of the rich data captured provides a useful framework with which to measure the degree and nature of user engagement utilizing routine system-generated data. It also contributes to knowledge of how users engage with text messaging (short message service)-based health promotion interventions and demonstrates how data generated on user interactions could inform improvements to the design and delivery of a service, thereby enhancing its effectiveness. 
%M 30389651
%R 10.2196/10190
%U https://mhealth.jmir.org/2018/11/e10190/
%U https://doi.org/10.2196/10190
%U http://www.ncbi.nlm.nih.gov/pubmed/30389651

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 10
%P e11039
%T A Short Message Service Intervention for Improving Infant Feeding Practices in Shanghai, China: Planning, Implementation, and Process Evaluation
%A Jiang,Hong
%A Li,Mu
%A Wen,Li Ming
%A Baur,Louise A
%A He,Gengsheng
%A Ma,Xiaoying
%A Qian,Xu
%+ Global Health Institute, School of Public Health, Fudan University, Mailbox 175, No. 138 Yixueyuan Road, Shanghai, 200032, China, 86 21 64179976, h_jiang@fudan.edu.cn
%K mHealth
%K short message service
%K breastfeeding
%K infant feeding practices
%K health services
%K planning and development
%K implementation
%K process evaluation
%D 2018

%7 29.10.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Although mobile health (mHealth) has been widely applied in health care services, few studies have reported the detailed process of the development and implementation of text messaging (short message service, SMS) interventions. Objective: Our study aims to demonstrate the process and lessons learned from a community-based text messaging (SMS) intervention for improving infant feeding in Shanghai, China. Methods: The intervention included planning and development, implementation, and process evaluation. A 3-phase process was adopted during planning and development: (1) a formative study with expectant and new mothers to explore the barriers of appropriate infant feeding practices; (2) a baseline questionnaire survey to understand potential intervention approaches; and (3) development of the text message bank. The text messaging intervention was delivered via a computer-based platform. A message bank was established before the start of the intervention containing information on the benefits of breastfeeding, preparing for breastfeeding, early initiation of breastfeeding, timely introduction of complementary foods, and establishing appropriate feeding practices, etc. An expert advisory committee oversaw the content and quality of the message bank. Process evaluation was conducted through field records and qualitative interviews with participating mothers. Results: We found that the text messaging intervention was feasible and well received by mothers because of its easy and flexible access. The weekly based message frequency was thought to be appropriate, and the contents were anticipatory and trustworthy. Some mothers had high expectations for timely response to inquiries. Occasionally, the text messages were not delivered due to unstable telecommunication transmission. Mothers suggested that the messages could be more personalized. Conclusions: This study demonstrates the feasibility and value of text messaging intervention in filling gaps in delivering health care services and promoting healthy infant feeding practices in settings where personal contact is limited. 
%M 30373728
%R 10.2196/11039
%U http://mhealth.jmir.org/2018/10/e11039/
%U https://doi.org/10.2196/11039
%U http://www.ncbi.nlm.nih.gov/pubmed/30373728

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 4
%N 4
%P e68
%T Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review
%A Tom-Aba,Daniel
%A Nguku,Patrick Mboya
%A Arinze,Chinedu Chukwujekwu
%A Krause,Gerard
%+ Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffen Strasse 7, Braunschweig, 38124, Germany, 49 01739136081, daniel.tom-aba@helmholtz-hzi.de
%K case management
%K contact tracing
%K Ebola virus disease
%K eHealth
%K mHealth
%K systematic review
%K West Africa
%D 2018

%7 29.10.2018
%9 Review
%J JMIR Public Health Surveill
%G English
                
%X Background: The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language using the search strategy: (“outbreak” OR “epidemic”) AND (“mobile phone” OR “smartphone” OR “smart phone” OR “mobile phone” OR “tablet” OR “mHealth”) AND (“Ebola” OR ”EVD” OR “VHF” OR “Ebola virus disease” OR “viral hemorrhagic fever”) AND (“2014” OR “2015”). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools’ functionalities. Results: We identified 1220 publications through the search strategy, of which 6.31% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62% (34/55) offered functionalities for surveillance, 22% (10/45) for case management, 18% (7/38) for contact tracing, and 6% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities. Conclusions: Among the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development. 
%M 30373727
%R 10.2196/publichealth.9015
%U http://publichealth.jmir.org/2018/4/e68/
%U https://doi.org/10.2196/publichealth.9015
%U http://www.ncbi.nlm.nih.gov/pubmed/30373727

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 10
%P e11440
%T Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review
%A Bassi,Abhinav
%A John,Oommen
%A Praveen,Devarsetty
%A Maulik,Pallab K
%A Panda,Rajmohan
%A Jha,Vivekanand
%+ George Institute for Global Health, India, 311-312, Third Floor, Elegance Tower, Plot Number 8, Jasola District Centre, New Delhi, 110025, India, 91 1141588091, vjha@georgeinstitute.org.in
%K mHealth
%K telemedicine
%K health care system
%K India
%D 2018

%7 26.10.2018
%9 Review
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. Objective: We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. Methods: A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. Results: The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. Conclusions: In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes. 
%M 30368435
%R 10.2196/11440
%U http://mhealth.jmir.org/2018/10/e11440/
%U https://doi.org/10.2196/11440
%U http://www.ncbi.nlm.nih.gov/pubmed/30368435

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 10
%P e11076
%T Teleconsultation Using Mobile Phones for Diagnosis and Acute Care of Burn Injuries Among Emergency Physicians: Mixed-Methods Study
%A Klingberg,Anders
%A Wallis,Lee Alan
%A Hasselberg,Marie
%A Yen,Po-Yin
%A Fritzell,Sara Caroline
%+ Department of Public Health Sciences, Karolinska Institutet, Solnavägen 1, 171 77, Stockholm,, Sweden, 46 733357727, anders.klingberg@ki.se
%K mobile phone
%K referral and consultation
%K emergency medicine
%K mHealth
%K teleconsultations
%K burns
%K usability evaluation
%K think-aloud
%K video analysis
%K South Africa
%D 2018

%7 19.10.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The referral process in acute care remains challenging in many areas including burn care. Mobile phone apps designed explicitly for medical referrals and consultations could streamline the referral process by using structured templates and integrating features specific to different specialties. However, as these apps are competing with commercial chat services, usability becomes a crucial factor for successful uptake. Objective: The aim of this study was to assess the usability of a mobile phone app for remote consultations and referrals of burn injuries. Methods: A total of 24 emergency doctors and 4 burns consultants were recruited for the study. A mixed-methods approach was used including a usability questionnaire and a think-aloud interview. Think-aloud sessions were video-recorded, and content analysis was undertaken with predefined codes relating to the following 3 themes: ease of use, usefulness of content, and technology-induced errors. Results: The users perceived the app to be easy to use and useful, but some problems were identified. Issues relating to usability were associated with navigation, such as scrolling and zooming. Users also had problems in understanding the meaning of some icons and terminologies. Sometimes, some users felt limited by predefined options, and they wanted to be able to freely express their clinical findings. Conclusions: We found that users faced problems mainly with navigation when the app did not work in the same way as the other apps that were frequently used. Our study also resonates with previous findings that when using standardized templates, the systems should also allow the user to express their clinical findings in their own words. 
%M 30341047
%R 10.2196/11076
%U http://mhealth.jmir.org/2018/10/e11076/
%U https://doi.org/10.2196/11076
%U http://www.ncbi.nlm.nih.gov/pubmed/30341047

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 8
%P e169
%T Implementing eHealth Technology to Address Gaps in Early Infant Diagnosis Services: Qualitative Assessment of Kenyan Provider Experiences
%A Wexler,Catherine
%A Brown,Melinda
%A Hurley,Emily A
%A Ochieng,Martin
%A Goggin,Kathy
%A Gautney,Brad
%A Maloba,May
%A Lwembe,Raphael
%A Khamadi,Samoel
%A Finocchario-Kessler,Sarah
%+ Department of Family Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS,, United States, 1 913 945 7077, cwexler@kumc.edu
%K early infant diagnosis (EID)
%K HIV/AIDS
%K eHealth
%K mHealth
%K implementation science
%K Kenya
%D 2018

%7 22.08.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Literature suggests that electronic health (eHealth) interventions can improve the efficiency and accuracy of health service delivery and improve health outcomes and are generally well received by patients; however, there are limited data on provider experiences using eHealth interventions in resource-limited settings. The HIV Infant Tracking System (HITSystem) is an eHealth intervention designed to improve early infant diagnosis (EID) outcomes among HIV-exposed infants. Objective: We aimed to compare provider experiences with standard EID and HITSystem implementation at 6 Kenyan hospitals and 3 laboratories. The objective of this study was to better understand provider experiences implementing and using the HITSystem in order to assess facilitators and barriers that may impact adoption and sustainability of this eHealth intervention. Methods: As part of a randomized controlled trial to evaluate the HITSystem, we conducted semistructured interviews with 17 EID providers at participating intervention and control hospitals and laboratories. Results: Providers emphasized the perceived usefulness of the HITSystem, including improved efficiency in sample tracking and patient follow-up, strengthened communication networks among key stakeholders, and improved capacity to meet patient needs compared to standard EID. These advantages were realized from an intervention that providers saw as easy to use and largely compatible with workflow. However, supply stock outs and patient psychosocial factors (including fear of HIV status disclosure and poverty) provided ongoing challenges to EID service provision. Furthermore, slow or sporadic internet access and heavy workload prevented real-time HITSystem data entry for some clinicians. Conclusions: Provider experiences with the HITSystem indicate that the usefulness of the HITSystem, along with the ease with which it is able to be incorporated into hospital workflows, contributes to its sustained adoption and use in Kenyan hospitals. To maximize implementation success, care should be taken in intervention design and implementation to ensure that end users see clear advantages to using the technology and to account for variations in workflows, patient populations, and resource levels by allowing flexibility to suit user needs. Trial Registration: ClinicalTrials.gov NCT02072603; https://clinicaltrials.gov/ct2/show/NCT02072603 (Archived by WebCite at http://www.webcitation.org/71NgMCrAm) 
%M 30135052
%R 10.2196/mhealth.9725
%U http://mhealth.jmir.org/2018/8/e169/
%U https://doi.org/10.2196/mhealth.9725
%U http://www.ncbi.nlm.nih.gov/pubmed/30135052

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 4
%N 3
%P e11203
%T Bringing Real-Time Geospatial Precision to HIV Surveillance Through Smartphones: Feasibility Study
%A Nsabimana,Alain Placide
%A Uzabakiriho,Bernard
%A Kagabo,Daniel M
%A Nduwayo,Jerome
%A Fu,Qinyouen
%A Eng,Allison
%A Hughes,Joshua
%A Sia,Samuel K
%+ Junco Labs, 423 W 127th Street, Ground Floor, New York, NY,, United States, 1 518 880 9667, samuelsia@juncolabs.com
%K HIV surveillance
%K smartphones
%K mobile phones
%K geospatial data
%D 2018

%7 07.08.2018
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Precise measurements of HIV incidences at community level can help mount a more effective public health response, but the most reliable methods currently require labor-intensive population surveys. Novel mobile phone technologies are being tested for adherence to medical appointments and antiretroviral therapy, but using them to track HIV test results with automatically generated geospatial coordinates has not been widely tested. Objective: We customized a portable reader for interpreting the results of HIV lateral flow tests and developed a mobile phone app to track HIV test results in urban and rural locations in Rwanda. The objective was to assess the feasibility of this technology to collect front line HIV test results in real time and with geospatial context to help measure HIV incidences and improve epidemiological surveillance. Methods: Twenty health care workers used the technology to track the test results of 2190 patients across 3 hospital sites (2 urban sites in Kigali and a rural site in the Western Province of Rwanda). Mobile phones for less than US $70 each were used. The mobile phone app to record HIV test results could take place without internet connectivity with uploading of results to the cloud taking place later with internet. Results: A total of 91.51% (2004/2190) of HIV test results could be tracked in real time on an online dashboard with geographical resolution down to street level. Out of the 20 health care workers, 14 (70%) would recommend the lateral flow reader, and 100% would recommend the mobile phone app. Conclusions: Smartphones have the potential to simplify the input of HIV test results with geospatial context and in real time to improve public health surveillance of HIV. 
%M 30087088
%R 10.2196/11203
%U http://publichealth.jmir.org/2018/3/e11203/
%U https://doi.org/10.2196/11203
%U http://www.ncbi.nlm.nih.gov/pubmed/30087088

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 8
%P e10482
%T A Smartphone Game-Based Intervention (Tumaini) to Prevent HIV Among Young Africans: Pilot Randomized Controlled Trial
%A Winskell,Kate
%A Sabben,Gaëlle
%A Akelo,Victor
%A Ondeng'e,Ken
%A Obong'o,Christopher
%A Stephenson,Rob
%A Warhol,David
%A Mudhune,Victor
%+ Rollins School of Public Health, Hubert Department of Global Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 (404)727 5286, swinske@emory.edu
%K HIV
%K youth
%K Sub-Saharan Africa
%K Kenya
%K serious game
%K narrative
%K smartphone
%K pilot study
%K randomized controlled trial
%K mhealth
%K prevention
%D 2018

%7 01.08.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: There is a pressing need to ensure that youth in high HIV prevalence settings are prepared for a safer sexual debut. Smartphone ownership is increasing dramatically in low-income and middle-income countries. Smartphone games that are appropriately grounded in behavioral theory and evidence-based practice have the potential to become valuable tools in youth HIV prevention efforts in Sub-Saharan Africa. Objective: To pilot-test a theory-based, empirically grounded smartphone game for young Kenyans designed to increase age and condom use at first sex, aiming to establish directionality of effects on behavior change. Methods: Tumaini (“hope for the future” in Swahili) is an interactive, narrative-based game grounded in social cognitive theory. A randomized controlled pilot study was conducted in Kisumu, Western Kenya, from April to June 2017 with 60 participants aged 11-14 (mean 12.7) years. Intervention arm participants (n=30) were provided with an Android smartphone with Tumaini installed on it and were instructed to play the game for at least 1 hour a day for 16 days; control arm participants (n=30) received no intervention. All participants completed a survey on behavioral mediators, delivered via an audio computer-assisted self-interview system at baseline (T1), post intervention (T2), and at 6 weeks postintervention (T3). The postintervention survey for intervention arm participants included questions eliciting feedback on the game. Intervention arm participants and their parents participated in 8 postintervention focus group discussions. Game log files were analyzed to calculate the length of exposure to the game. Behavioral survey data were analyzed using two-sample t tests to compare mean change from T1 to T2 and to T3 for intervention versus control arm participants. Descriptive statistics on game feedback questions were computed. Focus group transcripts were uploaded to MAXQDA software, where they were labeled with deductive and inductive codes. Data were analyzed thematically and compared across demographics. Results: Intervention arm participants played Tumaini for a mean of approximately 27 hours. The intervention arm showed significant gains in sexual health-related knowledge and self-efficacy (both P<.001), behavioral intention for risk-avoidance strategies and sexual risk communication (P=.006), and overall survey scores (P<.001) compared with the control arm at T3. The postintervention survey revealed high subjective measures of the game’s value, relevance, and appeal. Focus groups identified a wide range of knowledge and skills the participants had gained, including setting goals and planning how to achieve them, which was perceived as a key motivator for avoiding or reducing risk. Conclusions: The study supports the need for further research to assess the efficacy of the game-based intervention. If proven efficacious, smartphone games have the potential to dramatically increase the reach of culturally adapted behavioral interventions while ensuring fidelity to intervention design. Trial Registration: ClinicalTrials.gov NCT03054051; http://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW) 
%M 30068501
%R 10.2196/10482
%U http://mhealth.jmir.org/2018/8/e10482/
%U https://doi.org/10.2196/10482
%U http://www.ncbi.nlm.nih.gov/pubmed/30068501

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 7
%P e158
%T The Complexity of Mental Health App Privacy Policies: A Potential Barrier to Privacy
%A Powell,Adam C
%A Singh,Preeti
%A Torous,John
%+ Payer+Provider Syndicate, 111 Beach Street Suite 4e, Boston, MA 02111, United States, 1 617 939 9168, powell@payerprovider.com
%K apps
%K privacy
%K ethics
%K mobile phone
%D 2018

%7 30.7.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In 2017, the Supreme Court of India ruled that privacy is a fundamental right of every citizen. Although mobile phone apps have the potential to help people with noncommunicable diseases, such as diabetes and mental illness, they often contain complex privacy policies, which consumers may not understand. This complexity may impede the ability of consumers to make decisions regarding privacy, a critical issue due to the stigma of mental illness. Objective: Our objective is to determine whether mental health apps have more complex privacy policies than diabetes apps. Methods: The study used privacy policies extracted from apps. The apps pertained to diabetes or mental health, and were all of Indian origin. Privacy policy reading complexity was compared between the two types of apps using a series of 15 readability measures. The universe of applicable apps on the Google Play store, as viewed between May and June 2017, was considered. The measures of readability were compared using chi-square tests. Results: No significant difference was found between the privacy policy readability of the diabetes apps versus the mental health apps for each of the measures considered. The mean Flesch-Kincaid Grade Level was 13.9 for diabetes apps and 13.6 for mental health apps; therefore, the mean policy grade level for both types of apps was written at a college level. Privacy policies in the 25th percentile of complexity were also written at a college level for both types of apps. Conclusions: Privacy policy complexity may be a barrier for informed decision making. 
%M 30061090
%R 10.2196/mhealth.9871
%U http://mhealth.jmir.org/2018/7/e158/
%U https://doi.org/10.2196/mhealth.9871
%U http://www.ncbi.nlm.nih.gov/pubmed/30061090

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 7
%P e156
%T Mobile-Based Nutrition Counseling and Unconditional Cash Transfers for Improving Maternal and Child Nutrition in Bangladesh: Pilot Study
%A Huda,Tanvir M
%A Alam,Ashraful
%A Tahsina,Tazeen
%A Hasan,Mohammad Mehedi
%A Khan,Jasmin
%A Rahman,Mohammad Masudur
%A Siddique,Abu Bakkar
%A Arifeen,Shams El
%A Dibley,Michael J
%+ Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney,, Australia, 61 412735284, huda.tanvir@gmail.com
%K unconditional cash transfer
%K mHealth
%K voice message
%K undernutrition
%D 2018

%7 18.07.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Inappropriate feeding practices, inadequate nutrition knowledge, and insufficient access to food are major risk factors for maternal and child undernutrition. There is evidence to suggest that the combination of cash transfer and nutrition education improves child growth. However, a cost-effective delivery platform is needed to achieve complete, population-wide coverage of these interventions. Objective: This study aimed to assess the feasibility, acceptability, and perceived appropriateness of an intervention package consisting of voice messaging, direct counseling, and unconditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of a child’s life in a poor rural community in Bangladesh. Methods: We conducted a mixed-methods pilot study. We recruited 340 pregnant or recently delivered, lactating women from rural Bangladesh. The intervention consisted of an unconditional cash transfer combined with nutrition counseling, both delivered on a mobile platform. The participants received a mobile phone and BDT 787 per month (US $10). We used a voice messaging service to deliver nutrition-related messages. We provided additional nutrition counseling through a nutrition counselor from a call center. We carried out cross-sectional surveys at baseline and at the end of the study, focus group discussions, and in-depth interviews with participants and their family members. Results: Approximately 89% (245/275) of participants reported that they were able to operate the mobile phones without much trouble. Charging of the mobile handsets posed some challenges since only approximately 45% (124/275) households in our study had electricity at home. Approximately 26% (72/275) women reported they had charged their mobile phones at their neighbor’s house, while 34% (94/275) reported that they charged it at a marketplace. Less than 10% (22/275) of women reported difficulties understanding the voice messages or direct counseling through mobile phones, while only 3% (8/275) of women reported they had some problems withdrawing cash from the mobile bank agent. Approximately 87% (236/275) women reported spending the cash to purchase food for themselves and their children. Conclusions: The nature of our study precludes any conclusion about the effectiveness of the intervention package. However, the high coverage of our intervention and the positive feedback from the mothers were encouraging and support the feasibility, acceptability, and appropriateness of this program. Further research is needed to determine the efficacy and cost-effectiveness of mobile-based nutrition counseling and unconditional cash transfers in improving maternal and child nutrition in Bangladesh. 
%M 30021707
%R 10.2196/mhealth.8832
%U http://mhealth.jmir.org/2018/7/e156/
%U https://doi.org/10.2196/mhealth.8832
%U http://www.ncbi.nlm.nih.gov/pubmed/30021707

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 7
%P e155
%T Improving Linkage to HIV Care Through Mobile Phone Apps: Randomized Controlled Trial
%A Venter,Willem
%A Coleman,Jesse
%A Chan,Vincent Lau
%A Shubber,Zara
%A Phatsoane,Mothepane
%A Gorgens,Marelize
%A Stewart-Isherwood,Lynsey
%A Carmona,Sergio
%A Fraser-Hurt,Nicole
%+ Wits Reproductive Health and HIV Institute, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Hugh Soloman Building, 22 Esselen Street, Johannesburg, 2000, South Africa, 27 833991066, venter.francois@gmail.com
%K cell phones
%K app
%K Africa
%K linkage to care
%K HIV
%K patient information
%D 2018

%7 17.07.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In HIV treatment program, gaps in the “cascade of care” where patients are lost between diagnosis, laboratory evaluation, treatment initiation, and retention in HIV care, is a well-described challenge. Growing access to internet-enabled mobile phones has led to an interest in using the technology to improve patient engagement with health care. Objective: The objectives of this trial were: (1) to assess whether a mobile phone–enabled app could provide HIV patients with laboratory test results, (2) to better understand the implementation of such an intervention, and (3) to determine app effectiveness in improving linkage to HIV care after diagnosis. Methods: We developed and tested an app through a randomized controlled trial carried out in several primary health care facilities in Johannesburg. Newly diagnosed HIV-positive patients were screened, recruited, and randomized into the trial as they were giving a blood sample for initial CD4 staging. Trial eligibility included ownership of a phone compatible with the app and access to the internet. Trial participants were followed for a minimum of eight months to determine linkage to HIV care indicated by an HIV-related laboratory test result. Results: The trial outcome results are being prepared for publication, but here we describe the significant operational and technological lessons provided by the implementation. Android was identified as the most suitable operating system for the app, due to Android functionality and communication characteristics. Android also had the most significant market share of all smartphone operating systems in South Africa. The app was successfully developed with laboratory results sent to personal smartphones. However, given the trial requirements and the app itself, only 10% of screened HIV patients successfully enrolled. We report on issues such as patient eligibility, app testing in a dynamic phone market, software installation and compatibility, safe identification of patients, linkage of laboratory results to patients lacking unique identifiers, and present lessons and potential solutions. Conclusions: The implementation challenges and lessons of this trial may assist future similar mHealth interventions to avoid some of the pitfalls. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, could have led to better trial recruitment. However, the majority of screened patients were interested in the study, and the app was installed successfully in patients with suitable smartphones, suggesting that this may be a way to engage patients with their health care data in future. Trial Registration: ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW) 
%M 30021706
%R 10.2196/mhealth.8376
%U http://mhealth.jmir.org/2018/7/e155/
%U https://doi.org/10.2196/mhealth.8376
%U http://www.ncbi.nlm.nih.gov/pubmed/30021706

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 7
%P e137
%T Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial
%A Saleh,Shadi
%A Farah,Angie
%A Dimassi,Hani
%A El Arnaout,Nour
%A Constantin,Joanne
%A Osman,Mona
%A El Morr,Christo
%A Alameddine,Mohamad
%+ Health Management and Policy, College of Medicine, Mohammed bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Building 14, Dubai, 505055, United Arab Emirates, 971 +971521023423, ma164@aub.edu.lb
%K noncommunicable diseases
%K hypertension
%K diabetes mellitus
%K telemedicine
%K mobile health
%K rural health
%K refugees
%D 2018

%7 13.07.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)–related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations. Objective: The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon. Methods: This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients—1433 in the intervention group and 926 in the control group—was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp). Results: Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c;  P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01). Conclusions: This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population. Trial Registration: ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ) 
%M 30006326
%R 10.2196/mhealth.8146
%U http://mhealth.jmir.org/2018/7/e137/
%U https://doi.org/10.2196/mhealth.8146
%U http://www.ncbi.nlm.nih.gov/pubmed/30006326

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 7
%N 7
%P e162
%T Identifying Barriers and Facilitators of 13 mHealth Projects in North America and Africa: Protocol for a 5-Year Implementation Science Study
%A Tilahun,Binyam
%A Smillie,Kirsten
%A Bardosh,Kevin Louis
%A Murray,Melanie
%A Fitzgerald,Mark
%A Cook,Victoria
%A Poureslami,Iraj
%A Forrest,Jamie
%A Lester,Richard
%+ Division of Infectious Disease, Faculty of Medicine, University of British Columbia, 10th Avenue West, Vancouver, BC, V5Z0C1, Canada, 1 604 875 4588, tilahunb@mail.ubc.ca
%K mobile health
%K mHealth
%K text messaging
%K digital health
%K implementation science
%K Africa
%K North America
%D 2018

%7 03.07.2018
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Although many mHealth interventions have shown efficacy in research, few have been effectively implemented and sustained in real-world health system settings. Despite this programmatic gap, there is limited conclusive evidence identifying the factors that affect the implementation and successful integration of mHealth into a health system. Objective: The aim of this study is to examine the individual, organizational, and external level factors associated with the effective implementation of WelTel, an mHealth intervention designed to support outpatient medication adherence and engagement in care in Africa and North America. Methods: We will adopt the Consolidated Framework for Implementation Research (CFIR) constructs for evaluation of mHealth implementation including a scoring and monitoring system. We will apply the adapted tool to identify facilitators and barriers to implementation of the WelTel mHealth intervention in order to determine how the technology platform is perceived, diffused, adapted, and used by different mHealth project teams and health system actors in Africa and North America. We will use a mixed-methods approach to quantitatively test whether the factors identified in the CFIR framework are associated with the successful uptake of the mHealth intervention toward implementation goals. We will triangulate these data through interviews and focus group discussion with project stakeholders, exploring factors associated with successful implementation and sustainment of these interventions. Results: The development of the customized CFIR is finalized and currently is in pilot testing. The initial results of the use of the tool in those 13 implementations will be available in 2019. Continuous conference and peer- reviewed publications will be published in the coming years. Conclusions: The results of this study will provide an in-depth understanding of individual, organizational, and external level factors that influence the successful implementation of mHealth in different health systems and geographic contexts over time. Via the tool’s unique scoring system connected to qualitative descriptors, these data will inform the most critical implementation targets and contribute to the tailoring of strategies that will assist the health system in overcoming barriers to implementation, and ultimately, improve treatment adherence and engagement in care. Registered Report Identifier: RR1-10.2196/9633 
%M 29970360
%R 10.2196/resprot.9633
%U http://www.researchprotocols.org/2018/7/e162/
%U https://doi.org/10.2196/resprot.9633
%U http://www.ncbi.nlm.nih.gov/pubmed/29970360

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e126
%T The Use of Mobile Health Applications to Improve Patient Experience: Cross-Sectional Study in Chinese Public Hospitals
%A Lu,Chuntao
%A Hu,Yinhuan
%A Xie,Jinzhu
%A Fu,Qiang
%A Leigh,Isabella
%A Governor,Samuel
%A Wang,Guanping
%+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan,, China, 86 13554285879, hyh288@hotmail.com
%K mobile applications
%K technology
%K outpatients
%K patient satisfaction
%K surveys and questionnaire
%D 2018

%7 23.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The proliferation of mobile health apps has greatly changed the way society accesses the health care industry. However, despite the widespread use of mobile health apps by patients in China, there has been little research that evaluates the effect of mobile health apps on patient experience during hospital visits. Objective: The purpose of our study was to examine whether the use of mobile health apps improves patient experience and to find out the difference in patient experience between users and nonusers and the characteristics associated with the users of these apps. Methods: We used the Chinese Outpatient Experience Questionnaire to survey patient experience. A sample of 300 outpatients was randomly selected from 3 comprehensive public hospitals (3 tertiary hospitals) in Hubei province, China. Each hospital randomly selected 50 respondents from mobile health app users and 50 from nonusers. A chi-square test was employed to compare the different categorical characteristics between mobile health app users and nonusers. A t test was used to test the significance in continuous variables between user scores and nonuser scores. Multiple linear regression was conducted to determine whether the use of mobile health apps during hospital visits was associated with patient experience. Results: The users and nonusers differed in age (χ22=12.2, P=.002), education (χ23=9.3, P=.03), living place (χ21=7.7, P=.006), and the need for specialists (χ24=11.0, P=.03). Compared with nonusers, mobile health app users in China were younger, better educated, living in urban areas, and had higher demands for specialists. In addition, mobile health app users gave significantly higher scores than nonusers in total patient experience scores (t298=3.919, P<.001), the 18 items and the 5 dimensions of physician-patient communication (t298=2.93, P=.004), health information (t298=3.556, P<.001), medical service fees (t298=3.991, P<.001), short-term outcome (t298=4.533, P<.001), and general satisfaction (t298=4.304, P<.001). Multiple linear regression results showed that the use of mobile health apps during hospital visits influenced patient experience (t289=3.143, P=.002). After controlling for other factors, it was shown that the use of mobile health apps increased the outpatient experience scores by 17.7%. Additional results from the study found that the self-rated health status (t289=3.746, P<.001) and monthly income of patients (t289=2.416, P=.02) influenced the patient experience as well. Conclusions: The use of mobile health apps could improve patient experience, especially with regard to accessing health information, making physician-patient communication more convenient, ensuring transparency in medical charge, and ameliorating short-term outcomes. All of these may contribute to positive health outcomes. Therefore, we should encourage the adoption of mobile health apps in health care settings so as to improve patient experience. 
%M 29792290
%R 10.2196/mhealth.9145
%U http://mhealth.jmir.org/2018/5/e126/
%U https://doi.org/10.2196/mhealth.9145
%U http://www.ncbi.nlm.nih.gov/pubmed/29792290

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e122
%T Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial
%A Musiimenta,Angella
%A Atukunda,Esther C
%A Tumuhimbise,Wilson
%A Pisarski,Emily E
%A Tam,Melanie
%A Wyatt,Monique A
%A Ware,Norma C
%A Haberer,Jessica E
%+ Mbarara University of Science and Technology, Angella Musiimenta, PhD, Mbarara, PO Box 653, Uganda, 256 776820598, amusiimenta@must.ac.ug
%K real-time adherence monitoring
%K SMS
%K mobile health technologies
%K antiretroviral therapy
%K acceptability
%K feasibility study
%D 2018

%7 17.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. Objective: The aim of this study was to assess the acceptability and feasibility of real-time adherence monitoring linked to text messaging (short message service, SMS) reminders and notifications to support adherence among individuals living with HIV who are taking ART in rural southwestern Uganda. Methods: Individuals living with HIV who were initiating ART were enrolled in a pilot randomized controlled trial and followed up for 9 months. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses in the scheduled SMS and triggered SMS arms. Study participants and social supporters participated in qualitative semistructured in-depth interviews on acceptability and feasibility of this technology. An inductive, content analytic approach, framed by the unified theory of acceptance and use of technology model, was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded based upon device metrics collected electronically and summarized descriptively. Results: A total of 63 participants participated in the study. Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable; the predominant feedback was perceived utility—the intervention was beneficial in motivating and reminding patients to take medication, as well as enabling provision of social support. The intervention was found to be technically feasible, as data were obtained from most participants as expected most of the time. Potential challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. Conclusions: Real-time adherence monitoring integrated with SMS reminders and social support notifications is a generally acceptable (based primarily on perceived utility) and feasible intervention in a resource-limited country. Future efforts should focus on optimized device design, user training to overcome the challenges we encountered, cost effectiveness studies, as well as studying the monitoring aspect of the device without accompanying interventions. Trial Registration: ClinicalTrials.gov NCT01957865; https://clinicaltrials.gov/ct2/show/NCT01957865 (Archived by WebCite at http://www.webcitation.org/6zFiDlXDa) 
%M 29773527
%R 10.2196/mhealth.9031
%U http://mhealth.jmir.org/2018/5/e122/
%U https://doi.org/10.2196/mhealth.9031
%U http://www.ncbi.nlm.nih.gov/pubmed/29773527

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e119
%T Multistakeholder Perspectives on Maternal Text Messaging Intervention in Uganda: Qualitative Study
%A Ilozumba,Onaedo
%A Dieleman,Marjolein
%A Van Belle,Sara
%A Mukuru,Moses
%A Bardají,Azucena
%A Broerse,Jacqueline EW
%+ Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, Netherlands, 31 205983143, ona.ilozumba@vu.nl
%K maternal health
%K telemedicine
%K community health workers
%K Uganda
%K evaluation studies
%D 2018

%7 10.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Despite continued interest in the use of mobile health for improving maternal health outcomes, there have been limited attempts to identify relevant program theories. Objectives: This study had two aims: first, to explicate the assumptions of program designers, which we call the program theory and second, to contrast this program theory with empirical data to gain a better understanding of mechanisms, facilitators, and barriers related to the program outcomes. Methods: To achieve the aforementioned objectives, we conducted a retrospective qualitative study of a text messaging (short message service) platform geared at improving individual maternal health outcomes in Uganda. Through interviews with program designers (n=3), we elicited 3 main designers’ assumptions and explored these against data from qualitative interviews with primary beneficiaries (n=26; 15 women and 11 men) and health service providers (n=6), as well as 6 focus group discussions with village health team members (n=50) who were all involved in the program. Results: Our study results highlighted that while the program designers’ assumptions were appropriate, additional mechanisms and contextual factors, such as the importance of incentives for village health team members, mobile phone ownership, and health system factors should have been considered. Conclusions: Our results indicate that text messages could be an effective part of a more comprehensive maternal health program when context and system barriers are identified and addressed in the program theories. 
%M 29748159
%R 10.2196/mhealth.9565
%U http://mhealth.jmir.org/2018/5/e119/
%U https://doi.org/10.2196/mhealth.9565
%U http://www.ncbi.nlm.nih.gov/pubmed/29748159

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 5
%P e117
%T Determinants of Intention to Use Mobile Phone Caller Tunes to Promote Voluntary Blood Donation: Cross-Sectional Study
%A Appiah,Bernard
%A Burdine,James N
%A Aftab,Ammar
%A Asamoah-Akuoko,Lucy
%A Anum,David A
%A Kretchy,Irene A
%A Samman,Elfreda W
%A Appiah,Patience B
%A Bates,Imelda
%+ Research Program on Public and International Engagement for Health, Department of Environmental and Occupational Health, Texas A&M School of Public Health, Texas A&M University, 1266 TAMU, College Station, Texas, TX, 77843, United States, 1 9794369456, appiah@sph.tamhsc.edu
%K caller tunes
%K blood donation
%K sub-Saharan Africa
%K technology acceptance model
%K mobile health
%D 2018

%7 04.05.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Voluntary blood donation rates are low in sub-Saharan Africa. Sociobehavioral factors such as a belief that donated blood would be used for performing rituals deter people from donating blood. There is a need for culturally appropriate communication interventions to encourage individuals to donate blood. Health care interventions that use mobile phones have increased in developing countries, although many of them focus on SMS text messaging (short message service, SMS). A unique feature of mobile phones that has so far not been used for aiding blood donation is caller tunes. Caller tunes replace the ringing sound heard by a caller to a mobile phone before the called party answers the call. In African countries such as Ghana, instead of the typical ringing sound, a caller may hear a message or song. Despite the popularity of such caller tunes, there is a lack of empirical studies on their potential use for promoting blood donation. Objective: The aim of this study was to use the technology acceptance model to explore the influence of the factors—perceived ease of use, perceived usefulness, attitude, and free of cost—on intentions of blood or nonblood donors to download blood donation-themed caller tunes to promote blood donation, if available. Methods: A total of 478 blood donors and 477 nonblood donors were purposively sampled for an interviewer-administered questionnaire survey at blood donation sites in Accra, Ghana. Data were analyzed using descriptive statistics, exploratory factor analysis, and confirmatory factory analysis or structural equation modeling, leading to hypothesis testing to examine factors that determine intention to use caller tunes for blood donation among blood or nonblood donors who use or do not use mobile phone caller tunes. Results: Perceived usefulness had a significant effect on intention to use caller tunes among blood donors with caller tunes (beta=.293, P<.001), blood donors without caller tunes (beta=.165, P=.02, nonblood donors with caller tunes (beta=.278, P<.001), and nonblood donors without caller tunes (beta=.164, P=.01). Attitudes had significant effect on intention to use caller tunes among blood donors without caller tunes (beta=.351, P<.001), nonblood donors with caller tunes (beta=.384, P<.001), nonblood donors without caller tunes (beta=.539, P<.001) but not among blood donors with caller tunes (beta=.056, P=.44). The effect of free-of-cost caller tunes on the intention to use for blood donation was statistically significant (beta=.169, P<.001) only in the case of nonblood donors without caller tunes, whereas this path was statistically not significant in other models. Conclusions: Our results provide empirical evidence for designing caller tunes to promote blood donation in Ghana. The study found that making caller tunes free is particularly relevant for nonblood donors with no caller tunes. 
%M 29728343
%R 10.2196/mhealth.9752
%U http://mhealth.jmir.org/2018/5/e117/
%U https://doi.org/10.2196/mhealth.9752
%U http://www.ncbi.nlm.nih.gov/pubmed/29728343

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 4
%N 2
%P e46
%T Recommendations for the Development of a Mobile HIV Prevention Intervention for Men Who Have Sex With Men and Hijras in Mumbai: Qualitative Study
%A Rawat,Shruta
%A Wilkerson,J Michael
%A Lawler,Sylvia M
%A Patankar,Pallav
%A Rosser,BR Simon
%A Shukla,Kanjani
%A Butame,Seyram
%A Ekstrand,Maria L
%+ School of Public Health, University of Texas Health Science Center at Houston, 7000 Fannin St, Ste 2620, Houston, TX,, United States, 1 713 500 9974, Johnny.M.Wilkerson@uth.tmc.edu
%K health promotion
%K health seeking
%K gays and lesbians
%K Internet
%K HIV/AIDS
%D 2018

%7 03.05.2018
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: As Internet and mobile phone use expands in India, there is an opportunity to develop mobile health (mHealth) interventions for marginalized populations, including men who have sex with men (MSM) and hijras (transgender women), hesitant to access traditional health care systems. Objective: The purpose of this study was to determine if an mHealth intervention was acceptable to MSM and hijras living in Mumbai, and if so, what features would be useful in targeting the prevention of HIV acquisition and to increase the quality of life among persons living with HIV/AIDS. Methods: Data from 4 focus groups with MSM and interviews with 4 hijras, 10 health service providers, and 8 mHealth developers were thematically analyzed. Results: Once the need for an mHealth intervention was confirmed, comments about features were organized into 3 themes: content, interface, and retention. Content subthemes included providing sex education for younger community members, providing information about STIs, and providing information and social support for persons living with HIV. Interface subthemes included presenting content using pictures; using videos to present stories of role models; using push notifications for testing, appointment, and medication reminders; using geolocation to link to just-in-time services; and using telemedicine to increase access to health service providers and community services. The 5 retention subthemes included keeping it fun, using gaming mechanics, developing content in regional languages, protecting confidentiality, and linking to social networking apps. Conclusions: These findings may help inform mHealth development in India. 
%M 29724705
%R 10.2196/publichealth.9088
%U http://publichealth.jmir.org/2018/2/e46/
%U https://doi.org/10.2196/publichealth.9088
%U http://www.ncbi.nlm.nih.gov/pubmed/29724705

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 4
%P e106
%T Mobile Health Initiatives in Vietnam: Scoping Study
%A Lam,Jeffrey A
%A Dang,Linh Thuy
%A Phan,Ngoc Tran
%A Trinh,Hue Thi
%A Vu,Nguyen Cong
%A Nguyen,Cuong Kieu
%+ Institute of Population, Health and Development, 14th Floor, ICON 4 Building, 243A De La Thanh, Lang Thuong, Dong Da, Hanoi,, Viet Nam, 84 2473000988 ext 341, cuong.kieu.nguyen@phad.org
%K mHealth
%K eHealth
%K mobile health
%K telemedicine
%K Vietnam
%K scoping review
%D 2018

%7 24.04.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) offers a promising solution to the multitude of challenges the Vietnamese health system faces, but there is a scarcity of published information on mHealth in Vietnam. Objective: The objectives of this scoping study were (1) to summarize the extent, range, and nature of mHealth initiatives in Vietnam and (2) to examine the opportunities and threats of mHealth utilization in the Vietnamese context. Methods: This scoping study systematically identified and extracted relevant information from 20 past and current mHealth initiatives in Vietnam. The study includes multimodal information sources, including published literature, gray literature (ie, government reports and unpublished literature), conference presentations, Web-based documents, and key informant interviews. Results: We extracted information from 27 records from the electronic search and conducted 14 key informant interviews, allowing us to identify 20 mHealth initiatives in Vietnam. Most of the initiatives were primarily funded by external donors (n=15), while other initiatives were government funded (n=1) or self-funded (n=4). A majority of the initiatives targeted vulnerable and hard-to-reach populations (n=11), aimed to prevent the occurrence of disease (n=12), and used text messaging (short message service, SMS) as part of their intervention (n=14). The study revealed that Vietnamese mHealth implementation has been challenged by factors including features unique to the Vietnamese language (n=4) and sociocultural factors (n=3). Conclusions: The largest threats to the popularity of mHealth initiatives are the absence of government policy, lack of government interest, heavy dependence on foreign funding, and lack of technological infrastructure. Finally, while current mHealth initiatives have already demonstrated promising opportunities for alternative models of funding, such as social entrepreneurship or private business models, sustainable mHealth initiatives outside of those funded by external donors have not yet been undertaken. 
%M 29691214
%R 10.2196/mhealth.8639
%U http://mhealth.jmir.org/2018/4/e106/
%U https://doi.org/10.2196/mhealth.8639
%U http://www.ncbi.nlm.nih.gov/pubmed/29691214

%0 Journal Article
        
%@ 2292-9495
%I JMIR Publications
%V 5
%N 2
%P e16
%T Relationship Between Evidence Requirements, User Expectations, and Actual Experiences: Usability Evaluation of the Twazon Arabic Weight Loss App
%A Alnasser,Aroub
%A Kyle,Janet
%A Alkhalifah,Abdulrahman
%A Marais,Debbi
%+ Food Science and Nutrition Department, College of Food and Agriculture Sciences, King Saud University, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 118056476, aroub@ksu.edu.sa
%K mHealth
%K weight loss
%K obesity
%K smartphones
%K mobile applications
%K Saudi Arabia
%K women's health
%D 2018

%7 17.04.2018
%9 Original Paper
%J JMIR Hum Factors
%G English
                
%X Background: Saudi Arabia has faced a steady growth in the prevalence of obesity. The concurrent and ubiquitous use of mobile technology, such as smartphones and apps, provides an opportunity for the implementation of mHealth technology, a method for delivering behavioral interventions. Despite their effectiveness in promoting lifestyle and diet modification, culturally adapted weight loss apps and related interventions are lacking in Gulf Cooperation Council countries. Objective: The objective of our study was to identify the relationship between adherence to evidence-informed practices, potential user expectations, and actual user experiences in order to enhance the understanding of the overall usability of the Twazon Arabic weight loss app. Methods: In 2 previous studies, 39 Saudi women were recruited for focus group discussions and 240 Saudi women were recruited for an app-based weight loss intervention. Usability of the Twazon Arabic weight loss app was evaluated by analyzing the opinions and experiences of 26 participants who engaged with the Twazon app for 4 months; the System Usability Scale (SUS) and word clouds were used. The results were triangulated with potential user expectations obtained in the focus group discussion and with the findings from an Arabic app screening for evidence-informed practices. Results: The average reported SUS score was 69.3. The most favored features were the calorie counter, step counter, and physical activity calorie counter. The features in need of improvement were the social network, notifications, and the Twazon Saudi Food Database. Twazon users preferred and found useful 7 of the 13 evidence-informed weight loss practices that were integrated into the features of the app. Conclusions: Triangulation identified the most notable relationship to be the disparity between user experience and 2 of the evidence-informed practices, namely a minimum weight loss goal of 0.5 to 1 kg/week and social support; no relationship was found between user expectations and evidence-informed weight loss practices. The overall usability of the Twazon Arabic weight loss app ranged between high marginal and acceptable, indicating that some improvements to the app should be considered for implementation in future app-based weight loss interventions of this kind. 
%M 29666042
%R 10.2196/humanfactors.9765
%U http://humanfactors.jmir.org/2018/2/e16/
%U https://doi.org/10.2196/humanfactors.9765
%U http://www.ncbi.nlm.nih.gov/pubmed/29666042

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 4
%P e76
%T Women’s Perceptions of Using Mobile Phones for Maternal and Child Health Support in Afghanistan: Cross-Sectional Survey
%A Yamin,Fazal
%A Kaewkungwal,Jaranit
%A Singhasivanon,Pratap
%A Lawpoolsri,Saranath
%+ Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithee Road, Ratchathewi, Bangkok,, Thailand, 66 2 306 9188, saranath.law@mahidol.ac.th
%K Afghanistan
%K mobile health
%K maternal health, child health
%K perception
%K mobile phone
%D 2018

%7 10.04.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Growing rates of global mobile subscriptions pave the way for implementation of mobile health (mHealth) initiatives, especially among hard-to-reach populations. Objective: This study aimed to determine the perceptions of Afghan women regarding the use of mobile phones for maternal and child health services. Methods: A cross-sectional survey was conducted in both rural and urban districts of Nangarhar Province, Afghanistan. The interviewer-administered questionnaire was used to assess participants’ demographic profile, mobile phone usage, and perception of respondents toward different aspects of health care delivery via mobile phones. Results: Of the 240 participants, 142 (59.2%) owned mobile phones and 220 (91.7%) routinely used mobile phones. Approximately 209 (87.1%) of participants were willing to receive health messages via a mobile phone. Automated voice call was the most preferred method for sending health messages. More than 90% of the women reported that they would like to receive reminders for their children’s vaccinations and antenatal care visits. Conclusions: Users’ perception was associated with mobile phone ownership, literacy level, and experience using mobile phones. In the study area, where the literacy rate is low, mHealth was well perceived. 
%M 29636317
%R 10.2196/mhealth.9504
%U http://mhealth.jmir.org/2018/4/e76/
%U https://doi.org/10.2196/mhealth.9504
%U http://www.ncbi.nlm.nih.gov/pubmed/29636317

%0 Journal Article
        
%@ 2291-9694
%I JMIR Publications
%V 6
%N 2
%P e18
%T Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians’ Perceptions and Attitudes
%A Daniel,Fady
%A Jabak,Suha
%A Sasso,Roula
%A Chamoun,Yara
%A Tamim,Hani
%+ Department of Internal Medicine, American University of Beirut Medical Center, American University of Beirut, Hamra, Cairo Street, Beirut,, Lebanon, 961 3614660, fd21@aub.edu.lb
%K social media
%K communication
%K patient-physician communication
%K technology use
%D 2018

%7 06.04.2018
%9 Original Paper
%J JMIR Med Inform
%G English
                
%X Background: The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective: The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods: This was a cross-sectional observational study using an online survey that addressed physicians’ perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results: A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions: The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. 
%M 29625955
%R 10.2196/medinform.8895
%U http://medinform.jmir.org/2018/2/e18/
%U https://doi.org/10.2196/medinform.8895
%U http://www.ncbi.nlm.nih.gov/pubmed/29625955

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 4
%N 1
%P e25
%T A Participatory System for Preventing Pandemics of Animal Origins: Pilot Study of the Participatory One Health Disease Detection (PODD) System
%A Yano,Terdsak
%A Phornwisetsirikun,Somphorn
%A Susumpow,Patipat
%A Visrutaratna,Surasing
%A Chanachai,Karoon
%A Phetra,Polawat
%A Chaisowwong,Warangkhana
%A Trakarnsirinont,Pairat
%A Hemwan,Phonpat
%A Kaewpinta,Boontuan
%A Singhapreecha,Charuk
%A Kreausukon,Khwanchai
%A Charoenpanyanet,Arisara 
%A Robert,Chongchit Sripun
%A Robert,Lamar
%A Rodtian,Pranee
%A Mahasing,Suteerat
%A Laiya,Ekkachai
%A Pattamakaew,Sakulrat
%A Tankitiyanon,Taweesart
%A Sansamur,Chalutwan
%A Srikitjakarn,Lertrak
%+ Faculty of Veterinary Medicine, Chiang Mai University, Chonlapratan Road, Maehia, Muang, Chiang Mai, 50100, Thailand, 66 871850280, lertrak.s@gmail.com
%K community-owned disease surveillance system
%K PODD
%K mobile app
%K one health
%K participatory approach
%K backyard chicken
%K pandemic prevention
%D 2018

%7 21.03.2018
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Aiming for early disease detection and prompt outbreak control, digital technology with a participatory One Health approach was used to create a novel disease surveillance system called Participatory One Health Disease Detection (PODD). PODD is a community-owned surveillance system that collects data from volunteer reporters; identifies disease outbreak automatically; and notifies the local governments (LGs), surrounding villages, and relevant authorities. This system provides a direct and immediate benefit to the communities by empowering them to protect themselves. Objective: The objective of this study was to determine the effectiveness of the PODD system for the rapid detection and control of disease outbreaks. Methods: The system was piloted in 74 LGs in Chiang Mai, Thailand, with the participation of 296 volunteer reporters. The volunteers and LGs were key participants in the piloting of the PODD system. Volunteers monitored animal and human diseases, as well as environmental problems, in their communities and reported these events via the PODD mobile phone app. LGs were responsible for outbreak control and provided support to the volunteers. Outcome mapping was used to evaluate the performance of the LGs and volunteers. Results: LGs were categorized into one of the 3 groups based on performance: A (good), B (fair), and C (poor), with the majority (46%,34/74) categorized into group B. Volunteers were similarly categorized into 4 performance groups (A-D), again with group A showing the best performance, with the majority categorized into groups B and C. After 16 months of implementation, 1029 abnormal events had been reported and confirmed to be true reports. The majority of abnormal reports were sick or dead animals (404/1029, 39.26%), followed by zoonoses and other human diseases (129/1029, 12.54%). Many potentially devastating animal disease outbreaks were detected and successfully controlled, including 26 chicken high mortality outbreaks, 4 cattle disease outbreaks, 3 pig disease outbreaks, and 3 fish disease outbreaks. In all cases, the communities and animal authorities cooperated to apply community contingency plans to control these outbreaks, and community volunteers continued to monitor the abnormal events for 3 weeks after each outbreak was controlled. Conclusions: By design, PODD initially targeted only animal diseases that potentially could emerge into human pandemics (eg, avian influenza) and then, in response to community needs, expanded to cover human health and environmental health issues. 
%M 29563079
%R 10.2196/publichealth.7375
%U http://publichealth.jmir.org/2018/1/e25/
%U https://doi.org/10.2196/publichealth.7375
%U http://www.ncbi.nlm.nih.gov/pubmed/29563079

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 4
%N 1
%P e20
%T Effect of Mobile Phone Text Message Reminders on Routine Immunization Uptake in Pakistan: Randomized Controlled Trial
%A Kazi,Abdul Momin
%A Ali,Murtaza
%A Zubair,Khurram
%A Kalimuddin,Hussain
%A Kazi,Abdul Nafey
%A Iqbal,Saleem Perwaiz
%A Collet,Jean-Paul
%A Ali,Syed Asad
%+ Department of Paediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 34864232, momin.kazi@aku.edu
%K SMS
%K mobile phone
%K reminders
%K low- and middle-income countries
%K routine immunization
%K children
%D 2018

%7 07.03.2018
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Improved routine immunization (RI) coverage is recommended as the priority public health strategy to decrease vaccine-preventable diseases and eradicate polio in Pakistan and worldwide. Objective: The objective of this study was to ascertain whether customized, automated, one-way text messaging (short message service, SMS) reminders delivered to caregivers via mobile phones when a child is due for an RI visit can improve vaccination uptake and timelines in Pakistan. Methods: This was a randomized controlled trial, conducted in an urban squatter settlement area of Karachi, Pakistan. Infants less than 2 weeks of age with at least one family member who had a valid mobile phone connection and was comfortable receiving and reading SMS text messages were included. Participants were randomized to the intervention (standard care + one-way SMS reminder) or control (standard care) groups. The primary outcome was to compare the proportion of children immunized up to date at 18 weeks of age. Vaccine given at 6, 10, and 14 weeks schedule includes DPT-Hep-B-Hib vaccine (ie, diphtheria, pertussis, and tetanus; hepatitis B; and Haemophilus influenza type b) and oral poliovirus vaccine (OPV). Data were analyzed using chi-square tests of independence and tested for both per protocol (PP) and intention-to-treat (ITT) analyses. Results: Out of those approached, 84.3% (300/356) of the participants were eligible for enrollment and 94.1% (318/338) of the participants had a working mobile phone. Only children in the PP analyses, who received an SMS reminder for vaccine uptake at 6 weeks visit, showed a statistically significant difference (96.0%, 86/90 vs 86.4%, 102/118; P=.03).The immunization coverage was consistently higher in the intervention group according to ITT analyses at the 6 weeks scheduled visit (76.0% vs 71.3%, P=.36). The 10 weeks scheduled visit (58.7% vs 52.7%, P=.30) and the 14 weeks scheduled visit (31.3% vs 26.0%, P=.31), however, were not statistically significant. Conclusions: Automated simple one-way SMS reminders in local languages might be feasible for improving routine vaccination coverage. Whether one-way SMS reminders alone can have a strong impact on parental attitudes and behavior for improvement of RI coverage and timeliness needs to be further evaluated by better-powered studies and by comparing different types and content of text messages in low-and middle-income countries (LMICs). Trial Registration: ClinicalTrials.gov NCT01859546; https://clinicaltrials.gov/ct2/show/NCT01859546 (Archived by WebCite at http://www.webcitation.org/6xFr57AOc) 
%M 29514773
%R 10.2196/publichealth.7026
%U http://publichealth.jmir.org/2018/1/e20/
%U https://doi.org/10.2196/publichealth.7026
%U http://www.ncbi.nlm.nih.gov/pubmed/29514773

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 3
%P e50
%T Reliability of Self-Reported Mobile Phone Ownership in Rural North-Central Nigeria: Cross-Sectional Study
%A Menson,William Nii Ayitey
%A Olawepo,John Olajide
%A Bruno,Tamara
%A Gbadamosi,Semiu Olatunde
%A Nalda,Nannim Fazing
%A Anyebe,Victor
%A Ogidi,Amaka
%A Onoka,Chima
%A Oko,John Okpanachi
%A Ezeanolue,Echezona Edozie
%+ Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S Maryland Pkwy, Las Vegas, Las Vegas, NV, 89154, United States, 1 443 682 5034, william.menson@unlv.edu
%K reliability
%K phone ownership
%K resource-limited setting
%K cell phone use
%K rural population
%K developing countries
%K self report
%K Nigeria
%K telemedicine
%D 2018

%7 01.03.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: mHealth practitioners seek to leverage the ubiquity of the mobile phone to increase the impact and robustness of their interventions, particularly in resource-limited settings. However, data on the reliability of self-reported mobile phone access is minimal. Objective: We sought to ascertain the reliability of self-reported ownership of and access to mobile phones among a population of rural dwellers in north-central Nigeria. Methods: We contacted participants in a community-based HIV testing program by phone to determine actual as opposed to self-reported mobile phone access. A phone script was designed to conduct these calls and descriptive analyses conducted on the findings. Results: We dialed 349 numbers: 110 (31.5%) were answered by participants who self-reported ownership of the mobile phone; 123 (35.2%) of the phone numbers did not ring at all; 28 (8.0%) rang but were not answered; and 88 (25.2%) were answered by someone other than the participant. We reached a higher proportion of male participants (68/133, 51.1%) than female participants (42/216, 19.4%; P<.001). Conclusions: Self-reported access to mobile phones in rural and low-income areas in north-central Nigeria is higher than actual access. This has implications for mHealth programming, particularly for women’s health. mHealth program implementers and researchers need to be cognizant of the low reliability of self-reported mobile phone access. These observations should therefore affect sample-size calculations and, where possible, alternative means of reaching research participants and program beneficiaries should be established. 
%M 29496656
%R 10.2196/mhealth.8760
%U https://mhealth.jmir.org/2018/3/e50/
%U https://doi.org/10.2196/mhealth.8760
%U http://www.ncbi.nlm.nih.gov/pubmed/29496656

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 2
%P e46
%T Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study
%A Han,Hui
%A Zhang,Jing Ying
%A Hser,Yih-Ing
%A Liang,Di
%A Li,Xu
%A Wang,Shan Shan
%A Du,Jiang
%A Zhao,Min
%+ Collaborative Innovation Center for Brain Science, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Xu Hui District, Shanghai, 200030, China, 86 18017311220, dujiangdou@163.com
%K mHealth
%K substance use
%K heroin dependence
%K amphetamine-type stimulant (ATS) dependence
%K mobile app
%K China
%D 2018

%7 27.02.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment. Methods: A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67% [50/75]) were randomly assigned to the experimental group and 25 (33% [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated. Results: The mean age of the participants was 41.6 (SD 8.0) years, and 71% (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29% (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7%, 79.2%, 72.4%, and 85.8%, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2%, 65.1%, 61.9%, and 71.5%, respectively. The post-intervention survey indicated that 46% (32/70) of the participants preferred face-to-face interviews rather than the mHealth app. Conclusions: This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China. 
%M 29487040
%R 10.2196/mhealth.8388
%U http://mhealth.jmir.org/2018/2/e46/
%U https://doi.org/10.2196/mhealth.8388
%U http://www.ncbi.nlm.nih.gov/pubmed/29487040

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 1
%P e27
%T A Breastfeed-Promoting Mobile App Intervention: Usability and Usefulness Study
%A Wang,Chih-Jau
%A Chaovalit,Pimwadee
%A Pongnumkul,Suporn
%+ National Electronics and Computer Technology Center, 112 Phahonyothin Road, Khlong Nueng, Khlong Luang District, Pathum Thani, 12120, Thailand, 66 2 564 6900 ext 72293, wang.chihjau@gmail.com
%K mobile health
%K breast feeding
%K mobile applications
%K health promotion
%K usability
%K usefulness
%D 2018

%7 26.01.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Breastfeeding is proven to have lasting health benefits for both mothers and infants; however, 6-month exclusive breastfeeding rate remains below 20% in Thailand. Although the number of research literature and commercial apps for breastfeeding women is significantly growing, they are country-specific and restricted to English-speaking users. There exists a major knowledge gap on how mobile health apps could support breastfeeding in Thailand. To address these gaps, MoomMae has been developed with the intention to support Thai women in breastfeeding outside of their homes and in keeping their feeding records. Objective: The aim of this study was to evaluate the usability and usefulness of MoomMae, a mobile phone app designed to support breastfeeding women. Methods: Our study was reviewed and approved by Thailand’s National Science and Technology Development Agency (NSTDA) ethics committee. A total of 21 breastfeeding women with at least one Android phone or tablet were recruited via convenience and snowball sampling. The study process for each participant was as follows: the participant was requested to attend a preuse interview and given the app to use for 4 weeks. Following this period, a postuse interview was conducted to examine the usability and usefulness of the app. Both sessions were held individually and audiorecorded for qualitative analysis. Results: The mean scores of usability and usefulness from the postuse survey were 4.33 (SD 0.87; range 1-5) and 4.60 (SD 0.74; range 2-5). Our qualitative analysis revealed a total of 137 feedbacks: 71 related to usability and 66 associated with usefulness. A further sentimental analysis showed that comments on usability were generally negative (59 negative, 11 positive, and 1 neutral), and comments on usefulness were relatively positive (56 positive, 9 negative, and 1 neutral). We discovered 26 unique design issues and proposed recommendations for future improvement. Conclusions: Our usability and usefulness assessment of MoomMae demonstrated that MoomMae has a great potential to be a useful self-management tool for breastfeeding mothers in Thailand. The qualitative analysis suggested that the app is supportive of breastfeeding on demand, but the flow and inputs of the app should be redesigned to be more intuitive. For future implementations, the most desirable feature is a pump-reminding notification system. 
%M 29374000
%R 10.2196/mhealth.8337
%U http://mhealth.jmir.org/2018/1/e27/
%U https://doi.org/10.2196/mhealth.8337
%U http://www.ncbi.nlm.nih.gov/pubmed/29374000

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 20
%N 1
%P e18
%T A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study
%A Gbadamosi,Semiu Olatunde
%A Eze,Chuka
%A Olawepo,John Olajide
%A Iwelunmor,Juliet
%A Sarpong,Daniel F
%A Ogidi,Amaka Grace
%A Patel,Dina
%A Oko,John Okpanachi
%A Onoka,Chima
%A Ezeanolue,Echezona Edozie
%+ Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154-1026, United States, 1 702 895 4950, semiu.gbadamosi@unlv.edu
%K mHealth
%K prenatal screening
%K HIV
%K hepatitis B
%K sickle cell disease
%K Nigeria
%K telemedicine
%K prenatal diagnosis
%K infectious disease transmission, vertical
%D 2018

%7 15.01.2018
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. Objective: Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. Methods: We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. Results: We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. Conclusions: Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) 
%M 29335234
%R 10.2196/jmir.8716
%U http://www.jmir.org/2018/1/e18/
%U https://doi.org/10.2196/jmir.8716
%U http://www.ncbi.nlm.nih.gov/pubmed/29335234

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 1
%P e16
%T Tanzania Health Information Technology (T-HIT) System: Pilot Test of a Tablet-Based System to Improve Prevention of Mother-to-Child Transmission of HIV
%A Bull,Sheana
%A Thomas,Deborah SK
%A Nyanza,Elias C
%A Ngallaba,Sospatro E
%+ Department of Geography & Environmental Sciences, University of Colorado Denver, PO Box 173364, CB 172, Denver, CO, 80217-3364, United States, 1 303 315 7557, deborah.thomas@ucdenver.edu
%K mHealth
%K decision aids
%K HIV
%K healthcare workers
%D 2018

%7 15.01.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The prevention of mother-to-child transmission (PMTCT) of HIV requires innovative solutions. Although routine monitoring is effective in some areas, standardized and easy-to-scale solutions to identify and monitor pregnant women, test them for HIV, and treat them and their children is still lacking. Mobile health (mHealth) offers opportunities for surveillance and reporting in rural areas of low- and middle-income countries. Objective: The aim of this study was to document the preliminary impacts of the Tanzania Health Information Technology (T-HIT) system mHealth intervention aimed at health workers for PMTCT care delivery and capacity building in a rural area of Tanzania. Methods: We developed T-HIT as a tablet-based system for an electronic data collection system designed to capture and report PMTCT data during antenatal, delivery, and postnatal visits in Misungwi, Tanzania. T-HIT was tested by health workers in a pilot randomized trial comparing seven sites using T-HIT assigned at random to seven control sites; all sites maintained standard paper record-keeping during the pilot intervention period. We compared numbers of antenatal visits, number of HIV tests administered, and women testing positive across all sites. Results: Health workers recorded data from antenatal visits for 1530 women; of these, 695 (45.42%) were tested for HIV and 3.59% (55/1530) tested positive. Health workers were unable to conduct an HIV test for 103 women (6.73%, 103/1530) because of lack of reagent, which is not captured on paper logs. There was no difference in the activity level for testing when comparing sites T-HIT to non-T-HIT sites. We observed a significant postintervention increase in the numbers of women testing positive for HIV compared with the preintervention period (P=.04), but this was likely not attributable to the T-HIT system. Conclusions: T-HIT had a high degree of acceptability and feasibility and is perceived as useful by health workers, who documented more antenatal visits during the pilot intervention compared with a traditional system of paper logs, suggesting potential for improvements in antenatal care for women at risk for HIV. 
%M 29335236
%R 10.2196/mhealth.8513
%U https://mhealth.jmir.org/2018/1/e16/
%U https://doi.org/10.2196/mhealth.8513
%U http://www.ncbi.nlm.nih.gov/pubmed/29335236

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 7
%N 1
%P e6
%T Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project
%A McBride,Bronwyn
%A Nguyen,Liem Thanh
%A Wiljer,David
%A Vu,Nguyen C
%A Nguyen,Cuong K
%A O'Neil,John
%+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada, 1 778 782 5361, joneil@sfu.ca
%K mobile health
%K Vietnam
%K maternal health
%K reproductive health
%K health equity
%D 2018

%7 11.01.2018
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective: The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods: This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system. Results: The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions: This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. 
%M 29326095
%R 10.2196/resprot.7912
%U http://www.researchprotocols.org/2018/1/e6/
%U https://doi.org/10.2196/resprot.7912
%U http://www.ncbi.nlm.nih.gov/pubmed/29326095

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 6
%N 1
%P e5
%T A Mobile App to Screen for Neurocognitive Impairment: Preliminary Validation of NeuroScreen Among HIV-Infected South African Adults
%A Robbins,Reuben N
%A Gouse,Hetta
%A Brown,Henry G
%A Ehlers,Andries
%A Scott,Travis M
%A Leu,Cheng-Shiun
%A Remien,Robert H
%A Mellins,Claude A
%A Joska,John A
%+ HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute & Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, United States, 1 6467746968, rnr2110@cumc.columbia.edu
%K HIV
%K neurocognitive
%K impairment
%K lay health workers
%K resource-limited settings
%K South Africa
%K tablet
%K app
%K neuropsychology
%D 2018

%7 05.01.2018
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Neurocognitive impairment (NCI) is one of the most common complications of HIV infection, and has serious medical and functional consequences. South Africa has 7 million people living with HIV (PLHIV) with up to three-quarters of antiretroviral therapy (ART)-naïve individuals having NCI. South Africa’s health system struggles to meet the care needs of its millions of PLHIV; screening for NCI is typically neglected due to limited clinical staff trained to administer, score, and interpret neuropsychological tests, as well as long test batteries and limited screening tools for South African populations. Without accurate, clinically useful, and relatively brief NCI screening tests that can be administered by all levels of clinical staff, critical opportunities to provide psychoeducation, behavioral planning, additional ART adherence support, and adjuvant therapies for NCI (when they become available) are missed. To address these challenges and gap in care, we developed an mHealth app screening tool, NeuroScreen, to detect NCI that can be administered by all levels of clinical staff, including lay health workers. Objective: The purpose of this study was to examine sensitivity and specificity of an adapted version of NeuroScreen to detect NCI (as determined by a gold standard neuropsychological test battery administered by a trained research psychometrist) among HIV-infected South Africans when administered by a lay health worker. Methods: A total of 102 HIV-infected black South African adults who had initiated ART at least 12 months prior were administered NeuroScreen and a gold standard neuropsychological test battery in the participants’ choice of language (ie, English or isiXhosa). Three composite z scores were calculated for NeuroScreen: (1) sum of all individual test scores, (2) sum of all individual test scores and error scores from four tests, and (3) sum of four tests (abbreviated version). Global deficit scores were calculated for the gold standard battery where a score of 0.5 or greater indicated the presence of NCI. Results: The mean age of participants was 33.31 (SD 7.46) years, most (59.8%, 61/102) had at least 12 years of education, and 81.4% (83/102) of the sample was female. Gold standard test battery results indicated that 26.5% (27/102) of the sample had NCI. Sensitivity and specificity of age-, education-, and sex-adjusted NeuroScreen scores were 81.48% and 74.67% for composite score 1, 81.48% and 81.33% for composite score 2, and 92.59% and 70.67% for composite score 3, respectively. Conclusions: NeuroScreen, a highly automated, easy-to-use, tablet-based screening test to detect NCI among English- and isiXhosa-speaking South African HIV patients demonstrated robust sensitivity and specificity to detect NCI when administered by lay health workers. NeuroScreen could help make screening for NCI more feasible. However, additional research is needed with larger samples and normative test performance data are needed. 
%M 29305338
%R 10.2196/mhealth.9148
%U http://mhealth.jmir.org/2018/1/e5/
%U https://doi.org/10.2196/mhealth.9148
%U http://www.ncbi.nlm.nih.gov/pubmed/29305338

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 12
%P e174
%T Developing mHealth Messages to Promote Postmenstrual Regulation Contraceptive Use in Bangladesh: Participatory Interview Study
%A Eckersberger,Elisabeth
%A Pearson,Erin
%A Andersen,Kathryn
%A Hossain,Altaf
%A Footman,Katharine
%A Biswas,Kamal Kanti
%A Nuremowla,Sadid
%A Reiss,Kate
%+ Ipas, PO Box 9990, Chapel Hill, NC, 27515, United States, 1 9199677052, eckersbergere@ipas.org
%K abortion
%K reproductive health services
%K contraception
%K family planning
%K mHealth
%K Bangladesh
%D 2017

%7 14.12.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Abortions are restricted in Bangladesh, but menstrual regulation is an approved alternative, defined as a procedure of regulating the menstrual cycle when menstruation is absent for a short duration. Use of contraception after menstrual regulation can reduce subsequent unintended pregnancy, but in Bangladesh, the contraceptive method mix is dominated by short-term methods, which have higher discontinuation and failure rates. Mobile phones are a channel via which menstrual regulation clients could be offered contraceptive support after leaving the clinic. Objective: This study aimed to support the development of a mobile phone intervention to support postmenstrual regulation family planning use in Bangladesh. It explored what family planning information women want to receive after having a menstrual regulation procedure, whether they would like to receive this information via their mobile phone, and if so, what their preferences are for the way in which it is delivered. Methods: We conducted participatory interviews with 24 menstrual regulation clients in Dhaka and Sylhet divisions in Bangladesh. Women were recruited from facilities in urban and peri-urban areas, which included public sector clinics supported by Ipas, an international nongovernmental organization (NGO), and NGO clinics run by Marie Stopes. Main themes covered in the interviews were factors affecting the use of contraception, what information and support women want after their menstrual regulation procedure, how respondents would prefer to receive information about contraception, and other key issues for mobile health (mHealth) interventions, such as language and privacy. As part of the in-depth interviews, women were shown and played 6 different messages about contraception on the research assistant’s phone, which they were given to operate, and were then asked to give feedback. Results: Women were open to both receiving messages about family planning methods on their mobile phones and talking to a counselor about family planning methods over the phone after their menstrual regulation. Women most commonly wanted information about the contraceptive method they were currently using and wanted this information to be tailored to their particular needs. Women preferred voice messages to text and liked the interactive voice message format. When asked to repeat and identify the main points of the messages, women demonstrated good understanding of the content. Women did not seem too concerned with privacy or with others reading the messages and welcomed including their husbands in speaking to a counselor. Conclusions: This study found that menstrual regulation clients are very interested in receiving information on their phones to support family planning use and wanted more information about the method of contraception they were using. Participatory voicemail was the preferred modality. 
%M 29242175
%R 10.2196/mhealth.6969
%U http://mhealth.jmir.org/2017/12/e174/
%U https://doi.org/10.2196/mhealth.6969
%U http://www.ncbi.nlm.nih.gov/pubmed/29242175

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 12
%P e186
%T How Do Infant Feeding Apps in China Measure Up? A Content Quality Assessment
%A Zhao,Jing
%A Freeman,Becky
%A Li,Mu
%+ School of Public Health, University of Sydney, Edward Ford Building, A27, Camperdown, New South Wales, 2006, Australia, 61 406502156, jzha5010@uni.sydney.edu.au
%K apps
%K mobile phone
%K Chinese
%D 2017

%7 06.12.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Globally, with the popularization of mobile phones, the number of health-related mobile phone apps has skyrocketed to 259,000 in 2016. In the digital era, people are accessing health information through their fingertips. In China, there are several apps that claim to provide infant feeding and nutrition guidance. However, the quality of information in those apps has not been extensively assessed. Objective: We aimed to assess the quality of Chinese infant feeding apps using comprehensive quality assessment criteria and to explore Chinese mothers’ perceptions on apps’ quality and usability. Methods: We searched for free-to-download Chinese infant feeding apps in the iTunes and Android App Stores. We conducted a comprehensive assessment of the accountability, scientific basis, accuracy of information relevant to infant feeding, advertising policy, and functionality and carried out a preliminary screening of infant formula advertisements in the apps. In addition, we also conducted exploratory qualitative research through semistructured interviews with Chinese mothers in Shanghai to elicit their views about the quality of apps. Results: A total of 4925 apps were screened, and 26 apps that met the selection criteria were evaluated. All 26 apps were developed by commercial entities, and the majority of them were rated poorly. The highest total score was 62.2 (out of approximately 100) and the lowest was 16.7. In the four quality domains assessed, none of them fulfilled all the accountability criteria. Three out of 26 apps provided information covering the three practices from the World Health Organization’s infant feeding recommendations. Only one app described its advertising policy in its terms of usage. The most common app functionality was a built-in social forum (19/26). Provision of a website link was the least common functionality (2/26). A total of 20 out of 26 apps promoted infant formula banner advertisements on their homepages. In addition, 12 apps included both e-commerce stores and featured infant formula advertisements. In total, 21 mothers were interviewed face-to-face. Mothers highly valued immediate access to parenting information and multifunctionality provided by apps. However, concerns regarding incredible information and commercial activities in apps, as well as the desire for information and support offered by health care professionals were expressed. Conclusions: The findings provide valuable information on Chinese infant feeding apps. The results are concerning, particularly with the relative absence of scientific basis and credibility and the large number of commercial advertisements that are displayed. Apps do seem to be able to provide an opportunity for mothers to access health information and support; it is time for tighter controls on content and advertisements. Ongoing app research and development should focus on implementation of a standard framework, which would drive the development of high-quality apps to support healthy infant feeding through cooperation among academics, health professionals, app users, app developers, and government bodies. 
%M 29212627
%R 10.2196/mhealth.8764
%U http://mhealth.jmir.org/2017/12/e186/
%U https://doi.org/10.2196/mhealth.8764
%U http://www.ncbi.nlm.nih.gov/pubmed/29212627

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 12
%P e182
%T App-Supported Promotion of Child Growth and Development by Community Health Workers in Kenya: Feasibility and Acceptability Study
%A van Heerden,Alastair
%A Sen,Debjeet
%A Desmond,Chris
%A Louw,Julia
%A Richter,Linda
%+ Human Sciences Research Council, Sweetwaters, Pietermaritzburg,, South Africa, 27 33 324 5015 ext 5015, avanheerden@hsrc.ac.za
%K child health
%K child development
%K monitoring and evaluation
%K parent support
%K mHealth
%D 2017

%7 05.12.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Early childhood is a critical phase of development. In low resource settings, monitoring this stage of development and providing appropriate and timely feedback is a challenge. Community-based service providers play a key role in promoting early childhood development in areas where government services are weak. These community-based service providers are also tasked with the collection of monitoring and evaluation data for donors and local government. Usually, collection of these data aims to provide accountability, learning, and correction leading to improvement. However, such data is rarely used beyond the accountability stage. Objective: The purpose of this study was to test the feasibility and acceptability of the Information for Action (IFA) mobile phone app. The IFA app was designed for use by community health volunteers (CHVs), and repackages routinely collected data about children into useful, offline decision support for caregivers and program managers. Methods: The IFA app was tested with a convenience sample of 10 CHVs in West Katweng’a, a sublocation of Rarieda subcounty in western Kenya. CHVs used the IFA app for 5 months as part of their regular home visits to households containing children aged 0 to 5 years, after which a qualitative assessment of the app was conducted. A total of 16 caregivers who received services from the CHVs were randomly selected to participate in 1 of 2 focus group discussions about their experience. Results: The app was reported to help facilitate interactive dialog between CHVs and caregivers, leading to improved quality of home visits. Caregivers described the app as shifting the relationship from feeling harassed by CHVs to experiencing genuine interest from CHVs. CHVs reported feasibility challenges primarily related to infrastructure. The limited battery life of mobile phones combined with the lack of readily available electricity made it difficult to keep the phones charged. CHVs reported initial anxiety as first-time mobile phones users, including concerns about using the IFA app. With time, increased levels of confidence were seen. Conclusions: Acceptability was high with both CHVs and caregivers, who reported an improvement in their client-provider relationship. A number of feasibility challenges were experienced. 
%M 29208588
%R 10.2196/mhealth.6911
%U http://mhealth.jmir.org/2017/12/e182/
%U https://doi.org/10.2196/mhealth.6911
%U http://www.ncbi.nlm.nih.gov/pubmed/29208588

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 11
%P e171
%T Using Android and Open Data Kit Technology in Data Management for Research in Resource-Limited Settings in the Niger Delta Region of Nigeria: Cross-Sectional Household Survey
%A Maduka,Omosivie
%A Akpan,Godwin
%A Maleghemi,Sylvester
%+ Department of Preventive and Social Medicine, College of Health Sciences, University of Port Harcourt, Alakahia, Choba, Port Harcourt, 50001, Nigeria, 234 8033298096, omosivie.maduka@uniport.edu.ng
%K mobile phones
%K technology
%K Africa
%D 2017

%7 30.11.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Data collection in Sub-Saharan Africa has traditionally been paper-based. However, the popularization of Android mobile devices and data capture software has brought paperless data management within reach. We used Open Data Kit (ODK) technology on Android mobile devices during a household survey in the Niger Delta region of Nigeria. Objective: The aim of this study was to describe the pros and cons of deploying ODK for data management. Methods: A descriptive cross-sectional household survey was carried out by 6 data collectors between April and May 2016. Data were obtained from 1706 persons in 601 households across 6 communities in 3 states in the Niger Delta. The use of Android mobile devices and ODK technology involved form building, testing, collection, aggregation, and download for data analysis. The median duration for data collection per household and per individual was 25.7 and 9.3 min, respectively. Results: Data entries per device ranged from 33 (33/1706, 1.93%) to 482 (482/1706, 28.25%) individuals between 9 (9/601, 1.5%) and 122 (122/601, 20.3%) households. The most entries (470) were made by data collector 5. Only 2 respondents had data entry errors (2/1706, 0.12%). However, 73 (73/601, 12.1%) households had inaccurate date and time entries for when data collection started and ended. The cost of deploying ODK was estimated at US $206.7 in comparison with the estimated cost of US $466.7 for paper-based data management. Conclusions: We found the use of mobile data capture technology to be efficient and cost-effective. As Internet services improve in Africa, we advocate their use as effective tools for health information management. 
%M 29191798
%R 10.2196/mhealth.7827
%U http://mhealth.jmir.org/2017/11/e171/
%U https://doi.org/10.2196/mhealth.7827
%U http://www.ncbi.nlm.nih.gov/pubmed/29191798

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 11
%P e368
%T Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala
%A Olson,Daniel
%A Lamb,Molly
%A Lopez,Maria Renee
%A Colborn,Kathryn
%A Paniagua-Avila,Alejandra
%A Zacarias,Alma
%A Zambrano-Perilla,Ricardo
%A Rodríguez-Castro,Sergio Ricardo
%A Cordon-Rosales,Celia
%A Asturias,Edwin Jose
%+ University of Colorado School of Medicine, Section of Pediatric Infectious Diseases, 13123 East 16th Avenue, Box 055, Aurora, CO, 80045, United States, 1 7207772838, daniel.olson@ucdenver.edu
%K mobile phone
%K app
%K participatory
%K syndromic surveillance
%K norovirus
%K dengue
%K acute febrile illness
%K diarrhea
%K Guatemala
%D 2017

%7 09.11.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: With their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database. Objective: We studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala. Methods: Randomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits. Results: From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range 58%-89%). Households with a poor (<70%) weekly reporting rate using the Vigilant-e app during the first 25 weeks of observation (n=57) had a greater number of children (mean 2.8, SD 1.5 vs mean 2.5, SD 1.3; risk ratio [RR] 1.2, 95% CI 1.1-1.4), were less likely to have used mobile phones for text messaging at study enrollment (61%, 35/57 vs 76.7%, 115/150; RR 0.6, 95% CI 0.4-0.9), and were less likely to access care at the local public clinic (35%, 20/57 vs 67.3%, 101/150; RR 0.4, 95% CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1%, 84/147 vs 43.8%, 141/322; RR 1.4, 95% CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (<70%) was associated with lower case reporting of acute gastroenteritis, norovirus-associated acute gastroenteritis, acute febrile illness, and dengue virus-associated acute febrile illness (P<.001). Parent-reported syndromic data on the Vigilant-e app demonstrated agreement with nurse-collected data for fever (kappa=.57, P<.001), vomiting (kappa=.63, P<.001), and diarrhea (kappa=.61, P<.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day: kappa=.65-.70; ≥2 days: kappa=.08-.29). Conclusions: In a resource-limited area of rural Guatemala, a mobile phone app-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental reported data and nurse-reported data during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment. 
%M 29122738
%R 10.2196/jmir.8041
%U http://www.jmir.org/2017/11/e368/
%U https://doi.org/10.2196/jmir.8041
%U http://www.ncbi.nlm.nih.gov/pubmed/29122738

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 10
%P e158
%T Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study
%A Doocy,Shannon
%A Paik,Kenneth E
%A Lyles,Emily
%A Hei Tam,Hok
%A Fahed,Zeina
%A Winkler,Eric
%A Kontunen,Kaisa
%A Mkanna,Abdalla
%A Burnham,Gilbert
%+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4105022628, doocy1@jhu.edu
%K mHealth
%K hypertension
%K diabetes mellitus
%K chronic disease
%K Lebanon, Syria
%K refugees
%D 2017

%7 18.10.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective: The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods: A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results: Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, P<.001) and blood sugar measurements (−6.9%, P=.03) significantly decreased following the implementation of treatment guidelines. Recording of BP readings also decreased after the mHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, P<.001) and the guidelines phase (7.7%, P<.001). There were a great proportion of patients for whom blood sugar, BP, weight, height, and BMI were recorded using the tablet compared with in paper records; however, only differences in BMI were statistically significant (31.6% higher in app data as compared with paper records; P<.001). Data extracted from the mHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, P<.001 and physical activity counseling and 59.7% in app vs 7.1% in paper records, P<.001). There were statistically significant increases in all four measures of patient-provider interaction across study phases. Provider inquiry of medical history increased by 16.6% from baseline following guideline implementation and by 28.2% from baseline to mHealth implementation (P<.001). From baseline, patient report of provider inquiry regarding medication complications increased in the guidelines and mHealth phases by 12.9% and 59.6%, respectively, (P<.001). The proportion of patients reporting that providers asked other questions relevant to their illness increased from baseline through guidelines implementation by 27.8% and to mHealth implementation by 66.3% (P<.001). Follow-up scheduling increased from baseline to the guidelines phase by 20.6% and the mHealth phase by 39.8% (P<.001). Conclusions: Results from this study of an mHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control. 
%M 29046266
%R 10.2196/mhealth.7745
%U http://mhealth.jmir.org/2017/10/e158/
%U https://doi.org/10.2196/mhealth.7745
%U http://www.ncbi.nlm.nih.gov/pubmed/29046266

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 10
%P e155
%T Tackling Regional Public Health Issues Using Mobile Health Technology: Event Report of an mHealth Hackathon in Thailand
%A Pathanasethpong,Atipong
%A Soomlek,Chitsutha
%A Morley,Katharine
%A Morley,Michael
%A Polpinit,Pattarawit
%A Dagan,Alon
%A Weis,James W
%A Celi,Leo Anthony
%+ Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, 123 Mittraphab Road, Khon Kaen,, Thailand, 66 891758278, atipat@kku.ac.th
%K hackathon
%K mHealth
%K interdisciplinary collaboration
%D 2017

%7 16.10.2017
%9 Viewpoint
%J JMIR Mhealth Uhealth
%G English
                
%X Hackathons are intense, short, collaborative events focusing on solving real world problems through interdisciplinary teams. This is a report of the mHealth hackathon hosted by Khon Kaen University in collaboration with MIT Sana and faculty members from Harvard Medical School with the aim to improve health care delivery in the Northeast region of Thailand. Key health challenges, such as improving population health literacy, tracking disease trajectory and outcomes among rural communities, and supporting the workflow of overburdened frontline providers, were addressed using mHealth. Many modifications from the usual format of hackathon were made to tailor the event to the local context and culture, such as the process of recruiting participants and how teams were matched and formed. These modifications serve as good learning points for hosting future hackathons. There are also many lessons learned about how to achieve a fruitful collaboration despite cultural barriers, how to best provide mentorship to the participants, how to instill in the participants a sense of mission, and how to match the participants in a fair and efficient manner. This event showcases how interdisciplinary collaboration can produce results that are unattainable by any discipline alone and demonstrates that innovations are the fruits of collective wisdom of people from different fields of expertise who work together toward the same goals.
%M 29038098
%R 10.2196/mhealth.8259
%U http://mhealth.jmir.org/2017/10/e155/
%U https://doi.org/10.2196/mhealth.8259
%U http://www.ncbi.nlm.nih.gov/pubmed/29038098

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 10
%P e148
%T Using Mobile Phones to Improve Vaccination Uptake in 21 Low- and Middle-Income Countries: Systematic Review
%A Oliver-Williams,Clare
%A Brown,Elizabeth
%A Devereux,Sara
%A Fairhead,Cassandra
%A Holeman,Isaac
%+ Cardiovascular Epidemiology Unit, Department of Public Health & Primary Care, University of Cambridge, Wort's Causeway, Cambridge,, United Kingdom, 44 1223 748650, cto21@medschl.cam.ac.uk
%K cell phones
%K vaccination
%K communication
%K telemedicine
%K mHealth
%K global health
%D 2017

%7 04.10.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: The benefits of vaccination have been comprehensively proven; however, disparities in coverage persist because of poor health system management, limited resources, and parental knowledge and attitudes. Evidence suggests that health interventions that engage local parties in communication strategies improve vaccination uptake. As mobile technology is widely used to improve health communication, mobile health (mHealth) interventions might be used to increase coverage. Objective: The aim of this study was to conduct a systematic review of the available literature on the use of mHealth to improve vaccination in low- and middle-income countries with large numbers of unvaccinated children. Methods: In February 2017, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, and Web of Science, as well as three health organization websites—Communication Initiative Network, TechNet-21, and PATH—were searched to identify mHealth intervention studies on vaccination uptake in 21 countries. Results: Ten peer-reviewed studies and 11 studies from white or gray literature were included. Nine took place in India, three in Pakistan, two each in Malawi and Nigeria, and one each in Bangladesh, Zambia, Zimbabwe, and Kenya. Ten peer-reviewed studies and 7 white or gray studies demonstrated improved vaccination uptake after interventions, including appointment reminders, mobile phone apps, and prerecorded messages. Conclusions: Although the potential for mHealth interventions to improve vaccination coverage seems clear, the evidence for such interventions is not. The dearth of studies in countries facing the greatest barriers to immunization impedes the prospects for evidence-based policy and practice in these settings. 
%M 28978495
%R 10.2196/mhealth.7792
%U http://mhealth.jmir.org/2017/10/e148/
%U https://doi.org/10.2196/mhealth.7792
%U http://www.ncbi.nlm.nih.gov/pubmed/28978495

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 3
%N 4
%P e65
%T Lessons From the Implementation of Mo-Buzz, a Mobile Pandemic Surveillance System for Dengue
%A Lwin,May Oo
%A Jayasundar,Karthikayen
%A Sheldenkar,Anita
%A Wijayamuni,Ruwan
%A Wimalaratne,Prasad
%A Ernst,Kacey C
%A Foo,Schubert
%+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 67906669, tmaylwin@ntu.edu.sg
%K pandemics
%K dengue
%K health communication
%K telemedicine
%K epidemiology
%K participatory surveillance
%K participatory epidemiology
%D 2017

%7 02.10.2017
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Approximately 128 countries and 3.9 billion people are at risk of dengue infection. Incidence of dengue has increased over the past decades, becoming a growing public health concern for countries with populations that are increasingly susceptible to this vector-borne disease, such as Sri Lanka. Almost 55,150 dengue cases were reported in Sri Lanka in 2016, with more than 30.40% of cases (n=16,767) originating from Colombo, which struggles with an outdated manual paper-based dengue outbreak management system. Community education and outreach about dengue are also executed using paper-based media channels such as pamphlets and brochures. Yet, Sri Lanka is one of the countries with the most affordable rates of mobile services in the world, with penetration rates higher than most developing countries. Objectives: To combat the issues of an exhausted dengue management system and to make use of new technology, in 2015, a mobile participatory system for dengue surveillance called Mo-Buzz was developed and launched in Colombo, Sri Lanka. This paper describes the system’s components and uptake, along with other similar disease surveillance systems. Methods: We developed Mo-Buzz and tested its feasibility for dengue. Two versions of the app were developed. The first was for use by public health inspectors (PHIs) to digitize form filling and recording of site visit information, and track dengue outbreaks on a real-time dengue hotspot map using the global positioning system technology. The system also provides updated dengue infographics and educational materials for the PHIs to educate the general public. The second version of Mo-Buzz was created for use by the general public. This system uses dynamic mapping to help educate and inform the general public about potential outbreak regions and allow them to report dengue symptoms and post pictures of potential dengue mosquito–breeding sites, which are automatically sent to the health authorities. Targeted alerts can be sent to users depending on their geographical location. Results: We assessed the usage and the usability of the app and its impact on overall dengue transmission in Colombo. Initial uptake of Mo-Buzz for PHIs was low; however, after more training and incentivizing of usage, the uptake of the app in PHIs increased from less than 10% (n=3) to 76% (n=38). The general public user evaluation feedback was fruitful in providing improvements to the app, and at present, a number of solutions are being reviewed as viable options to boost user uptake. Conclusions: From our Mo-Buzz study, we have learned that initial acceptance of such systems can be slow but eventually positive. Mobile and social media interventions, such as Mo-Buzz, are poised to play a greater role in shaping risk perceptions and managing seasonal and sporadic outbreaks of infectious diseases in Asia and around the world. 
%M 28970191
%R 10.2196/publichealth.7376
%U https://publichealth.jmir.org/2017/4/e65/
%U https://doi.org/10.2196/publichealth.7376
%U http://www.ncbi.nlm.nih.gov/pubmed/28970191

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 8
%P e116
%T Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study
%A Blitchtein-Winicki,Dora
%A Zevallos,Karine
%A Samolski,M Reuven
%A Requena,David
%A Velarde,Chaska
%A Briceño,Patricia
%A Piazza,Marina
%A Ybarra,Michele L
%+ Executive Office of Research, Peruvian National Institute of Health, Cápac Yupanqui 1400, Jesus María, Lima, CP 11, Peru, 51 999 090917, dblit2007@gmail.com
%K Pilot Projects, Text Messaging, Smoking Cessation, Young Adult, Cognitive Therapy, Feasibility Studies, Latinos
%D 2017

%7 04.08.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima. 
%M 28778850
%R 10.2196/mhealth.7532
%U http://mhealth.jmir.org/2017/8/e116/
%U https://doi.org/10.2196/mhealth.7532
%U http://www.ncbi.nlm.nih.gov/pubmed/28778850

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 7
%P e93
%T Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study
%A Cheng,Feng
%A Xu,Junfang
%A Su,Chunyan
%A Fu,Xiaoxing
%A Bricker,Jonathan
%+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA,, United States, 1 206 667 5074, jbricker@fredhutch.org
%K smoking cessation
%K smartphone apps
%K China
%D 2017

%7 11.07.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. 
%M 28698170
%R 10.2196/mhealth.7462
%U http://mhealth.jmir.org/2017/7/e93/
%U https://doi.org/10.2196/mhealth.7462
%U http://www.ncbi.nlm.nih.gov/pubmed/28698170

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 6
%N 6
%P e126
%T Mobile Phone Short Messages to Improve Exclusive Breastfeeding and Reduce Adverse Infant Feeding Practices: Protocol for a Randomized Controlled Trial in Yangon, Myanmar
%A Hmone,Myat Pan
%A Li,Mu
%A Alam,Ashraful
%A Dibley,Michael J
%+ Sydney Medical School, School of Public Health, The University of Sydney, A27, Edward Ford Building, Sydney,, Australia, 61 4 2470 8124, myat.panhmone@sydney.edu.au
%K randomized controlled trial
%K mHealth
%K text messaging (SMS)
%K intervention studies
%K exclusive breastfeeding
%K infant and young child feeding
%K nutrition
%K Myanmar
%K pregnant women
%K child health
%D 2017

%7 28.06.2017
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Myanmar has a high burden of mortality for children aged younger than 5 years in which undernutrition plays a major role. Despite current efforts, the exclusive breastfeeding rate for children under 6 months is only 24%. To date there have been no interventions using mobile phones to improve breastfeeding and other feeding practices in Myanmar. Objective: This study aims to implement a breastfeeding promotion intervention using mobile phone text messages in Yangon, Myanmar, and evaluate its impact on breastfeeding practices. Methods: M528 is a 2-group parallel-arm randomized controlled trial with 9 months follow-up from recruitment until 6 months post-delivery. A total of 353 pregnant women between 28 and 34 weeks’ gestation who had access to a mobile phone and were able to read and write have been recruited from the Central Women’s Hospital, Yangon, and allocated randomly to an intervention or control group in a 1:1 ratio. The intervention group received breastfeeding promotional SMS messages 3 times a week while the control group received maternal and child health care messages (excluding breastfeeding-related messages) once a week. The SMS messages were tailored for the women’s stage of gestation or the child’s age. A formative qualitative study was conducted prior to the trial to inform the study design and text message content. We hypothesize that the exclusive breastfeeding rate in the intervention group will be double that in the control group. The primary outcome is exclusive breastfeeding from birth to 6 months and secondary outcomes are median durations of exclusive breastfeeding and other infant feeding practices. Both primary and secondary outcomes were assessed by monthly phone calls at 1 to 6 months postdelivery in both groups. Participants’ delivery status was tracked through text messages, phone calls, and hospital records, and delivery characteristics were assessed 1 month after delivery. Child morbidity and breastfeeding self-efficacy scores were assessed at 1, 3, and 5 months postdelivery. Social desirability was measured at 5 months, and text messages expressing delivery success and user experience were assessed at the end of the study. Results: The targeted 353 pregnant women were recruited between January and March 2015. Baseline data have been collected; SMS messages have been developed and pretested and sent to the women from both groups. Follow-up data collection via phone calls has been completed. Data analysis is being done and results are expected soon. This is the first RCT study examining the effects of mobile text messaging for promoting exclusive breastfeeding. Conclusions: This trial is timely in Myanmar following the telecommunications market opening in 2014. Our results will help determine whether text messaging is an effective and feasible method for promoting appropriate feeding practices and will inform further research to assess how this model could be replicated in the broader community. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12615000063516; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367704 (Archived by WebCite at http://www.webcitation.org/ 6rGif3l81) 
%M 28659252
%R 10.2196/resprot.7679
%U http://www.researchprotocols.org/2017/6/e126/
%U https://doi.org/10.2196/resprot.7679
%U http://www.ncbi.nlm.nih.gov/pubmed/28659252

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 6
%P e216
%T What Predicts Online Health Information-Seeking Behavior Among Egyptian Adults? A Cross-Sectional Study
%A Ghweeba,Mayada
%A Lindenmeyer,Antje
%A Shishi,Sobhi
%A Abbas,Mostafa
%A Waheed,Amani
%A Amer,Shaymaa
%+ Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom, 44 0 121 4145390, a.lindenmeyer@bham.ac.uk
%K Internet
%K information-seeking behavior
%K computer literacy
%K surveys and questionnaires
%K Egypt
%D 2017

%7 22.06.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of users worldwide. Yet, little is known about the personal characteristics of Egyptian Internet users who search for online health information (OHI). Objective: The aim of the study was to identify the personal characteristics of Egyptian OHI seekers and to determine any associations between their personal characteristics and their health information-seeking behavior. Methods:  This cross-sectional questionnaire study was conducted from June to October 2015. A Web-based questionnaire was sent to Egyptian users aged 18 years and older (N=1400) of a popular Arabic-language health information website. The questionnaire included (1) demographic characteristics; (2) self-reported general health status; and (3) OHI-seeking behavior that included frequency of use, different topics sought, and self-reported impact of obtained OHI on health behaviors. Data were analyzed using descriptive statistics and multiple regression analysis. Results: A total of 490 participants completed the electronic questionnaire with a response rate equivalent to 35.0% (490/1400). Regarding personal characteristics, 57.1% (280/490) of participants were females, 63.4% (311/490) had a university level qualification, and 37.1% (182/490) had a chronic health problem. The most commonly sought OHI by the participants was nutrition-related. Results of the multiple regression analysis showed that 31.0% of the variance in frequency of seeking OHI among Egyptian adults can be predicted by personal characteristics. Participants who sought OHI more frequently were likely to be female, of younger age, had higher education levels, and good self-reported general health. Conclusions: Our results provide insights into personal characteristics and OHI-seeking behaviors of Egyptian OHI users. This will contribute to better recognize their needs, highlight ways to increase the availability of appropriate OHI, and may lead to the provision of tools allowing Egyptian OHI users to navigate to the highest-quality health information. 
%M 28642216
%R 10.2196/jmir.6855
%U http://www.jmir.org/2017/6/e216/
%U https://doi.org/10.2196/jmir.6855
%U http://www.ncbi.nlm.nih.gov/pubmed/28642216

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 5
%P e72
%T A Smartphone-Based Approach for Triage of Human Papillomavirus-Positive Sub-Saharan African Women: A Prospective Study
%A Urner,Esther
%A Delavy,Martine
%A Catarino,Rosa
%A Viviano,Manuela
%A Meyer-Hamme,Ulrike
%A Benski,Anne-Caroline
%A Jinoro,Jeromine
%A Heriniainasolo,Josea Lea
%A Undurraga,Manuela
%A De Vuyst,Hugo
%A Combescure,Christophe
%A Vassilakos,Pierre
%A Petignat,Patrick
%+ Gynecology Division, Department of Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, Geneva, 1206, Switzerland, 41 22 372 68 16, martinegilliane@gmail.com
%K cervical cancer
%K squamous intraepithelial lesions of the cervix
%K HPV
%K acetic acid
%K lugol’s iodine
%K smartphone
%K mobile phone
%D 2017

%7 29.05.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Sub-Saharan African countries are marked by a high incidence of cervical cancer. Madagascar ranks 11th among the countries with the highest cervical cancer incidence worldwide. Objective: The aim of the study was to evaluate the performances of digital smartphone-based visual inspection with acetic acid (D-VIA) and Lugol’s iodine (D-VILI) for diagnosing cervical precancer and cancer. Methods: Human papillomavirus (HPV)-positive women recruited through a cervical screening campaign had D-VIA and D-VILI examinations with endocervical curettage (ECC) and cervical biopsy. Three images were captured for each woman (native, D-VIA, D-VILI) using a smartphone camera. The images were randomly coded and distributed on 2 online databases (Google Forms). The D-VIA form included native and D-VIA images, and the D-VILI form included native and D-VILI images. Pathological cases were defined as cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Physicians rated the images as non-pathological or pathological. Using the ECC and cervical biopsy results as references, the sensitivity and specificity of D-VIA and D-VILI examinations for each and all physicians were calculated. Results: Altogether, 15 clinicians assessed 240 images. Sensitivity was higher for the D-VIA interpretations (94.1%; 95% CI 81.6-98.3) than for the D-VILI interpretations (78.8%; 95% CI 54.1-92.1; P=.009). In contrast, the specificity was higher for the D-VILI interpretations (56.4%; 95% CI 38.3-72.9) than for the D-VIA interpretations (50.4%; 95% CI 35.9-64.8; P=.005). Conclusion: Smartphone-based image for triage of HPV-positive women is more accurate for detecting CIN2+ lesions with D-VIA than D-VILI, although with a small loss of specificity. 
%M 28554879
%R 10.2196/mhealth.6697
%U http://mhealth.jmir.org/2017/5/e72/
%U https://doi.org/10.2196/mhealth.6697
%U http://www.ncbi.nlm.nih.gov/pubmed/28554879

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 6
%N 5
%P e100
%T An mHealth Framework to Improve Birth Outcomes in Benue State, Nigeria: A Study Protocol
%A Ezeanolue,Echezona Edozie
%A Gbadamosi,Semiu Olatunde
%A Olawepo,John Olajide
%A Iwelunmor,Juliet
%A Sarpong,Daniel
%A Eze,Chuka
%A Ogidi,Amaka
%A Patel,Dina
%A Onoka,Chima
%+ Global Health Initiative, School of Community Health Sciences, University of Nevada, 4505 S Maryland Parkway, Las Vegas, NV, 89154-4009, United States, 1 702 895 2687, echezona.ezeanolue@unlv.edu
%K mHealth
%K smart card
%K HIV
%K hepatitis B
%K sickle cell disease
%K mobile health technology
%K Nigeria
%D 2017

%7 26.05.2017
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The unprecedented coverage of mobile technology across the globe has led to an increase in the use of mobile health apps and related strategies to make health information available at the point of care. These strategies have the potential to improve birth outcomes, but are limited by the availability of Internet services, especially in resource-limited settings such as Nigeria. Objective: Our primary objective is to determine the feasibility of developing an integrated mobile health platform that is able to collect data from community-based programs, embed collected data into a smart card, and read the smart card using a mobile phone-based app without the need for Internet access. Our secondary objectives are to determine (1) the acceptability of the smart card among pregnant women and (2) the usability of the smart card by pregnant women and health facilities in rural Nigeria. Methods: We will leverage existing technology to develop a platform that integrates a database, smart card technology, and a mobile phone-based app to read the smart cards. We will recruit 300 pregnant women with one of the three conditions—HIV, hepatitis B virus infection, and sickle cell trait or disease—and four health facilities in their community. We will use Glasgow’s Reach, Effectiveness, Adoption, Implementation, and Maintenance framework as a guide to assess the implementation, acceptability, and usability of the mHealth platform. Results: We have recruited four health facilities and 300 pregnant women with at least one of the eligible conditions. Over the course of 3 months, we will complete the development of the mobile health platform and each participant will be offered a smart card; staff in each health facility will receive training on the use of the mobile health platform. Conclusions: Findings from this study could offer a new approach to making health data from pregnant women available at the point of delivery without the need for an Internet connection. This would allow clinicians to implement evidence-based interventions in real time to improve health outcomes. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) 
%M 28550003
%R 10.2196/resprot.7743
%U http://www.researchprotocols.org/2017/5/e100/
%U https://doi.org/10.2196/resprot.7743
%U http://www.ncbi.nlm.nih.gov/pubmed/28550003

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e140
%T Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities
%A Greenleaf,Abigail R
%A Gibson,Dustin G
%A Khattar,Christelle
%A Labrique,Alain B
%A Pariyo,George W
%+ Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, agreenleaf@jhu.edu
%K mHealth
%K developing countries
%K Africa South of the Sahara
%K cell phones
%K health surveys
%K reproducibility of results
%K surveys and questionnaires
%K text messaging
%K interviews as topic
%K humans
%K research design
%K data collection methods
%D 2017

%7 05.05.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. Objective: The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Methods: Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Results: Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. Conclusions: This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. 
%M 28476728
%R 10.2196/jmir.7331
%U http://www.jmir.org/2017/5/e140/
%U https://doi.org/10.2196/jmir.7331
%U http://www.ncbi.nlm.nih.gov/pubmed/28476728

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e137
%T Leveraging Mobile Phones for Monitoring Risks for Noncommunicable Diseases in the Future
%A Ellis,Jennifer A
%+ Bloomberg Philanthropies, 25 E 78th St., New York, NY,, United States, 1 212 205 0129, Jennifer@bloomberg.org
%K mHealth
%K low- and middle-income countries
%K noncommunicable diseases
%K health systems strengthening
%D 2017

%7 05.05.2017
%9 Guest Editorial
%J J Med Internet Res
%G English
                
%X 
%M 28476721
%R 10.2196/jmir.7622
%U http://www.jmir.org/2017/5/e137/
%U https://doi.org/10.2196/jmir.7622
%U http://www.ncbi.nlm.nih.gov/pubmed/28476721

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e139
%T Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review
%A Gibson,Dustin G
%A Pereira,Amanda
%A Farrenkopf,Brooke A
%A Labrique,Alain B
%A Pariyo,George W
%A Hyder,Adnan A
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu
%K survey methodology
%K cellular phone
%K interactive voice response
%K short messages service
%K computer-assisted telephone interview
%K mobile phone surveys
%D 2017

%7 05.05.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective: The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods: Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions: Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. 
%M 28476725
%R 10.2196/jmir.7428
%U http://www.jmir.org/2017/5/e139/
%U https://doi.org/10.2196/jmir.7428
%U http://www.ncbi.nlm.nih.gov/pubmed/28476725

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e112
%T The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing
%A Gibson,Dustin G
%A Farrenkopf,Brooke A
%A Pereira,Amanda
%A Labrique,Alain B
%A Pariyo,George William
%+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, Baltimore, MD, 21231, United States, 1 4432878763, dgibso28@jhu.edu
%K interactive voice response
%K noncommunicable disease
%K survey methodology
%K public health surveillance
%K cellular phone
%K risk factors
%D 2017

%7 05.05.2017
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology—a mobile phone survey (MPS) method—has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. Objective: The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. Methods: We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant’s understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. Results: A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. Conclusions: Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC. 
%M 28476724
%R 10.2196/jmir.7340
%U http://www.jmir.org/2017/5/e112/
%U https://doi.org/10.2196/jmir.7340
%U http://www.ncbi.nlm.nih.gov/pubmed/28476724

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e121
%T Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases
%A Labrique,Alain
%A Blynn,Emily
%A Ahmed,Saifuddin
%A Gibson,Dustin
%A Pariyo,George
%A Hyder,Adnan A
%+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, W5501, Johns Hopkins Bloomberg SPH, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4102361568, alabriqu@jhsph.edu
%K surveys and questionnaires
%K sampling studies
%K mobile health
%K mobile phone
%K research methodology
%D 2017

%7 05.05.2017
%9 Policy Proposal
%J J Med Internet Res
%G English
                
%X In low- and middle-income countries (LMICs), historically, household surveys have been carried out by face-to-face interviews to collect survey data related to risk factors for noncommunicable diseases. The proliferation of mobile phone ownership and the access it provides in these countries offers a new opportunity to remotely conduct surveys with increased efficiency and reduced cost. However, the near-ubiquitous ownership of phones, high population mobility, and low cost require a re-examination of statistical recommendations for mobile phone surveys (MPS), especially when surveys are automated. As with landline surveys, random digit dialing remains the most appropriate approach to develop an ideal survey-sampling frame. Once the survey is complete, poststratification weights are generally applied to reduce estimate bias and to adjust for selectivity due to mobile ownership. Since weights increase design effects and reduce sampling efficiency, we introduce the concept of automated active strata monitoring to improve representativeness of the sample distribution to that of the source population. Although some statistical challenges remain, MPS represent a promising emerging means for population-level data collection in LMICs.
%M 28476726
%R 10.2196/jmir.7329
%U http://www.jmir.org/2017/5/e121/
%U https://doi.org/10.2196/jmir.7329
%U http://www.ncbi.nlm.nih.gov/pubmed/28476726

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 6
%N 5
%P e81
%T Evaluation of Mechanisms to Improve Performance of Mobile Phone Surveys in Low- and Middle-Income Countries: Research Protocol
%A Gibson,Dustin G
%A Pariyo,George William
%A Wosu,Adaeze C
%A Greenleaf,Abigail R
%A Ali,Joseph
%A Ahmed,Saifuddin
%A Labrique,Alain B
%A Islam,Khaleda
%A Masanja,Honorati
%A Rutebemberwa,Elizeus
%A Hyder,Adnan A
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu
%K IVR
%K CATI
%K Bangladesh
%K Tanzania
%K Uganda
%K mHealth
%K mobile phone survey
%K noncommunicable diseases
%K survey methodology
%D 2017

%7 05.05.2017
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Mobile phone ownership and access have increased rapidly across low- and middle-income countries (LMICs) within the last decade. Concomitantly, LMICs are experiencing demographic and epidemiologic transitions, where non-communicable diseases (NCDs) are increasingly becoming leading causes of morbidity and mortality. Mobile phone surveys could aid data collection for prevention and control of these NCDs but limited evidence of their feasibility exists. Objective: The objective of this paper is to describe a series of sub-studies aimed at optimizing the delivery of interactive voice response (IVR) and computer-assisted telephone interviews (CATI) for NCD risk factor data collection in LMICs. These sub-studies are designed to assess the effect of factors such as airtime incentive timing, amount, and structure, survey introduction characteristics, different sampling frames, and survey modality on key survey metrics, such as survey response, completion, and attrition rates. Methods: In a series of sub-studies, participants will be randomly assigned to receive different airtime incentive amounts (eg, 10 minutes of airtime versus 20 minutes of airtime), different incentive delivery timings (airtime delivered before survey begins versus delivery upon completion of survey), different survey introductions (informational versus motivational), different narrative voices (male versus female), and different sampling frames (random digit dialing versus mobile network operator-provided numbers) to examine which study arms will yield the highest response and completion rates. Furthermore, response and completion rates and the inter-modal reliability of the IVR and CATI delivery methods will be compared. Results: Research activities are expected to be completed in Bangladesh, Tanzania, and Uganda in 2017. Conclusions: This is one of the first studies to examine the feasibility of using IVR and CATI for systematic collection of NCD risk factor information in LMICs. Our findings will inform the future design and implementation of mobile phone surveys in LMICs. 
%M 28476729
%R 10.2196/resprot.7534
%U http://www.researchprotocols.org/2017/5/e81/
%U https://doi.org/10.2196/resprot.7534
%U http://www.ncbi.nlm.nih.gov/pubmed/28476729

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e115
%T Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries
%A Pariyo,George W
%A Wosu,Adaeze C
%A Gibson,Dustin G
%A Labrique,Alain B
%A Ali,Joseph
%A Hyder,Adnan A
%+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street E 8648, Baltimore, MD, 21205, United States, 1 410 502 5790, gpariyo1@jhu.edu
%K NCDs
%K policy
%K mHealth
%K policy analysis
%K surveys
%D 2017

%7 05.05.2017
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X The growing burden of noncommunicable diseases (NCDs), for example, cardiovascular diseases and chronic respiratory diseases, in low- and middle-income countries (LMICs) presents special challenges for policy makers, due to resource constraints and lack of timely data for decision-making. Concurrently, the increasing ubiquity of mobile phones in LMICs presents possibilities for rapid collection of population-based data to inform the policy process. The objective of this paper is to highlight potential benefits of mobile phone surveys (MPS) for developing, implementing, and evaluating NCD prevention and control policies. To achieve this aim, we first provide a brief overview of major global commitments to NCD prevention and control, and subsequently explore how countries can translate these commitments into policy action at the national level. Using the policy cycle as our frame of reference, we highlight potential benefits of MPS which include (1) potential cost-effectiveness of using MPS to inform NCD policy actions compared with using traditional household surveys; (2) timeliness of assessments to feed into policy and planning cycles; (3) tracking progress of interventions, hence assessment of reach, coverage, and distribution; (4) better targeting of interventions, for example, to high-risk groups; (5) timely course correction for suboptimal or non-effective interventions; (6) assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage (UHC); and (7) monitoring progress in reducing catastrophic medical expenditure due to chronic health conditions in general, and NCDs in particular. We conclude that MPS have potential to become a powerful data collection tool to inform policies that address public health challenges such as NCDs. Additional forthcoming assessments of MPS in LMICs will inform opportunities to maximize this technology.
%M 28476720
%R 10.2196/jmir.7302
%U http://www.jmir.org/2017/5/e115/
%U https://doi.org/10.2196/jmir.7302
%U http://www.ncbi.nlm.nih.gov/pubmed/28476720

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 19
%N 5
%P e133
%T Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda
%A Hyder,Adnan A
%A Wosu,Adaeze C
%A Gibson,Dustin G
%A Labrique,Alain B
%A Ali,Joseph
%A Pariyo,George W
%+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD, 21205, United States, 1 410 502 8947, ahyder1@jhu.edu
%K mHealth
%K noncommunicable disease
%K mobile phone
%K research agenda
%K survey
%D 2017

%7 05.05.2017
%9 Viewpoint
%J J Med Internet Res
%G English
                
%X Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally, with 75% of these occurring in low- and middle-income countries (LMICs). Many LMICs seek cost-effective methods to obtain timely and quality NCD risk factor data that could inform resource allocation, policy development, and assist evaluation of NCD trends over time. Over the last decade, there has been a proliferation of mobile phone ownership and access in LMICs, which, if properly harnessed, has great potential to support risk factor data collection. As a supplement to traditional face-to-face surveys, the ubiquity of phone ownership has made large proportions of most populations reachable through cellular networks. However, critical gaps remain in understanding the ways by which mobile phone surveys (MPS) could aid in collection of NCD data in LMICs. Specifically, limited information exists on the optimization of these surveys with regard to incentives and structure, comparative effectiveness of different MPS modalities, and key ethical, legal, and societal issues (ELSI) in the development, conduct, and analysis of these surveys in LMIC settings. We propose a research agenda that could address important knowledge gaps in optimizing MPS for the collection of NCD risk factor data in LMICs and provide an example of a multicountry project where elements of that agenda aim to be integrated over the next two years.
%M 28476722
%R 10.2196/jmir.7246
%U http://www.jmir.org/2017/5/e133/
%U https://doi.org/10.2196/jmir.7246
%U http://www.ncbi.nlm.nih.gov/pubmed/28476722

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 6
%N 4
%P e70
%T The Malaria System MicroApp: A New, Mobile Device-Based Tool for Malaria Diagnosis
%A Oliveira,Allisson Dantas
%A Prats,Clara
%A Espasa,Mateu
%A Zarzuela Serrat,Francesc
%A Montañola Sales,Cristina
%A Silgado,Aroa
%A Codina,Daniel Lopez
%A Arruda,Mercia Eliane
%A i Prat,Jordi Gomez
%A Albuquerque,Jones
%+ Federal Rural University of Pernambuco, Department of Statistics and Informatics, Rua Dom Manoel de Medeiros, s/n, Dois Irmãos, Recife, 52171900, Brazil, 55 8133206491, allissondantas@gmail.com
%K artificial intelligence
%K applied computing
%K automated diagnosis
%K malaria
%K mobile devices
%D 2017

%7 25.04.2017
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Malaria is a public health problem that affects remote areas worldwide. Climate change has contributed to the problem by allowing for the survival of Anopheles in previously uninhabited areas. As such, several groups have made developing news systems for the automated diagnosis of malaria a priority. Objective: The objective of this study was to develop a new, automated, mobile device-based diagnostic system for malaria. The system uses Giemsa-stained peripheral blood samples combined with light microscopy to identify the Plasmodium falciparum species in the ring stage of development. Methods: The system uses image processing and artificial intelligence techniques as well as a known face detection algorithm to identify Plasmodium parasites. The algorithm is based on integral image and haar-like features concepts, and makes use of weak classifiers with adaptive boosting learning. The search scope of the learning algorithm is reduced in the preprocessing step by removing the background around blood cells. Results: As a proof of concept experiment, the tool was used on 555 malaria-positive and 777 malaria-negative previously-made slides. The accuracy of the system was, on average, 91%, meaning that for every 100 parasite-infected samples, 91 were identified correctly. Conclusions: Accessibility barriers of low-resource countries can be addressed with low-cost diagnostic tools. Our system, developed for mobile devices (mobile phones and tablets), addresses this by enabling access to health centers in remote communities, and importantly, not depending on extensive malaria expertise or expensive diagnostic detection equipment. 
%M 28442456
%R 10.2196/resprot.6758
%U http://www.researchprotocols.org/2017/4/e70/
%U https://doi.org/10.2196/resprot.6758
%U http://www.ncbi.nlm.nih.gov/pubmed/28442456

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 4
%P e47
%T A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings
%A Maar,Marion A
%A Yeates,Karen
%A Perkins,Nancy
%A Boesch,Lisa
%A Hua-Stewart,Diane
%A Liu,Peter
%A Sleeth,Jessica
%A Tobe,Sheldon W
%+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca
%K mobile health
%K health care texting
%K SMS
%K protocol
%K process evaluation
%K process assessment (health care)
%K health services, Indigenous
%K Tanzania
%K community-based participatory research
%K DREAM-GLOBAL
%D 2017

%7 20.04.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Objective: Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Methods: Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results: Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and settings. These four levels represent evaluation domains and became the core focus of the evaluation. In addition, primary implementation themes to explore in each of the domains were identified as follows: (1) the major active components of the intervention, (2) technology of the intervention, (3) cultural congruence, (4) task shifting, and (5) unintended consequences. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified the data or information sources to best answer our questions. Conclusions: Using DREAM-GLOBAL to illustrate our approach, we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of a pragmatic trial as well as inform scale up. The human organizational level domains used to focus the primary implementation themes in the DREAM-GLOBAL process evaluation framework are sufficiently supported in our research, and the literature and can serve as a valuable tool for other mHealth process evaluations. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6oxfHXege) 
%M 28428165
%R 10.2196/mhealth.7044
%U http://mhealth.jmir.org/2017/4/e47/
%U https://doi.org/10.2196/mhealth.7044
%U http://www.ncbi.nlm.nih.gov/pubmed/28428165

%0 Journal Article
        
%@ 2371-4379
%I JMIR Publications
%V 2
%N 1
%P e6
%T How’s Your Sugar? Evaluation of a Website for Aboriginal People With Diabetes
%A Adams,Karen
%A Liebzeit,Anna
%A Browne,Jennifer
%A Atkinson,Petah
%+ Gukwonderuk, Faculty of Medicine Nursing and Health Science, Monash University, 27 Rainforest Walk, Clayton, 3800, Australia, 61 3 9902 4328, karen.adams@monash.edu
%K Aboriginal and Torres Strait Islander peoples
%K type 2 diabetes mellitus
%K Indigenous populations
%K Internet
%D 2017

%7 04.04.2017
%9 Original Paper
%J JMIR Diabetes
%G English
                
%X Background: Australia’s Aboriginal and Torres Strait Islander peoples (hereafter referred to as “Aboriginal people”) have the longest continuing culture in the world, living sustainably for at least 65,000 years on the Australian continent. In relatively recent times, colonization processes have resulted in Aboriginal people experiencing unacceptable health inequalities compared with other Australians. One disease introduced due to colonization is diabetes, the second leading cause of death for Aboriginal peoples. Objectives: The objective of this study was to describe the construction and utilization of the website “How’s Your Sugar, ” a website for Aboriginal people with type 2 diabetes (herein after referred to as diabetes). The questions for the evaluation were as follows: how was the website constructed; did target groups utilize the website; and did engagement with the website improve diabetes management. Methods: A mixed-method study design was employed. A content analysis of project documents provided information about the website construction. Data from Google analytics provided information about website utilization. To describe patterns of website sessions, percentages and numbers were calculated. A voluntary survey provided more information on website utilization and diabetes self-management. Percentage, numbers, and 95% CIs were calculated for each variable. A chi-square test was performed for Aboriginal status, age, gender, and Aboriginal diabetic status using Australian population estimates and Aboriginal diabetes rates. Results: The website development drew on Aboriginal health, social marketing, interactive health promotion frameworks, as well as evidence for diabetes self-management. The website build involved a multidisciplinary team and participation of Aboriginal diabetics, Aboriginal diabetic family members, and Aboriginal health workers. This participation allowed for inclusion of Aboriginal ways of knowing and being. The highest number of website sessions came from Australia, 98.15% (47,717/48,617) and within Australia, Victoria 50.97% (24,323/47,717). There were 129 survey respondents, and the distribution had more female, 82.9% (107/129, 95% CI 76-88), Aboriginal, 21.7% (28/129, 95% CI 16-30), and Aboriginal diabetic, 48% (13/27, 95% CI 31-66) respondents than expected with P<.001 for these three groups. Most common reasons for visits were university assignment research, 40.6% (41/101), and health workers looking for information, 20.8% (21/101). The sample size was too small to calculate diabetes self-management change. Conclusions: Inclusion of Aboriginal ways of knowing and being alongside other theoretical and evidence models in Web design is possible. Aboriginal people do utilize Web-based health promotion, and further understanding about reaching to this population would be of use. Provision of an education resource would likely have enhanced educational engagement. Web-based technologies are rapidly evolving, and these can potentially measure behavior change in engaging ways that also have benefits for the participant. A challenge for designers is inclusivity of cultural diversity for self-determination. 
%M 30291066
%R 10.2196/diabetes.6930
%U http://diabetes.jmir.org/2017/1/e6/
%U https://doi.org/10.2196/diabetes.6930
%U http://www.ncbi.nlm.nih.gov/pubmed/30291066

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 4
%P e41
%T Processes and Recommendations for Creating mHealth Apps for Low-Income Populations
%A Stephan,Laura Siga
%A Dytz Almeida,Eduardo
%A Guimaraes,Raphael Boesche
%A Ley,Antonio Gaudie
%A Mathias,Rodrigo Gonçalves
%A Assis,Maria Valéria
%A Leiria,Tiago Luiz Luz
%+ Instituto de Cardiologia, Fundação Universitária de Cardiologia, Av Princesa Isabel, 370 - Santana, Porto Alegre, RS, 90620-001, Brazil, 55 51 32303600, emaildalaura@gmail.com
%K mHealth
%K atrial fibrillation
%K low-income population
%D 2017

%7 03.04.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile health (mHealth) apps have shown to improve health indicators, but concerns remain about the inclusion of populations from low- and medium-income countries (LMIC) in these new technologies. Atrial fibrillation (AF) is a chronic condition with a challenging management. Previous studies have shown socioeconomic differences in the prescription of anticoagulant treatment and shared decision strategies are encouraged to achieve better outcomes. mHealth can aid both doctors and patients in this matter. Objective: We describe the development of an mHealth app (aFib) idealized to aid shared decision between doctor and patient about anticoagulation prophylaxis in AF in a low-income and low-literacy population in Brazil. On the basis of our research, we suggest the processes to be followed when developing mHealth apps in this context. Methods: A multidisciplinary team collected information about the target population and its needs and detected the best opportunity to insert the app in their current health care. Literature about the subject was reviewed and important data were selected to be delivered through good navigability, easy terminology, and friendly design. The app was evaluated in a multimethod setting. Results: The steps suggested to develop an mHealth app target to LMIC are: (1) characterize the problem and the target user, (2) review the literature, (3) translate information to knowledge, (4) protect information, and (5) evaluate usability and efficacy. Conclusions: We expect that these recommendations can guide the development of new mHealth apps in LMIC, on a scientific basis. 
%M 28373155
%R 10.2196/mhealth.6510
%U http://mhealth.jmir.org/2017/4/e41/
%U https://doi.org/10.2196/mhealth.6510
%U http://www.ncbi.nlm.nih.gov/pubmed/28373155

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 3
%P e38
%T mHealth for Clinical Decision-Making in Sub-Saharan Africa: A Scoping Review
%A Adepoju,Ibukun-Oluwa Omolade
%A Albersen,Bregje Joanna Antonia
%A De Brouwere,Vincent
%A van Roosmalen,Jos
%A Zweekhorst,Marjolein
%+ Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1105, WN Building, Room S-544, Amsterdam, 1081HV, Netherlands, 31 205983143, i.o.adepoju@vu.nl
%K mHealth
%K decision support systems, clinical
%K sub-Saharan Africa
%K clinical decision-making
%D 2017

%7 23.03.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: In a bid to deliver quality health services in resource-poor settings, mobile health (mHealth) is increasingly being adopted. The role of mHealth in facilitating evidence-based clinical decision-making through data collection, decision algorithms, and evidence-based guidelines, for example, is established in resource-rich settings. However, the extent to which mobile clinical decision support systems (mCDSS) have been adopted specifically in resource-poor settings such as Africa and the lessons learned about their use in such settings are yet to be established. Objective: The aim of this study was to synthesize evidence on the use of mHealth for point-of-care decision support and improved quality of care by health care workers in Africa. Methods: A scoping review of 4 peer-reviewed and 1 grey literature databases was conducted. No date limits were applied, but only articles in English language were selected. Using pre-established criteria, 2 reviewers screened articles and extracted data. Articles were analyzed using Microsoft Excel and MAXQDA. Results: We retained 22 articles representing 11 different studies in 7 sub-Saharan African countries. Interventions were mainly in the domain of maternal health and ranged from simple text messaging (short message service, SMS) to complex multicomponent interventions. Although health workers are generally supportive of mCDSS and perceive them as useful, concerns about increased workload and altered workflow hinder sustainability. Facilitators and barriers to use of mCDSS include technical and infrastructural support, ownership, health system challenges, and training. Conclusions: The use of mCDSS in sub-Saharan Africa is an indication of progress in mHealth, although their effect on quality of service delivery is yet to be fully explored. Lessons learned are useful for informing future research, policy, and practice for technologically supported health care delivery, especially in resource-poor settings. 
%M 28336504
%R 10.2196/mhealth.7185
%U http://mhealth.jmir.org/2017/3/e38/
%U https://doi.org/10.2196/mhealth.7185
%U http://www.ncbi.nlm.nih.gov/pubmed/28336504

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications
%V 5
%N 3
%P e32
%T mHealth Interventions for Health System Strengthening in China: A Systematic Review
%A Tian,Maoyi
%A Zhang,Jing
%A Luo,Rong
%A Chen,Shi
%A Petrovic,Djordje
%A Redfern,Julie
%A Xu,Dong Roman
%A Patel,Anushka
%+ The George Institute for Global Health at Peking University Health Science Center, Suite 1801, Tower B, Horizon Tower, 6 Zhichun Road, Beijing, 100088, China, 86 1082800577 ext 303, mtian@georgeinstitute.org.cn
%K mHealth
%K China
%K health care systems
%D 2017

%7 16.03.2017
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. Objective: The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. Methods: We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. Results: A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. Conclusions: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care. 
%M 28302597
%R 10.2196/mhealth.6889
%U http://mhealth.jmir.org/2017/3/e32/
%U https://doi.org/10.2196/mhealth.6889
%U http://www.ncbi.nlm.nih.gov/pubmed/28302597

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 6
%N 2
%P e23
%T For You and Your Baby (4YYB): Adapting the Centers for Disease Control and Prevention’s Text4Baby Program for Saudi Arabia
%A Bahanshal,Soha
%A Coughlin,Steven
%A Liu,Benyuan
%+ Department of Computer Science, University of Massachusetts Lowell, 1 University Ave, Lowell, MA,, United States, 1 781 654 7200, bahasoha@gmail.com
%K Saudi Arabia
%K telemedicine
%K text messaging
%K health knowledge, attitudes, practice
%K pregnant women
%D 2017

%7 28.02.2017
%9 Viewpoint
%J JMIR Res Protoc
%G English
                
%X Background: Poor birth outcomes in the Kingdom of Saudi Arabia (KSA) have been found to be partially due to missed prenatal appointments as well as lack of knowledge of healthy pregnancy behaviors. Objective: The objectives are to summarize birth outcomes and the antenatal care system in KSA, summarize research related to the US Text4Baby mobile health program, and outline the development of an Arabic version of the Text4baby app, For You and Your Baby (4YYB). Methods: First, birth outcomes, health care access, and smartphone usage among Saudi Arabian women are reviewed. Next, the current evidence behind Text4Baby is described. Finally, a plan to develop and test 4YYB is proposed. In the plan, studies will need to be conducted to determine the effectiveness of 4YYB in educating pregnant Saudi women on healthy knowledge and behaviors. This will create an evidence base behind 4YYB before it is launched as a full-scale public health effort in KSA. Results: The KSA offers public medical services but remaining challenges include poor birth outcomes and health care access barriers. An estimated 73% to 84% of Saudi women of child-bearing age use smartphone social media apps. A total of 13 published articles on Text4Baby were identified and reviewed. Due to design limitations, the studies provide only limited evidence about the effectiveness of the program in increasing healthy pregnancy knowledge and behaviors. To be useful for Saudi women, the educational messages in 4YYB will need to be translated from English to Arabic and tailored for cultural norms. Conclusions: Developing the 4YYB Arabic-language app for use by pregnant Saudi Arabian women based on Text4Baby is a viable approach, but a rigorous study design is needed to determine its effectiveness in improving healthy pregnancy knowledge and behaviors. 
%M 28246065
%R 10.2196/resprot.5818
%U http://www.researchprotocols.org/2017/2/e23/
%U https://doi.org/10.2196/resprot.5818
%U http://www.ncbi.nlm.nih.gov/pubmed/28246065

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 3
%N 1
%P e5
%T Assessing Mobile Phone Access and Perceptions for Texting-Based mHealth Interventions Among Expectant Mothers and Child Caregivers in Remote Regions of Northern Kenya: A Survey-Based Descriptive Study
%A Kazi,Abdul Momin
%A Carmichael,Jason-Louis
%A Hapanna,Galgallo Waqo
%A Wangoo,Patrick Gikaria
%A Karanja,Sarah
%A Wanyama,Denis
%A Muhula,Samuel Opondo
%A Kyomuhangi,Lennie Bazira
%A Loolpapit,Mores
%A Wangalwa,Gilbert Bwire
%A Kinagwi,Koki
%A Lester,Richard Todd
%+ Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver General Hospital site, Department of Medicine, 10th Floor, Gordon and Leslie Diamond Health Care Centre, room #10127 – 2775, Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 604 875 4111 ext 63140, mominkazi@gmail.com
%K mobile health
%K text messaging
%K prenatal care
%K immunization
%K Kenya
%D 2017

%7 30.01.2017
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: With a dramatic increase in mobile phone use in low- and middle-income countries, mobile health (mHealth) has great potential to connect health care services directly to participants enrolled and improve engagement of care. Rural and remote global settings may pose both significant challenges and opportunities. Objective: The objective of our study was to understand the demographics, phone usage and ownership characteristics, and feasibility among patients in rural and remote areas of Kenya of having text messaging (short messaging service, SMS)-based mHealth intervention for improvements in antenatal care attendance and routine immunization among children in Northern Kenya. Methods: A survey-based descriptive study was conducted between October 2014 and February 2015 at 8 health facilities in Northern Kenya as part of a program to scale up an mHealth service in rural and remote regions. The study was conducted at 6 government health facilities in Isiolo, Marsabit, and Samburu counties in remote and northern arid lands (NAL). Two less remote health facilities in Laikipia and Meru counties in more populated central highlands were included as comparison sites. Results: A total of 284 participants were surveyed; 63.4% (180/284) were from NAL clinics, whereas 36.6% (104/284) were from adjacent central highland clinics. In the NAL, almost half (48.8%, 88/180) reported no formal education and 24.4% (44/180) self-identified as nomads. The majority of participants from both regions had access to mobile phone: 99.0% (103/104) of participants from central highlands and 82.1% (147/180) of participants from NAL. Among those who had access to a phone, there were significant differences in network challenges and technology literacy between the 2 regions. However, there was no significant difference in the proportion of participants from NAL and central highlands who indicated that they would like to receive a weekly SMS text message from their health care provider (90.0% vs 95.0%; P=.52). Overall, 92.0% (230/250) of participants who had access to a telephone said that they would like to receive a weekly SMS text message from their health care provider. Most phone users already spent the equivalent of 626 SMS text messages on mobile credit for personal use. Conclusions: Despite the remoteness of northern Kenya’s NAL, the results indicate that the majority of pregnant women or care givers attending the maternal, newborn, and child health clinics have access to mobile phone and would like to receive text messages from their health care provider. mHealth programs, if designed appropriately for these settings, may be an innovative way for engaging women in care for improved maternal and newborn child health outcomes in order to achieve sustainable development goals. 
%M 28137702
%R 10.2196/publichealth.5386
%U http://publichealth.jmir.org/2017/1/e5/
%U https://doi.org/10.2196/publichealth.5386
%U http://www.ncbi.nlm.nih.gov/pubmed/28137702

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 2
%N 2
%P e169
%T Effect of Performance Feedback on Community Health Workers’ Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial
%A Kaphle,Sangya
%A Matheke-Fischer,Michael
%A Lesh,Neal
%+ Dimagi Software Innovations, 585 Massachusetts Ave #3, Cambridge, MA, 02139, United States, 1 617 649 2214, sangyakaphle@gmail.com
%K community health workers
%K performance feedback
%K motivation
%K supportive supervision
%K mHealth apps
%D 2016

%7 07.12.2016
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective: The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods: In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results: We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass’s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass’s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. 
%M 27927607
%R 10.2196/publichealth.3381
%U http://publichealth.jmir.org/2016/2/e169/
%U https://doi.org/10.2196/publichealth.3381
%U http://www.ncbi.nlm.nih.gov/pubmed/27927607

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 5
%N 4
%P e224
%T Efficacy of Mobile Serious Games in Increasing HIV Risk Perception in Swaziland: A Randomized Control Trial (SGprev Trial) Research Protocol
%A Lukhele,Bhekumusa Wellington
%A Musumari,Patou
%A El-Saaidi,Christina
%A Techasrivichien,Teeranee
%A Suguimoto,S. Pilar
%A Ono Kihara,Masako
%A Kihara,Masahiro
%+ Department of Global Health and Socio Epidemiology, Frontier Laboratory Bldg, 2nd Fl., Kyoto University School of Public Health Yoshida Konoe-cho, Sakyo-ku, Kyoto, 6068501, Japan, 81 757534350 ext 4350, bhekumusa.lukhele.36x@st.kyoto-u.ac.jp
%K eHealth
%K mHealth
%K gamification
%K Internet
%K HIV prevention
%K innovation
%D 2016

%7 22.11.2016
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: The human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) continue to be a major public health problem in Sub-Saharan Africa (SSA), particularly in Swaziland, which has the highest HIV prevalence in this region. A wide range of strategies and interventions have been used to promote behavior change, though almost all such interventions have involved mass media. Therefore, innovative behavior change strategies beyond mass media communication are urgently needed. Serious games have demonstrated effectiveness in advancing health in the developed world; however, no rigorous serious games interventions have been implemented in HIV prevention in SSA. Objective: We plan to test whether a serious game intervention delivered on mobile phones to increase HIV risk perception, increase intention to reduce sexual partnerships, and increase intention to know own and partners HIV status will be more effective compared with current prevention efforts. Methods: This is a two-arm randomized intervention trial. We will recruit 380 participants who meet the following eligibility criteria: 18-29 years of age, own a smartphone running an Android-based operating system, have the WhatsApp messaging app, live in Swaziland, and can adequately grant informed consent. Participants will be allocated into a smartphone interactive, educational story game, and a wait-list control group in a 1:1 allocation ratio. Subsequently, a self-administered Web-based questionnaire will be issued at baseline and after 4 weeks of exposure to the game. We hypothesize that the change in HIV risk perception between pre- and post-intervention assessment is greater in the intervention group compared with the change in the control group. Our primary hypothesis is based on the assumption that increased perceived risk of HIV provides cues to engage in protective behavior. Our primary outcome measure is HIV risk perceived mean change between pre- and post-intervention compared with the mean change in the wait-list control group at 4-weeks post-intervention. We will use standardized regression coefficients to calculate the effect of the intervention on our primary outcome with P values. We will conduct both intention to treat and as treated analysis. Results: This study is funded by Hayao Nakayama Foundation for Science & Technology and Culture; Grant number H26-A2-41. The research and development approval has been obtained from Kyoto University Graduate School and Faculty of Medicine Ethics Committee, Japan, and Swaziland’s Ministry of Health Ethics and Scientific committee. Results are expected in February 2017. Conclusions: This study will provide evidence on the efficiency of a mobile phone interactive game in increasing HIV risk perception in Swaziland. Our findings may also be generalizable to similar settings in SSA. Trial Registration: University Hospital Medical Information Network Clinical Trial Registry ID number (UMIN-CTR):UMIN000021781; URL:https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000025103 (Archived by WebCite at http://www.webcitation.org/6hOphB11a). 
%M 27876685
%R 10.2196/resprot.6543
%U http://www.researchprotocols.org/2016/4/e224/
%U https://doi.org/10.2196/resprot.6543
%U http://www.ncbi.nlm.nih.gov/pubmed/27876685

%0 Journal Article
        
%@ 2561-3278
%I JMIR Publications
%V 1
%N 1
%P e1
%T A Six-Step Framework on Biomedical Signal Analysis for Tackling Noncommunicable Diseases: Current and Future Perspectives
%A Elgendi,Mohamed
%A Howard,Newton
%A Lovell,Nigel
%A Cichocki,Andrzej
%A Brearley,Matt
%A Abbott,Derek
%A Adatia,Ian
%+ Department of Obstetrics & Gynecology, University of British Columbia, BC Children's Hospital, C424, 4480 Oak Street, Vancouver, BC, V6H 3N1, Canada, 1 604 600 4139, moe.elgendi@gmail.com
%K mobile health
%K smart healthcare
%K affordable diagnostics
%K wearable devices
%K global health
%K eHealth
%K mHealth
%K point-of-care devices
%D 2016

%7 17.10.2016
%9 Viewpoint
%J JMIR Biomed Eng
%G English
                
%X Low- and middle-income countries (LMICs) continue to face major challenges in providing high-quality and universally accessible health care. Researchers, policy makers, donors, and program implementers consistently strive to develop and provide innovative approaches to eliminate geographical and financial barriers to health care access. Recently, interest has increased in using mobile health (mHealth) as a potential solution to overcome barriers to improving health care in LMICs. Moreover, with use increasing and cost decreasing for mobile phones and Internet, mHealth solutions are becoming considerably more promising and efficient. As part of mHealth solutions, biomedical signals collection and processing may play a major role in improving global health care. Information extracted from biomedical signals might increase diagnostic precision while augmenting the robustness of health care workers’ clinical decision making. This paper presents a high-level framework using biomedical signal processing (BSP) for tackling diagnosis of noncommunicable diseases, especially in LMICs. Researchers can consider each of these elements during the research and design of BSP-based devices, enabling them to elevate their work to a level that extends beyond the scope of a particular application and use. This paper includes technical examples to emphasize the applicability of the proposed framework, which is relevant to a wide variety of stakeholders, including researchers, policy makers, clinicians, computer scientists, and engineers.
%R 10.2196/biomedeng.6401
%U http://biomedeng.jmir.org/2016/1/e1/
%U https://doi.org/10.2196/biomedeng.6401

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 2
%N 2
%P e159
%T High Burden of Unrecognized Atrial Fibrillation in Rural India: An Innovative Community-Based Cross-Sectional Screening Program
%A Soni,Apurv
%A Earon,Allison
%A Handorf,Anna
%A Fahey,Nisha
%A Talati,Kandarp
%A Bostrom,John
%A Chon,Ki
%A Napolitano,Craig
%A Chin,Michael
%A Sullivan,John
%A Raithatha,Shyamsundar
%A Goldberg,Robert
%A Nimbalkar,Somashekhar
%A Allison,Jeroan
%A Thanvi,Sunil
%A McManus,David
%+ University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA,, United States, 1 508 856 4265, apurv.soni@umassmed.edu
%K atrial fibrillation
%K India
%K screening
%K mobile technology
%K community health workers
%D 2016

%7 13.10.2016
%9 Short Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: Atrial fibrillation, the world’s most common arrhythmia, is a leading risk factor for stroke, a disease striking nearly 1.6 million Indians annually. Early detection and management of atrial fibrillation is a promising opportunity to prevent stroke but widespread screening programs in limited resource settings using conventional methods is difficult and costly. Objective: The objective of this study is to screen people for atrial fibrillation in rural western India using a US Food and Drug Administration-approved single-lead electrocardiography device, Alivecor. Methods: Residents from 6 villages in Anand District, Gujarat, India, comprised the base population. After obtaining informed consent, a team of trained research coordinators and community health workers enrolled a total of 354 participants aged 50 years and older and screened them at their residences using Alivecor for 2 minutes on 5 consecutive days over a period of 6 weeks beginning June, 2015. Results: Almost two-thirds of study participants were 55 years or older, nearly half were female, one-third did not receive any formal education, and more than one-half were from households earning less than US $2 per day. Twelve participants screened positive for atrial fibrillation yielding a sample prevalence of 5.1% (95% CI 2.7-8.7). Only one participant had persistent atrial fibrillation throughout all of the screenings, and 9 screened positive only once. Conclusions: Our study suggests a prevalence of atrial fibrillation in this Indian region (5.1%) that is markedly higher than has been previously reported in India and similar to the prevalence estimates reported in studies of persons from North America and Europe. Historically low reported burden of atrial fibrillation among individuals from low and middle-income countries may be due to a lack of routine screening. Mobile technologies may help overcome resource limitations for atrial fibrillation screening in underserved and low-resource settings. 
%M 27737818
%R 10.2196/publichealth.6517
%U http://publichealth.jmir.org/2016/2/e159/
%U https://doi.org/10.2196/publichealth.6517
%U http://www.ncbi.nlm.nih.gov/pubmed/27737818

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 18
%N 8
%P e226
%T Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review
%A Amoakoh-Coleman,Mary
%A Borgstein,Alexander Berend-Jan
%A Sondaal,Stephanie FV
%A Grobbee,Diederick E
%A Miltenburg,Andrea Solnes
%A Verwijs,Mirjam
%A Ansah,Evelyn K
%A Browne,Joyce L
%A Klipstein-Grobusch,Kerstin
%+ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands, P.O. Box 85500, Utrecht, 3508 GA, Netherlands, 31 244 623553, menba19@yahoo.com
%K maternal
%K mHealth
%K neonatal
%K providers of care
%K low- and middle-income countries
%D 2016

%7 19.08.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective: We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods: The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results: A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions: mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap. 
%M 27543152
%R 10.2196/jmir.5533
%U http://www.jmir.org/2016/8/e226/
%U https://doi.org/10.2196/jmir.5533
%U http://www.ncbi.nlm.nih.gov/pubmed/27543152

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 18
%N 8
%P e207
%T mHealth Intervention to Improve Diabetes Risk Behaviors in India: A Prospective, Parallel Group Cohort Study
%A Pfammatter,Angela
%A Spring,Bonnie
%A Saligram,Nalini
%A Davé,Raj
%A Gowda,Arun
%A Blais,Linelle
%A Arora,Monika
%A Ranjani,Harish
%A Ganda,Om
%A Hedeker,Donald
%A Reddy,Sethu
%A Ramalingam,Sandhya
%+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1574, angela.pfammatter@northwestern.edu
%K mHealth
%K diabetes
%K health promotion
%D 2016

%7 05.08.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: In low/middle income countries like India, diabetes is prevalent and health care access limited. Most adults have a mobile phone, creating potential for mHealth interventions to improve public health. To examine the feasibility and initial evidence of effectiveness of mDiabetes, a text messaging program to improve diabetes risk behaviors, a global nonprofit organization (Arogya World) implemented mDiabetes among one million Indian adults. Objective: A prospective, parallel cohort design was applied to examine whether mDiabetes improved fruit, vegetable, and fat intakes and exercise. Methods: Intervention participants were randomly selected from the one million Nokia subscribers who elected to opt in to mDiabetes. Control group participants were randomly selected from non-Nokia mobile phone subscribers. mDiabetes participants received 56 text messages in their choice of 12 languages over 6 months; control participants received no contact. Messages were designed to motivate improvement in diabetes risk behaviors and increase
awareness about the causes and complications of diabetes. Participant health behaviors (exercise and fruit, vegetable, and fat intake) were assessed between 2012 and 2013 via telephone surveys by blinded assessors at baseline and 6 months later. Data were cleaned and analyzed in 2014 and 2015. Results: 982 participants in the intervention group and 943 in the control group consented to take the phone survey at baselne. At the end of the 6-month
period, 611 (62.22%) in the intervention and 632 (67.02%) in the control group completed the follow-up telephone survey. Participants receiving texts demonstrated greater improvement in a health behavior composite score over 6 months, compared with those who received no messages F(1, 1238) = 30.181, P<.001, 95% CI, 0.251-0.531. Fewer intervention participants demonstrated health behavior decline compared with controls. Improved fruit, vegetable, and fat consumption (P<.01) but not exercise were observed in those receiving messages, as compared with controls. Conclusions: A text messaging intervention was feasible and showed initial evidence of effectiveness in improving diabetes-related health behaviors, demonstrating the potential to facilitate population-level behavior change in a low/middle income country. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12615000423516; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367946&isReview=true (Archived by WebCite at http://www.webcitation.org/6j5ptaJgF) 
%M 27496271
%R 10.2196/jmir.5712
%U http://www.jmir.org/2016/8/e207/
%U https://doi.org/10.2196/jmir.5712
%U http://www.ncbi.nlm.nih.gov/pubmed/27496271

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 5
%N 3
%P e158
%T MHealth to Improve Measles Immunization in Guinea-Bissau: Study Protocol for a Randomized Controlled Trial
%A Rossing,Emil
%A Ravn,Henrik
%A Batista,Celso Soares Pereira
%A Rodrigues,Amabelia
%+ OPEN, Odense Patient data Explorative Network, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. floor, Odense C, DK-5000, Denmark, 45 61779344, emro@ssi.dk
%K mHealth
%K eHealth
%K SMS reminders
%K voice reminders
%K Guinea-Bissau, ODK
%K Africa
%K RapidSMS
%K health systems strengthening
%K randomized controlled trial
%K measles
%K immunization
%D 2016

%7 27.07.2016
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Recent studies have revealed a low measles vaccination (MV) rate in the Republic of Guinea-Bissau (West Africa) that has not increased in accordance with the increasing coverage of other vaccinations. Measles is the deadliest of all childhood rash/fever illnesses and spreads easily, implying that if the vaccination coverage is declining there is a significant risk of new measles outbreaks [27]. Meanwhile, mobile health (mHealth; the use of mobile phones for health interventions) has generated much enthusiasm, and shown potential in improving health service delivery in other contexts. Objective: The aim of this study is to evaluate the efficiency of mHealth as a tool for improving MV coverage while contributing to the mHealth evidence base. Methods: This study will take place at three health centers in different regions of Guinea-Bissau. Participants, defined as mothers of the children receiving the MV, will be enrolled when they arrive with their children at the health center to receive the Bacillus Calmette-Guérin vaccination, usually within one month of the child’s birth. Enrolment will continue until a study population of 990 children has been reached. The participants will be randomly assigned to a control arm or one of two intervention arms. Each of the three groups will have 330 participants, distributed equally between health centers. Participants in the first intervention arm will receive a scheduled short message service (SMS) text message reminding them of the MV. Participants in the second intervention arm will receive a voice call in addition to the SMS message, while the control arm will receive no interventions. The MV is scheduled to be administered at 9 months of age. Although the vaccine would still be effective after 12 months, local policy in Guinea-Bissau prevents children aged >12 months from receiving the vaccination, and thus the study will follow-up with participants after the children reach 12 months of age. Children who have not yet received the MV will be offered vaccination by the project group. Results: The study will analyze the efficiency of the intervention by determining its overall effect on MV coverage and timeliness when children reach 12 months of age. The main analysis will be stratified by intervention group, health center, level of education, ethnic group, and role of the person receiving the text messages (eg, mother, father, other family member). Secondary outcomes include the average number of health center visits (with intention to obtain the MV) required before successful administration. Conclusions: Despite the rapid proliferation of mHealth projects, only a small number have been evaluated in terms of direct links to health outcomes. This gap in knowledge requires solid evidence on which policy-makers can base decisions. This study aims to produce significant knowledge about mHealth implementation within a Sub-Saharan context while creating data-supported evidence. Trial Registration: Clinicaltrials.gov: NCT02662595; https://clinicaltrials.gov/ct2/show/NCT02662595 (Archived by WebCite at http://www.webcitation.org/6jH8YiSjY) 
%M 27466046
%R 10.2196/resprot.5968
%U http://www.researchprotocols.org/2016/3/e158/
%U https://doi.org/10.2196/resprot.5968
%U http://www.ncbi.nlm.nih.gov/pubmed/27466046

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications
%V 5
%N 3
%P e155
%T Voice-Message–Based mHealth Intervention to Reduce Postoperative Penetrative Sex in Recipients of Voluntary Medical Male Circumcision in the Western Cape, South Africa: Protocol of a Randomized Controlled Trial
%A Thomsen,Sarah C
%A Skinner,Donald
%A Toefy,Yoesrie
%A Esterhuizen,Tonya
%A McCaul,Michael
%A Petzold,Max
%A Diwan,Vinod
%+ Global Health, Department of Public Health Sciences, Karolinska Institutet, Jarvstigen 4, Solna,, Sweden, 46 7 0280 6979, sarah.thomsen@ki.se
%K protocol
%K RCT
%K male circumcision
%K HIV
%K mHealth
%K VMMC
%D 2016

%7 26.07.2016
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: There is an increased risk of transmission of sexually transmitted infections (STIs), including HIV, in the postoperative period after receiving voluntary medical male circumcision (VMMC). In South Africa, over 4 million men are being targeted with VMMC services but the health system is not able to offer quality counseling. More innovative strategies for communicating with and altering behavior in men and their partners in the postoperative period after VMMC are needed. Objective: This paper presents a study protocol to test the effectiveness of an mHealth intervention designed to task-shift behavior change communication from health care personnel to an automated phone message system, encouraging self-care. Methods: A single-blind, randomized controlled trial will be used. A total of 1188 participants will be recruited by nurses or clinicians at clinics in the study districts that have a high turnover of VMMC clients. The population will consist of men aged 18 years and older who indicate at the precounseling session that they possess a mobile phone and consent to participating in the study. Consenting participants will be randomized into either the control or intervention arm before undergoing VMMC. The control arm will receive the standard of care (pre- and postcounseling). The intervention arm will received standard of care and will be sent 38 messages over the 6-week recovery period. Patients will be followed up after 42 days. The primary outcome is self-reported sexual intercourse during the recovery period. Secondary outcomes include nonpenetrative sexual activity, STI symptoms, and perceived risk of acquiring HIV. Analysis will be by intention-to-treat. Results: Enrollment is completed. Follow-up is ongoing. Loss to follow-up is under 10%. No interim analyses have been conducted. Conclusions: The intervention has the potential of reducing risky sexual behavior after VMMC. The platform itself can be used for many other areas of health that require task shifting to patients for better efficiency and access. Trial Registration: Pan-African Clinical Trial Registry: PACTR201506001182385 
%M 27460771
%R 10.2196/resprot.5958
%U http://www.researchprotocols.org/2016/3/e155/
%U https://doi.org/10.2196/resprot.5958
%U http://www.ncbi.nlm.nih.gov/pubmed/27460771

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 18
%N 7
%P e149
%T A Social Media mHealth Solution to Address the Needs of Dengue Prevention and Management in Sri Lanka
%A Lwin,May O
%A Vijaykumar,Santosh
%A Rathnayake,Vajira Sampath
%A Lim,Gentatsu
%A Panchapakesan,Chitra
%A Foo,Schubert
%A Wijayamuni,Ruwan
%A Wimalaratne,Prasad
%A Fernando,Owen Noel Newton
%+ Nanyang Technological University, School of Computer Science and Engineering, 50 Nanyang Avenue, North Spine, N4-02c-75, Singapore, 639798, Singapore, 65 67905783, santoshv@ntu.edu.sg
%K dengue
%K public health inspector
%K mhealth
%K social media
%K surveillance
%K needs assessment
%K prevention and management
%D 2016

%7 01.07.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Sri Lanka has witnessed a series of dengue epidemics over the past five years, with the western province, home to the political capital of Colombo, bearing more than half of the dengue burden. Existing dengue monitoring prevention programs are exhausted as public health inspectors (PHIs) cope with increasing workloads and paper-based modes of surveillance and education, characterizing a reactive system unable to cope with the enormity of the problem. On the other hand, the unprecedented proliferation and affordability of mobile phones since 2009 and a supportive political climate have thus far remained unexploited for the use of mobile-based interventions for dengue management. Objective: To conduct a needs assessment of PHIs in Colombo with respect to their dengue-related tasks and develop a new mobile-based system to address these needs while strengthening existing systems. Methods: One-on-one in-depth interviews were conducted with 29 PHIs to a) gain a nuanced, in-depth understanding of the current state of surveillance practices, b) understand the logistical, technological and social challenges they confront, and c) identify opportunities for mobile-based interventions. Quantitative analysis included simple descriptive statistics while qualitative analysis comprised textual analysis of 209 pages of transcripts (or nearly 600 minutes of conversations) using grounded theory approaches. Results: Current paper-based data collection practices for dengue surveillance involved a circuitous, time consuming process that could take between 7-10 days to officially report and record a single case. PHIs confronted challenges in terms of unreliable, standalone GIS devices, delays in registering mosquito breeding sites and lack of engagement from communities while delivering dengue education. These findings, in concert with a high motivation to use mobile-based systems, informed the development of Mo-Buzz, a mobile-based system that integrates three components – digitized surveillance, dynamic disease mapping and digitized dengue education – on a common platform. The system was developed through an iterative, evolutionary, collaborative process, consistent with the Spiral model of software development and is currently being used by all 55 PHIs in the CMC system. Conclusions: Given the entrenched nature of existing paper-based systems in PHIs’ work habits, we expect a gradual adoption curve for Mo-Buzz in the future. Equally, we expect variable adoption of the system with respect to its specific components, and specific PHI sub-groups (younger versus older). The Mo-Buzz intervention is a response to multiple calls by the global mHealth community for collaborations in the area of mobile interventions for global health. Our experience revealed that the benefits of this paradigm lies in alleviating country-specific public health challenges through a commonly shared understanding of cultural mores, and sharing of knowledge and technologies. We call upon future researchers to further dissect the applicability of the Spiral Model of software development to mHealth interventions and contribute to the mHealth evidence debate from theoretical and applied perspectives. 
%M 27369296
%R 10.2196/jmir.4657
%U http://www.jmir.org/2016/7/e149/
%U https://doi.org/10.2196/jmir.4657
%U http://www.ncbi.nlm.nih.gov/pubmed/27369296

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 2
%N 1
%P e28
%T Development and Implementation of Culturally Tailored Offline Mobile Health Surveys
%A McIntosh,Scott
%A Pérez-Ramos,José
%A Demment,Margaret M
%A Vélez Vega,Carmen
%A Avendaño,Esteban
%A Ossip,Deborah J
%A Dye,Timothy D
%+ School of Medicine & Dentistry, Department of Public Health Sciences, University of Rochester, CU420644, 265 Crittenden Blvd, Rochester, NY, 14642, United States, 1 585 802 9944, scott_mcintosh@urmc.rochester.edu
%K mobile health
%K survey research
%K ethical review
%D 2016

%7 02.06.2016
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. Objective: The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. Methods: In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Results: Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Conclusions: Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs. 
%M 27256208
%R 10.2196/publichealth.5408
%U http://publichealth.jmir.org/2016/1/e28/
%U https://doi.org/10.2196/publichealth.5408
%U http://www.ncbi.nlm.nih.gov/pubmed/27256208

%0 Journal Article
        
%@ 2369-3762
%I JMIR Publications
%V 2
%N 1
%P e7
%T Enabling Access to Medical and Health Education in Rwanda Using Mobile Technology: Needs Assessment for the Development of Mobile Medical Educator Apps
%A Rusatira,Jean Christophe
%A Tomaszewski,Brian
%A Dusabejambo,Vincent
%A Ndayiragije,Vincent
%A Gonsalves,Snedden
%A Sawant,Aishwarya
%A Mumararungu,Angeline
%A Gasana,George
%A Amendezo,Etienne
%A Haake,Anne
%A Mutesa,Leon
%+ College of Medicine and Health Sciences, University of Rwanda, KN 73 ST, Kigali, 3286, Rwanda, 250 788665979, rusatirac2001@gmail.com
%K mobile medical education
%K technology
%K user-centered design
%D 2016

%7 01.06.2016
%9 Original Paper
%J JMIR Med Educ
%G English
                
%X Background: Lack of access to health and medical education resources for doctors in the developing world is a serious global health problem. In Rwanda, with a population of 11 million, there is only one medical school, hence a shortage in well-trained medical staff. The growth of interactive health technologies has played a role in the improvement of health care in developed countries and has offered alternative ways to offer continuous medical education while improving patient's care. However, low and middle-income countries (LMIC) like Rwanda have struggled to implement medical education technologies adapted to local settings in medical practice and continuing education. Developing a user-centered mobile computing approach for medical and health education programs has potential to bring continuous medical education to doctors in rural and urban areas of Rwanda and influence patient care outcomes. Objective: The aim of this study is to determine user requirements, currently available resources, and perspectives for potential medical education technologies in Rwanda. Methods: Information baseline and needs assessments data collection were conducted in all 44 district hospitals (DHs) throughout Rwanda. The research team collected qualitative data through interviews with 16 general practitioners working across Rwanda and 97 self-administered online questionnaires for rural areas. Data were collected and analyzed to address two key questions: (1) what are the currently available tools for the use of mobile-based technology for medical education in Rwanda, and (2) what are user's requirements for the creation of a mobile medical education technology in Rwanda? Results: General practitioners from different hospitals highlighted that none of the available technologies avail local resources such as the Ministry of Health (MOH) clinical treatment guidelines. Considering the number of patients that doctors see in Rwanda, an average of 32 patients per day, there is need for a locally adapted mobile education app that utilizes specific Rwandan medical education resources. Based on our results, we propose a mobile medical education app that could provide many benefits such as rapid decision making with lower error rates, increasing the quality of data management and accessibility, and improving practice efficiency and knowledge. In areas where Internet access is limited, the proposed mobile medical education app would need to run on a mobile device without Internet access. Conclusions: A user-centered design approach was adopted, starting with a needs assessment with representative end users, which provided recommendations for the development of a mobile medical education app specific to Rwanda. Specific app features were identified through the needs assessment and it was evident that there will be future benefits to ongoing incorporation of user-centered design methods to better inform the software development and improve its usability. Results of the user-centered design reported here can inform other medical education technology developments in LMIC to ensure that technologies developed are usable by all stakeholders. 
%M 27731861
%R 10.2196/mededu.5336
%U http://mededu.jmir.org/2016/1/e7/
%U https://doi.org/10.2196/mededu.5336
%U http://www.ncbi.nlm.nih.gov/pubmed/27731861

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e65
%T Perceptions of the Feasibility and Practicalities of Text Messaging-Based Infectious Disease Surveillance: A Questionnaire Survey
%A Dang,Linh Thuy
%A Vu,Nguyen Cong
%A Vu,Thiem Dinh
%A James,Spencer L
%A Katona,Peter
%A Katona,Lindsay
%A Rosen,Joseph M
%A Nguyen,Cuong Kieu
%+ Institute of Population, Health and Development, 18 Lane 132, Hoa Bang Street, Hanoi, 122667, Vietnam, 84 437822388 ext 822, cuong.kieu.nguyen@phad.org
%K SMS
%K SMS-based
%K infectious diseases
%K text messaging
%K surveillance
%K Vietnam
%D 2016

%7 25.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: In Vietnam, infectious disease surveillance data are collected via a paper-based system through four government tiers leading to a large delay. Meanwhile, mobile phones are abundant and very popular in the country, and known to be a useful tool in health care worldwide. Therefore, there is a great potential for the development of a timely disease surveillance system through the use of mobile phone short message service (SMS) text messages. Objective: This study aims to explore insights about the feasibility and practicalities of the utilization of SMS text messaging-based interventions in disease-reporting systems by identifying potential challenges and barriers in the text messaging process and looking at lessons learned. Methods: An SMS text messaging-based disease tracking system was set up in Vietnam with patient reports texted by clinic staff. Two 6-month trials utilizing this disease tracking system were designed and implemented in two northern provinces of Vietnam to report two infectious diseases: diarrhea and influenza-like illness. A structured self-reported questionnaire was developed to measure the feasibility and practicalities of the system from the participants. On the completion of the second trial in 2013, participating health staff from 40 commune health centers in the two pilot provinces were asked to complete the survey (N=80). Results: Most participants were female (61%, 49/80) and nearly half (44%, 35/80) were heads of a commune health center. Approximately two-thirds (63%, 50/80) of participants retained the basic structure of the SMS text message report and there was a strong influence (OR 28.2, 95% CI 5.3-151.2) of those people on the time they spent texting the information. The majority (88%, 70/80) felt the information conveyed in the SMS text message report was not difficult to understand. Most (86%, 69/80) believed that they could report all 28 infectious diseases asked for by the Ministry of Health by using SMS text messaging. Conclusions: From a health center staff perspective, a disease-reporting system utilizing text messaging technology is easy to use and has great potential to be implemented and expanded nationwide. The survey showed positive perceptions and feedback from the participants and contributed to a promising practical solution to improve the surveillance system of infectious disease in Vietnam. 
%M 27226418
%R 10.2196/mhealth.4509
%U http://mhealth.jmir.org/2016/2/e65/
%U https://doi.org/10.2196/mhealth.4509
%U http://www.ncbi.nlm.nih.gov/pubmed/27226418

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e64
%T The Use of Mobile Phone and Medical Apps among General Practitioners in Hangzhou City, Eastern China
%A Liu,Ying
%A Ren,Wen
%A Qiu,Yan
%A Liu,Juanjuan
%A Yin,Pei
%A Ren,Jingjing
%+ General Practice Department, The First Affiliated Hospital, College of Medicine, Zhejiang University, #79 Qingchun Road, Hangzhou, 310003, China, 86 138 1948 5898, lisarjj@126.com
%K mobile phone
%K app use
%K general practitioner
%K mobile technology
%D 2016

%7 24.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Mobile phones and mobile phone apps have expanded new forms of health professionals’ work. There are many studies on the use of mobile phone apps for different specialists. However, there are no studies on the current use of mobile phone apps among general practitioners (GPs). Objective: The objective of the study was to investigate the extent to which GPs own smartphones with apps and use them to aid their clinical activities. Methods: A questionnaire survey of GPs was undertaken in Hangzhou, Eastern China. Data probing GPs’ current use of medical apps in their clinical activities and factors influencing app use were collected and analyzed Results: 125 GPs participated in the survey. 90.4% of GPs owned a mobile phone, with 48.7% owning an iPhone and 47.8% owning an Android phone. Most mobile phone owners had 1-3 medical-related apps, with very few owning more than 4. There was no difference in number of apps between iPhone and Android owners (χ2=1.388, P=0.846). 36% of GPs reported using medical-related apps on a daily basis. The majority of doctors reported using apps to aid clinical activities less than 30 minutes per day. Conclusions: A high level of mobile phone ownership and usage among GPs was found in this study, but few people chose medical-related apps to support their clinical practice. 
%M 27220417
%R 10.2196/mhealth.4508
%U http://mhealth.jmir.org/2016/2/e64/
%U https://doi.org/10.2196/mhealth.4508
%U http://www.ncbi.nlm.nih.gov/pubmed/27220417

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications
%V 18
%N 5
%P e114
%T Potential Reach of mHealth Versus Traditional Mass Media for Prevention of Chronic Diseases: Evidence From a Nationally Representative Survey in a Middle-Income Country in Africa
%A Yepes,Maryam
%A Maurer,Jürgen
%A Viswanathan,Barathi
%A Gedeon,Jude
%A Bovet,Pascal
%+ University Institute of Social and Preventive Medicine (IUMSP), Route de la Corniche 10, 1010 Lausanne,, Switzerland, +41 21 314 7272, pascal.bovet@chuv.ch
%K digital divide
%K mHealth
%K eHealth
%K mass media
%K mobile phone
%K noncommunicable diseases
%K short message service
%K email
%K internet access
%K developing countries
%K low- and middle-income countries
%K Africa
%D 2016

%7 20.05.2016
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Public radio and television announcements have a long tradition in public health education. With the global rise of computer and mobile device ownership, short message service (SMS) and email-based health services (mHealth) are promising new tools for health promotion. Objective: Our objectives were to examine 1) self-reported exposure to programs related to noncommunicable diseases (NCDs) on national public television and radio during the 12 months preceding the survey (2013–2014), 2) current ownership of a mobile phone, smartphone, computer, or tablet, and use of the Internet, and 3) willingness of individuals to receive SMS or emails with information on health, with a focus on distribution of these variables across different demographic, socioeconomic status (SES), and NCD risk groups. Methods: We obtained data in a population survey of 1240 participants aged 25–64 years conducted in 2013–2014 in the Seychelles, a rapidly developing small island state in the African region. We administered a structured questionnaire and measured NCD risk factors. Univariate and multivariate analyses explored the relationships between outcomes and sociodemographic variables. Results: Of 1240 participants, 1037 (83.62%) reported exposure to NCD-related programs on public television, while a lower proportion of 740 adults (59.67%), reported exposure via public radio (P <.001). Exposure to NCD-related programs on public television was associated with older age (P <.001) and female sex (P <.001), but not with SES, while exposure to NCD-related programs on public radio was associated with older age (P <.001) and lower SES (P <.001). A total of 1156 (93.22%) owned a mobile phone and ownership was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Only 396 adults (31.93%) owned a smartphone and 244 adults (19.67%) used their smartphone to access the Internet. A total of 1048 adults (84.51%) reported willingness to receive health-related SMS, which was positively associated with female sex (P <.001), younger age (P <.001), and higher SES (P <.001). Controlling for SES, exposure to NCD-related programs on public television or radio and willingness to receive health-related SMS were not independently associated with a person’s NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and television) reached the majority of the population under study, including older adults and those in lower socioeconomic groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs, especially when targeted SMS messages are intended for younger adults and those in higher socioeconomic groups. By contrast, due to reduced Internet access, email-based programs had a more limited reach for health promotion programs. These findings emphasize the different reach of interventions using SMS or email versus traditional mass media, according to demographic and socioeconomic categories, for health education programs in a developing country. 
%M 27207074
%R 10.2196/jmir.5592
%U http://www.jmir.org/2016/5/e114/
%U https://doi.org/10.2196/jmir.5592
%U http://www.ncbi.nlm.nih.gov/pubmed/27207074

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e52
%T Are Text Messages a Feasible and Acceptable Way to Reach Female Entertainment Workers in Cambodia with Health Messages? A Cross-Sectional Phone Survey
%A Brody,Carinne
%A Dhaliwal,Sukhmani
%A Tuot,Sovannary
%A Johnson,Michael
%A Pal,Khuondyla
%A Yi,Siyan
%+ Touro University California, Public Health Program, Center for Global Health Research, 1310 Club Drive, Vallejo, CA, 94592, United States, 1 7076388533, carinne.brody@gmail.com
%K mHealth
%K short message service
%K Cambodia
%K female sex workers
%K HIV
%D 2016

%7 20.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions. Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services. Methods: This cross-sectional phone survey was conducted in May 2015 with 97 FEWs aged 18–35 years and currently working at an entertainment venue in Phnom Penh. Results: Of the 96 respondents, 51% reported sending text messages daily; of them, 47% used Khmer script and 45% used Romanized Khmer. Younger FEWs were more likely to report daily texting (P<.001). Most FEWs (98%) in this study reported feeling comfortable receiving private health messages despite the fact that 39% were sharing their phone with others. Younger FEWs were less likely to share their phone with others (P=.02). Of all of the FEWs, 47% reported owning a smartphone, and younger women were more likely to own a smartphone than were older women (P=.08). Conclusions: The findings from this study support the development of mHealth interventions targeting high-risk groups in urban areas of Cambodia. Our data suggest that mHealth interventions using texting may be a feasible way of reaching FEWs in Phnom Penh. 
%M 27207374
%R 10.2196/mhealth.5297
%U http://mhealth.jmir.org/2016/2/e52/
%U https://doi.org/10.2196/mhealth.5297
%U http://www.ncbi.nlm.nih.gov/pubmed/27207374

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e61
%T Mobile Phone Use Among Medical Residents: A Cross-Sectional Multicenter Survey in Saudi Arabia
%A Jamal,Amr
%A Temsah,Mohamad-Hani
%A Khan,Samina A
%A Al-Eyadhy,Ayman
%A Koppel,Cristina
%A Chiang,Michael F
%+ College of Medicine, Department of Family and Community Medicine, King Saud University, PO Box 90714, Riyadh, 11623, Saudi Arabia, 966 114690822, amrjamal@ksu.edu.sa
%K cell phones
%K mobile phone
%K telemedicine
%K medical education
%K medical residencies
%K educational techniques
%K patient care
%K communication methods
%K WhatsApp
%K Saudi Arabia
%K point of care technology
%D 2016

%7 19.05.2016
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile phones have great potential for medical education, as they allow health care providers and students to access resources efficiently at the precise time at the point-of-care to help in informed decision making. Objective: The objective of the study was to evaluate the prevalence of mobile phone usage among medical residents and to explore their attitudes, perceptions, and the challenges they experience when using mobile phones in academic and clinical practice. Methods: A cross-sectional survey was conducted on all 133 residents in 17 different specialties across two large academic hospitals in Riyadh, Saudi Arabia. The Web-based validated questionnaire measured mobile phone platform preferences, and their uses in general and medical practice. The perception of confidentiality and safety impact of using mobile phones for communication and accessing patient’s data was also explored, alongside challenges of use and how residents learn to use their mobile phone. Results: With a response rate of 101/133 (75.9%) and mean age of 27.8 (SD 3.0) years, we found that 100/101 (99.0%) of participants were mobile phone users with mean duration of use of 5.12 (SD 2.4) years, and a range from 1 to 12 years. There was no significant difference in use between male and female respondents. A negative linear correlation was found between age and use duration (P=.004). The most common operating system used by participants was the iOS platform (55/101, 54.5%), with English the most commonly used language to operate residents’ mobile phones (96/100, 96.0%) despite their native language being Arabic. For communication outside medical practice, chatting applications such as WhatsApp matched phone calls as most commonly used tools (each 88/101, 87.1%). These were also the primary tools for medical communication, but used at a lower rate (each 65/101, 64.4%). In medical practice, drug (83/101, 82.2%) and medical (80/101, 79.2%) references and medical calculation applications (61/101, 60.4%) were the most commonly used. Short battery life (48/92, 52%) was the most common technical difficulty, and distraction at least on a weekly basis (54/92, 58%) was the most likely side effect of using a mobile phone in medical practice. Practically, all participants agreed with the idea of integrating medical staff mobile phones with the hospital information system. Most residents described themselves as self-learners, while half learned from peers, and a quarter learned from the Internet. Only 7/101 (6.9%) had received formal training on the medical use of mobile phones. Over half of residents thought it was safe to discuss patients over their personal, nonencrypted email. Conclusions: Mobile phone use among medical residents has become almost universal in academic and clinical settings. Thus, academic and health care institutions should support proper utilization of these devices in medical training and point-of-care decision making, while continuing to protect patient confidentiality. 
%M 27197618
%R 10.2196/mhealth.4904
%U http://mhealth.jmir.org/2016/2/e61/
%U https://doi.org/10.2196/mhealth.4904
%U http://www.ncbi.nlm.nih.gov/pubmed/27197618

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e37
%T Mobile Health Insurance System and Associated Costs: A Cross-Sectional Survey of Primary Health Centers in Abuja, Nigeria
%A Chukwu,Emeka
%A Garg,Lalit
%A Eze,Godson
%+ University of Liverpool, Faculty of Computer Science and Engineering, Liverpool, Mercy side, Liverpool, L69 3BX, United Kingdom, 44 8037760629, emeka.chukwu@online.liverpool.ac.uk
%K mobile health
%K mHealth
%K eHealth
%K health financing
%K health insurance
%K public health informatics
%D 2016

%7 17.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Nigeria contributes only 2% to the world’s population, accounts for 10% of the global maternal death burden. Health care at primary health centers, the lowest level of public health care, is far below optimal in quality and grossly inadequate in coverage. Private primary health facilities attempt to fill this gap but at additional costs to the client. More than 65% Nigerians still pay out of pocket for health services. Meanwhile, the use of mobile phones and related services has risen geometrically in recent years in Nigeria, and their adoption into health care is an enterprise worth exploring. Objective: The purpose of this study was to document costs associated with a mobile technology–supported, community-based health insurance scheme. Methods: This analytic cross-sectional survey used a hybrid of mixed methods stakeholder interviews coupled with prototype throw-away software development to gather data from 50 public primary health facilities and 50 private primary care centers in Abuja, Nigeria. Data gathered documents costs relevant for a reliable and sustainable mobile-supported health insurance system. Clients and health workers were interviewed using structured questionnaires on services provided and cost of those services. Trained interviewers conducted the structured interviews, and 1 client and 1 health worker were interviewed per health facility. Clinic expenditure was analyzed to include personnel, fixed equipment, medical consumables, and operation costs. Key informant interviews included a midmanagement staff of a health-management organization, an officer-level staff member of a mobile network operator, and a mobile money agent. Results: All the 200 respondents indicated willingness to use the proposed system. Differences in the cost of services between public and private facilities were analyzed at 95% confidence level (P<.001). This indicates that average out-of-pocket cost of services at private health care facilities is significantly higher than at public primary health care facilities. Key informant interviews with a health management organizations and a telecom operator revealed high investment interests. Cost documentation analysis of income versus expenditure for the major maternal and child health service areas—antenatal care, routine immunization, and birth attendance for 1 year—showed that primary health facilities would still profit if technology-supported, health insurance schemes were adopted. Conclusions: This study demonstrates a case for the implementation of enrolment, encounter management, treatment verification, claims management and reimbursement using mobile technology for health insurance in Abuja, Nigeria. Available data show that the introduction of an electronic job aid improved efficiency. Although it is difficult to make a concrete statement on profitability of this venture but the interest of the health maintenance organizations and telecom experts in this endeavor provides a positive lead. 
%M 27189312
%R 10.2196/mhealth.4342
%U http://mhealth.jmir.org/2016/2/e37/
%U https://doi.org/10.2196/mhealth.4342
%U http://www.ncbi.nlm.nih.gov/pubmed/27189312

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications Inc.
%V 5
%N 2
%P e72
%T The Mobile Solutions for Immunization (M-SIMU) Trial: A Protocol for a Cluster Randomized Controlled Trial That Assesses the Impact of Mobile Phone Delivered Reminders and Travel Subsidies to Improve Childhood Immunization Coverage Rates and Timeliness in Western Kenya
%A Gibson,Dustin G
%A Kagucia,E. Wangeci
%A Ochieng,Benard
%A Hariharan,Nisha
%A Obor,David
%A Moulton,Lawrence H
%A Winch,Peter J
%A Levine,Orin S
%A Odhiambo,Frank
%A O'Brien,Katherine L
%A Feikin,Daniel R
%+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu
%K text message
%K reminders
%K SMS
%K M-PESA
%K Kenya
%K mobile
%K conditional cash transfer
%K CCT
%K incentive
%K measles
%K mHealth
%K immunization
%K pentavalent
%D 2016

%7 17.05.2016
%9 Protocol
%J JMIR Res Protoc
%G English
                
%X Background: Text message (short message service, SMS) reminders and incentives are two demand-side interventions that have been shown to improve health care–seeking behaviors by targeting participant characteristics such as forgetfulness, lack of knowledge, and transport costs. Applying these interventions to routine pediatric immunizations may improve vaccination coverage and timeliness. Objective: The Mobile Solutions for Immunization (M-SIMU) trial aims to determine if text message reminders, either with or without mobile phone–based incentives, sent to infant’s parents can improve immunization coverage and timeliness of routine pediatric vaccines in rural western Kenya. Methods: This is a four-arm, cluster, randomized controlled trial. Villages are randomized to one of four study arms prior to enrollment of participants. The study arms are: (1) no intervention (a general health-related text message will be texted to this group at the time of enrollment), (2) text message reminders only, (3) text message reminders and a 75 Kenyan Shilling (KES) incentive, or (4) text message reminders and a KES200 incentive. Participants assigned to study arms 2-4 will receive two text message reminders; sent 3 days before and one day before the scheduled immunization visit at 6, 10, and 14 weeks for polio and pentavalent (containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenza type b antigens) type b antigens) vaccines, and at 9 months for measles vaccine. Participants in incentive arms will, in addition to text message reminders as above, receive mobile phone–based incentives after each timely vaccination, where timely is defined as vaccination within 2 weeks of the scheduled date for each of the four routine expanded program immunization (EPI) vaccination visits. Mother-infant pairs will be followed to 12 months of age where the primary outcome, a fully immunized child, will be ascertained. A fully immunized child is defined as a child receiving vaccines for bacille Calmette-Guerin, three doses of pentavalent and polio, and measles by 12 months of age. General estimating equation (GEE) models that account for clustering will be employed for primary outcome analyses. Results: Enrollment was completed in October 2014. Twelve month follow-up visits to ascertain immunization status from the maternal and child health booklet were completed in February 2016. Conclusions: This is one of the first studies to examine the effect of text message reminders on immunization coverage and timeliness in a lower income country and is the first study to assess the effect of mobile money-based incentives to improve immunization coverage. Trial Registration: Clinicaltrials.gov NCT01878435; https://clinicaltrials.gov/ct2/show/NCT01878435 (Archived by WebCite at http://www.webcitation.org/6hQlwGYJR) 
%M 27189422
%R 10.2196/resprot.5030
%U http://www.researchprotocols.org/2016/2/e72/
%U https://doi.org/10.2196/resprot.5030
%U http://www.ncbi.nlm.nih.gov/pubmed/27189422

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 2
%P e30
%T Acceptability, Usability, and Views on Deployment of Peek, a Mobile Phone mHealth Intervention for Eye Care in Kenya: Qualitative Study
%A Lodhia,Vaishali
%A Karanja,Sarah
%A Lees,Shelley
%A Bastawrous,Andrew
%+ London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 7796277602, vaishali.lodhia@gmail.com
%K mobile phone
%K mHealth
%K qualitative
%K ophthalmic testing
%K acceptability
%K usability
%K Kenya
%D 2016

%7 09.05.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: The Portable Eye Examination Kit (Peek) is a mobile phone–based ophthalmic testing system that has been developed to perform comprehensive eye examinations. Shortages in ophthalmic personnel, the high cost, and the difficulty in transporting equipment have made it challenging to offer services, particularly in rural areas. Peek offers a solution for overcoming barriers of limited access to traditional ophthalmic testing methods and has been pilot tested on adults in Nakuru, Kenya, and compared with traditional eye examination tools. Objective: This qualitative study evaluated the acceptability and usability of Peek in addition to perceptions regarding its adoption and nationwide deployment. Methods: Semistructured interviews were conducted with patients and analyzed using a framework approach. This included analysis of interviews from 20 patients, 8 health care providers (HCPs), and 4 key decision makers in ophthalmic health care provision in Kenya. The participants were purposefully sampled. The coding structure involved predefined themes for assessing the following: (1) the context, that is, environment, user, task, and technology; (2) patient acceptability, that is, patients' perceived benefits, patient preference, and patient satisfaction; (3) usability, that is, efficiency, effectiveness, learnability, and flexibility and operability of Peek; and (4) the benefits of Peek in strengthening eye care provision, that is, capabilities enhancer, opportunity creator, social enabler, and knowledge generator. Emerging themes relating to the objectives were explored from the data using thematic analysis. Results: Patients found Peek to be acceptable because of its benefits in overcoming the barriers to accessing ophthalmic services. Most thought it to be fast, convenient, and able to reach a large population. All patients expressed being satisfied with Peek. The HCPs perceived it to satisfy the criteria for usability and found Peek to be acceptable based on the technology acceptance model. Peek was also found to have features required for strengthening ophthalmic delivery by aiding detection and diagnosis, provision of decision support, improving communication between provider and patient and among providers, linking patients to services, monitoring, and assisting in education and training. Some of the deployment-related issues included the need for government and community involvement, communication and awareness creation, data protection, infrastructure development including capacity creation, and training and maintenance support. Conclusions: According to all parties interviewed, Peek is an acceptable solution, as it provides a beneficial service, supports patients' needs, and fulfills HCPs' roles, overall contributing to strengthening eye health. 
%M 27160779
%R 10.2196/mhealth.4746
%U http://mhealth.jmir.org/2016/2/e30/
%U https://doi.org/10.2196/mhealth.4746
%U http://www.ncbi.nlm.nih.gov/pubmed/27160779

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 1
%P e22
%T Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study
%A Hacking,Damian
%A Haricharan,Hanne J
%A Brittain,Kirsty
%A Lau,Yan Kwan
%A Cassidy,Tali
%A Heap,Marion
%+ Health and Human Rights Programme, Department of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa, 27 848238040, damianuct@gmail.com
%K telemedicine
%K health knowledge, attitudes, practice
%K developing countries
%K hypertension
%D 2016

%7 10.03.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: The use of mobile phones to deliver health care (mHealth) is increasing in popularity due to the high prevalence of mobile phone penetration. This is seen in developing countries, where mHealth may be particularly useful in overcoming traditional access barriers. Non-communicable diseases may be particularly amenable to mHealth interventions, and hypertension is one with an escalating burden in the developing world. Objective: The objective of this study was to test whether the dissemination of health information via a short message service (SMS) led to improvements in health knowledge and self-reported health-related behaviors. Methods: A mixed methods study was carried out among a cohort of 223 hypertension clinic patients, in a resource-poor setting in Cape Town, South Africa, in 2012. Hypertensive outpatients were recruited at the clinic and administered a baseline questionnaire to establish existing knowledge of hypertension. Participants were then randomly assigned to intervention or control groups. The intervention group received 90 SMSes over a period of 17 weeks. Thereafter, the baseline questionnaire was readministered to both groups to gauge if any improvements in health knowledge had occurred. Those who received SMSes were asked additional questions about health-related behavior changes. A focus group was then conducted to obtain in-depth feedback about participants’ experience with, and response to, the SMS campaign. Results: No statistically significant changes in overall health knowledge were observed between the control and intervention groups. The intervention group had positive increases in self-reported behavior changes. These were reaffirmed by the focus groups, which also revealed a strong preference for the SMS campaign and the belief that the SMSes acted as a reminder to change, as opposed to providing new information. Conclusions: Although the content of the SMSes was not new, and did not improve health knowledge, SMSes were effective in motivating positive self-reported behavior change among hypertensive patients. Trial Registration: Pan African Clinical Trials Registry Number: PACTR201412000968462. Registered 18 December 2014 (Archived by WebCite at http://www.webcitation.org/6fhtyLRcO). 
%M 26964505
%R 10.2196/mhealth.4569
%U http://mhealth.jmir.org/2016/1/e22/
%U https://doi.org/10.2196/mhealth.4569
%U http://www.ncbi.nlm.nih.gov/pubmed/26964505

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 1
%P e16
%T The PAediatric Risk Assessment (PARA) Mobile App to Reduce Postdischarge Child Mortality: Design, Usability, and Feasibility for Health Care Workers in Uganda
%A English,Lauren Lacey
%A Dunsmuir,Dustin
%A Kumbakumba,Elias
%A Ansermino,John Mark
%A Larson,Charles P
%A Lester,Richard
%A Barigye,Celestine
%A Ndamira,Andrew
%A Kabakyenga,Jerome
%A Wiens,Matthew O
%+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 2733 Heather Street, Vancouver, BC, , Canada, 1 604 997 7753, mowiens@outlook.com
%K infectious disease
%K postdischarge mortality
%K mHealth
%K prediction model
%K risk assessment
%K usability
%K Africa
%K resource-limited settings
%D 2016

%7 15.02.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Postdischarge death in children is increasingly being recognized as a major contributor to overall child mortality. The PAediatric Risk Assessment (PARA) app is an mHealth tool developed to aid health care workers in resource-limited settings such as Sub-Saharan Africa to identify pediatric patients at high risk of both in-hospital and postdischarge mortality. The intended users of the PARA app are health care workers (ie, nurses, doctors, and clinical officers) with varying levels of education and technological exposure, making testing of this clinical tool critical to successful implementation. Objective: Our aim was to summarize the usability evaluation of the PARA app among target users, which consists of assessing the ease of use, functionality, and navigation of the interfaces and then iteratively improving the design of this clinical tool. Methods: Health care workers (N=30) were recruited to participate at Mbarara Regional Referral Hospital and Holy Innocents Children’s Hospital in Mbarara, Southwestern Uganda. This usability study was conducted in two phases to allow for iterative improvement and testing of the interfaces. The PARA app was evaluated using quantitative and qualitative measures, which were compared between Phases 1 and 2 of the study. Participants were given two patient scenarios that listed hypothetical information (ie, demographic, social, and clinical data) to be entered into the app and to determine the patient’s risk of in-hospital and postdischarge mortality. Time-to-completion and user errors were recorded for each participant while using the app. A modified computer system usability questionnaire was utilized at the end of each session to elicit user satisfaction with the PARA app and obtain suggestions for future improvements. Results: The average time to complete the PARA app decreased by 30% from Phase 1 to Phase 2, following user feedback and modifications. Participants spent the longest amount of time on the oxygen saturation interface, but modifications following Phase 1 cut this time by half. The average time-to-completion (during Phase 2) for doctors/medical students was 3 minutes 56 seconds. All participants agreed they would use the PARA app if available at their health facility. Given a high PARA risk score, participants suggested several interventions that would be appropriate for the sociocultural context in southwestern Uganda, which involved strengthening discharge and referral procedures within the current health care system. Conclusions: Through feedback and modifications made during this usability study, the PARA app was developed into a user-friendly app, encompassing user expectations and culturally intuitive interfaces for users with a range of technological exposure. Doctors and medical students had shorter task completion times, though all participants reported the usefulness of this tool to improve postdischarge outcomes. 
%M 26879041
%R 10.2196/mhealth.5167
%U http://mhealth.jmir.org/2016/1/e16/
%U https://doi.org/10.2196/mhealth.5167
%U http://www.ncbi.nlm.nih.gov/pubmed/26879041

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 1
%P e10
%T Unpacking the Black Box: A Formative Research Approach to the Development of Theory-Driven, Evidence-Based, and Culturally Safe Text Messages in Mobile Health Interventions
%A Maar,Marion A
%A Yeates,Karen
%A Toth,Zsolt
%A Barron,Marcia
%A Boesch,Lisa
%A Hua-Stewart,Diane
%A Liu,Peter
%A Perkins,Nancy
%A Sleeth,Jessica
%A Wabano,Mary Jo
%A Williamson,Pamela
%A Tobe,Sheldon W
%+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Road, Sudbury, ON, , Canada, 1 705 662 7233, mmaar@nosm.ca
%K Aboriginal people
%K behavioral change wheel
%K cultural safety
%K grounded theory
%K mobile phone
%K semiotics
%K SMS
%K Tanzania
%K text messages
%D 2016

%7 22.01.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Mobile-cellular subscriptions have increased steadily over the past decade. The accessibility of SMS messages over existing mobile networks is high and has almost universal availability even on older and unsophisticated mobile phones and in geographic settings where wireless coverage is weak. There is intensive exploration of this inexpensive mobile telecommunication technology to improve health services and promote behavior change among vulnerable populations. However, a neglected area of research is the documentation and critical analysis of the formative research process required in the development and refinement of effective SMS messages. Objective: The objective of this qualitative research study was to identify major factors that may impact on the effectiveness of evidence-based SMS messages designed to reduce health inequities in hypertension management in low resource settings, including Aboriginal populations in high-income countries and rural populations in low-income countries. Specifically, we were interested in uncovering the range of mediators that impact on appropriate message content transmission and, ultimately, on health behavior improvements in a range of these sociocultural settings. Methods: Collaborative qualitative research with Canadian Aboriginal and Tanzanian participants was conducted to deconstruct the content and transmission of evidence-based health information contained in SMS messages in the context of an international research project designed to address health inequalities in hypertension, and to develop a grounded theory of the major factors that mediate the effectiveness of this communication. We also examined the interrelationship of these mediators with the three essential conditions of the behavior system of the Behavioral Change Wheel model (capability, opportunity, and motivation) and cultural safety. Results: Four focus groups with a total of 45 participants were conducted. Our grounded theory research revealed how discrepancies develop between the evidence-based text message created by researchers and the message received by the recipient in mobile health interventions. These discrepancies were primarily generated by six mediators of meaning in SMS messages:  (1) negative or non-affirming framing of advocacies, (2) fear- or stress-inducing content, (3) oppressive or authoritarian content, (4) incongruity with cultural and traditional practices, (5) disconnect  with the reality of the social determinants of health and the diversity of cultures within a population, and (6) lack of clarity and/or practicality of content. These 6 mediators of meaning provide the basis for sound strategies for message development because they impact directly on the target populations’ capability, opportunity, and motivation for behavior change. Conclusions: The quality of text messages impacts significantly on the effectiveness of a mobile health intervention. Our research underscores the urgent need for interventions to incorporate and evaluate the quality of SMS messages and to examine the mediators of meaning within each targeted cultural and demographic group. Reporting on this aspect of mobile health intervention research will allow researchers to move away from the current black box of SMS text message development, thus improving the transparency of the process as well as the quality of the outcomes. 
%M 26800712
%R 10.2196/mhealth.4994
%U http://mhealth.jmir.org/2016/1/e10/
%U https://doi.org/10.2196/mhealth.4994
%U http://www.ncbi.nlm.nih.gov/pubmed/26800712

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 4
%N 1
%P e9
%T Possibilities and Expectations for mHealth in the Pacific Islands: Insights From Key Informants
%A Umali,Elaine
%A McCool,Judith
%A Whittaker,Robyn
%+ Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, , New Zealand, 64 3737599 ext 82372, elaine.umali@gmail.com
%K mHealth
%K Pacific Islands
%K prevention
%K health systems
%K health policy
%D 2016

%7 20.01.2016
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: The increase in mobile phone use across the globe is creating mounting interest for its application in addressing health system constraints. Although still limited, there is growing evidence of success in using mobile phones for health (mHealth) in low- and middle- income countries. The promise of mHealth to address key health system issues presents a huge potential for the Pacific Island countries where mobile use has radically increased. Current projections indicate an improved information and communications technology (ICT) environment to support greater access to mobile and digital devices in the Pacific region. Objective: The objective of the study was to explore key stakeholder perspectives on the potential for mHealth in the Pacific region. Methods: A series of in-depth interviews were conducted either face-to-face, via Skype or by email, with a series of key informants from the Pacific Rim region. Interviews were audio-recorded and later transcribed for detailed thematic analysis. Results: We found widespread support for the potential to use mobile phones as a mechanism to facilitate improved health service delivery in the region. Essential elements for the successful development and implementation of mHealth were identified by these stakeholders. These included: developing an understanding of the local context and the problems that may be usefully addressed by the addition of mHealth to existing strategies and services; consideration of local infrastructure, capability, policy, mobile literacy and engagement; learning from others, particularly other low- and middle-income countries (LMICs); the importance of building supportive environments and of evaluation to provide evidence of impact and total cost. Conclusions: The rapid growth of mobile phone use in the region presents a unique juxtaposition of opportunity and promise. Though the region lags behind other LMICs in the adoption of mHealth technologies, this offers the convenience of learning from past mHealth interventions and applying these learnings to achieve scale, sustainability and success. This study deepens the understanding of the potential of mHealth for the region, and offers a baseline from which discussions can be made to examine the limitations, barriers and complexities inherent in mHealth applications. 
%M 26792386
%R 10.2196/mhealth.4626
%U http://mhealth.jmir.org/2016/1/e9/
%U https://doi.org/10.2196/mhealth.4626
%U http://www.ncbi.nlm.nih.gov/pubmed/26792386

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 3
%P e76
%T Potential Roles of Mhealth for Community Health Workers: Formative Research With End Users in Uganda and Mozambique
%A Thondoo,Meelan
%A Strachan,Daniel Ll
%A Nakirunda,Maureen
%A Ndima,Sozinho
%A Muiambo,Abel
%A Källander,Karin
%A Hill,Zelee
%A ,
%+ Institute for Global Health, University College London, 30 guilford street, London, , United Kingdom, 44 207 905 2603, zhill.ich@gmail.com
%K mobile phones
%K mHealth
%K community health workers
%K motivation
%K performance
%D 2015

%7 23.07.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Community health workers are reemerging as an essential component of health systems in low-income countries. However, there are concerns that unless they are adequately supported, their motivation and performance will be suboptimal. mHealth presents an opportunity to improve support for community health workers; however, most interventions to date have been designed through a top-down approach, rarely involve the end user, and have not focused on motivation. Objective: To use formative research to explore the views of community health workers in Uganda and Mozambique on the potential role of mHealth in their work delivering integrated community case management of children. Methods: We conducted 24 in-depth interviews and 5 focus group discussions with community health workers in Uganda and Mozambique. Data were collected on: current phone use, preferred phone and charger characteristics, and perceptions of a range of potential mHealth interventions. Interviews were conducted in the local language, were audio recorded and converted into expanded notes. Interviews were coded for key thematic areas using both deductive and inductive codes. Deductive codes included mHealth’s potential impact on motivation and performance. Results: The most salient roles of mHealth in improving performance and motivation were reducing the need for travel, improving efficiency and planning, receiving feedback and information, and improving communication with supervisors and other community health workers. This was mostly through improved voice and short message service (SMS) text communication. Specific components of mHealth interventions that participants felt could improve motivation included increasing their visibility and credibility through branding of phones; providing an SMS response to data submission; and sending SMS messages about the importance of their work and achievements, rather than just reminders or technical messages. Participants identified feasibility issues related to the language of SMS messages, network coverage, and the need for a balance between phone function and battery life. Phones with a dual SIM cards would ameliorate network problems but would reduce battery life. The provision of a solar charger was viewed as beneficial. Conclusions: Conducting formative research with end users is likely to improve mHealth interventions by: (1) identifying interventions that are likely to have the greatest impact and be the most acceptable, (2) developing salient SMS messages, and (3) identifying feasibility issues. mHealth interventions also could have an important impact on health worker motivation, which should be considered by intervention developers and in evaluations, especially as small modifications could have a significant impact. Our study suggests that using phones to improve direct communication should be considered, even when planners aim to focus on the provision of a specific application. 
%M 26206419
%R 10.2196/mhealth.4208
%U http://mhealth.jmir.org/2015/3/e76/
%U https://doi.org/10.2196/mhealth.4208
%U http://www.ncbi.nlm.nih.gov/pubmed/26206419

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 3
%P e75
%T Effectiveness of Using Mobile Phone Image Capture for Collecting Secondary Data: A Case Study on Immunization History Data Among Children in Remote Areas of Thailand
%A Jandee,Kasemsak
%A Kaewkungwal,Jaranit
%A Khamsiriwatchara,Amnat
%A Lawpoolsri,Saranath
%A Wongwit,Waranya
%A Wansatid,Peerawat
%+ Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, The 60 Anniversary of His Majesty the King's Accession to the Throne Building, 420/6, Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, 66 23549181, jaranitk@biophics.org
%K health care information system
%K DEPIC
%K mobile technology
%K maternal and child health
%K mHealth
%K vaccine record
%K electronic data capture
%D 2015

%7 20.07.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Entering data onto paper-based forms, then digitizing them, is a traditional data-management method that might result in poor data quality, especially when the secondary data are incomplete, illegible, or missing. Transcription errors from source documents to case report forms (CRFs) are common, and subsequently the errors pass from the CRFs to the electronic database. Objective: This study aimed to demonstrate the usefulness and to evaluate the effectiveness of mobile phone camera applications in capturing health-related data, aiming for data quality and completeness as compared to current routine practices exercised by government officials. Methods: In this study, the concept of “data entry via phone image capture” (DEPIC) was introduced and developed to capture data directly from source documents. This case study was based on immunization history data recorded in a mother and child health (MCH) logbook. The MCH logbooks (kept by parents) were updated whenever parents brought their children to health care facilities for immunization. Traditionally, health providers are supposed to key in duplicate information of the immunization history of each child; both on the MCH logbook, which is returned to the parents, and on the individual immunization history card, which is kept at the health care unit to be subsequently entered into the electronic health care information system (HCIS). In this study, DEPIC utilized the photographic functionality of mobile phones to capture images of all immunization-history records on logbook pages and to transcribe these records directly into the database using a data-entry screen corresponding to logbook data records. DEPIC data were then compared with HCIS data-points for quality, completeness, and consistency. Results: As a proof-of-concept, DEPIC captured immunization history records of 363 ethnic children living in remote areas from their MCH logbooks. Comparison of the 2 databases, DEPIC versus HCIS, revealed differences in the percentage of completeness and consistency of immunization history records. Comparing the records of each logbook in the DEPIC and HCIS databases, 17.3% (63/363) of children had complete immunization history records in the DEPIC database, but no complete records were reported in the HCIS database. Regarding the individual’s actual vaccination dates, comparison of records taken from MCH logbook and those in the HCIS found that 24.2% (88/363) of the children’s records were absolutely inconsistent. In addition, statistics derived from the DEPIC records showed a higher immunization coverage and much more compliance to immunization schedule by age group when compared to records derived from the HCIS database. Conclusions: DEPIC, or the concept of collecting data via image capture directly from their primary sources, has proven to be a useful data collection method in terms of completeness and consistency. In this study, DEPIC was implemented in data collection of a single survey. The DEPIC concept, however, can be easily applied in other types of survey research, for example, collecting data on changes or trends based on image evidence over time. With its image evidence and audit trail features, DEPIC has the potential for being used even in clinical studies since it could generate improved data integrity and more reliable statistics for use in both health care and research settings. 
%M 26194880
%R 10.2196/mhealth.4183
%U http://mhealth.jmir.org/2015/3/e75/
%U https://doi.org/10.2196/mhealth.4183
%U http://www.ncbi.nlm.nih.gov/pubmed/26194880

%0 Journal Article
        
%@ 1929-0748
%I JMIR Publications Inc.
%V 4
%N 2
%P e76
%T Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There’s an App for That
%A Soong,Andrea
%A Chen,Julia Cen
%A Borzekowski,Dina LG
%+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, United States, 1 410 502 2482, asoong@jhu.edu
%K ecological momentary assessment
%K tobacco control
%K cell phones
%K mobile phones
%K mHealth
%K telemedicine
%K smoking
%D 2015

%7 24.06.2015
%9 Original Paper
%J JMIR Res Protoc
%G English
                
%X Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants’ behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults. Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries. Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data. Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion. Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection. 
%M 26109369
%R 10.2196/resprot.4408
%U http://www.researchprotocols.org/2015/2/e76/
%U https://doi.org/10.2196/resprot.4408
%U http://www.ncbi.nlm.nih.gov/pubmed/26109369

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 2
%P e61
%T Adoption and Usage of mHealth Technology on Quality and Experience of Care Provided by Frontline Workers: Observations From Rural India
%A Kaphle,Sangya
%A Chaturvedi,Sharad
%A Chaudhuri,Indrajit
%A Krishnan,Ram
%A Lesh,Neal
%+ Dimagi Software Innovations, Taarifa Road, Parklands, Nairobi, , Kenya, 254 733962903, sangyakaphle@gmail.com
%K mHealth
%K technology adoption
%K community health workers
%K CommCare
%D 2015

%7 28.05.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: mHealth apps are deployed with the aim of improving access, quality, and experience of health care. It is possible that any mHealth intervention can yield differential impacts for different types of users. Mediating and determining factors, including personal and socioeconomic factors, affect technology adoption, the way health workers leverage and use the technology, and subsequently the quality and experience of care they provide. Objective: To develop a framework to assess whether mHealth platforms affect the quality and experience of care provided by frontline workers, and whether these effects on quality and experience are different depending on the level of technology adoption and individual characteristics of the health worker. Literacy, education, age, and previous mobile experience are identified as individual factors that affect technology adoption and use, as well as factors that affect the quality and experience of care directly and via the technology. Methods: Formative research was conducted with 15 community health workers (CHWs) using CommCare, an mHealth app for maternal and newborn care, in Bihar, India. CHWs were first classified on the level of CommCare adoption using data from CommCareHQ and were then shadowed on home visits to evaluate their levels of technology proficiency, and the quality and experience of care provided. Regression techniques were employed to test the relationships. Out of all the CHWs, 2 of them refused to participate in the home visits, however, we did have information on their levels of technology adoption and background characteristics, which were included in the analysis as relevant. Results: Level of technology adoption was important for both quality and experience of care. The quality score for high users of CommCare was higher by 33.4% (P=.04), on average, compared to low users of CommCare. Those who scored higher on CommCare proficiency also provided significantly higher quality and experience of care, where an additional point in CommCare proficiency score increased the quality score by around half a point (0.541, P=.07), and experience score by around a third of a point (0.308, P=.03). Age affected CommCare user type negatively, with an increase in age increasing the likelihood of belonging to a lower category of CommCare adoption (-0.105, P=.08). Other individual characteristics did not affect adoption or the predicted values estimating the relationship between adoption and quality and experience of care, although illiteracy was able to affect the relationship negatively. Conclusions: mHealth technology adoption by frontline workers can positively impact the quality and experience of care they provide. Individual characteristics, especially literacy and age, can be important elements affecting technology adoption and the way users leverage the technology for their work. Our formative study provides informed hypotheses and methods for further research. 
%M 26023001
%R 10.2196/mhealth.4047
%U http://mhealth.jmir.org/2015/2/e61/
%U https://doi.org/10.2196/mhealth.4047
%U http://www.ncbi.nlm.nih.gov/pubmed/26023001

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 2
%P e41
%T What Overweight Women Want From a Weight Loss App: A Qualitative Study on Arabic Women
%A Alnasser,Aroub Abdulaziz
%A Alkhalifa,Abdulrahman Saleh
%A Sathiaseelan,Arjuna
%A Marais,Debbi
%+ King Saud University, Food Science and Nutrition, PO Box 86683, Riyadh, 11632, Saudi Arabia, 966 114556208, aroub@ksu.edu.sa
%K weight loss
%K focus groups
%K smartphone
%K mobile apps
%K Arabic
%K qualitative research
%D 2015

%7 20.05.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Overweight and obesity are international public health issues. With mobile and app use growing globally, the development of weight loss apps are increasing along with evidence that interventions using technology have been effective in the treatment of obesity. Although studies have been conducted regarding what content health professionals would recommend within weight loss apps, there are limited studies that explore users’ viewpoints. There is specifically a paucity of research that takes the cultural background of the user into consideration, especially in Middle Eastern countries where the lives and weight loss intervention needs of women not only vary vastly from the West, but the obesity rate is also increasing exponentially. Objective: The current study sought to explore the proposed features of an Arabic weight loss app by seeking the experiences and opinions of overweight and obese Saudi Arabian users in order to design a mobile phone app to fit their needs. Methods: Focus group discussions were conducted with a purposive sample of volunteer overweight and obese Saudi women (BMI ≥ 25) who were older than 18 years and who owned a mobile phone. The most common Arabic and English weight loss mobile apps were downloaded to initiate dialogue about app usage and to get their opinions on what an ideal weight loss app would look like and the features it would include. All transcribed, translated discussions were thematically analyzed, categorized for each of the main topics of the discussion, and specific quotations were identified. Results: Four focus groups were conducted with a total of 39 participants. Most participants owned an Android mobile phone and only a few participants were aware of the availability of health-related apps. Barriers to weight loss were identified including: motivation, support (social and professional), boring diets, customs, and lifestyle. Diverse themes emerged as suggestions for an ideal weight loss app including: Arabic language and culturally sensitive; motivational support and social networking; dietary and physical activity tools; and a tailorable, user-friendly interface. Conclusions: This study identifies weight loss app features from the users’ perspective, which should be considered in the development of a weight loss app for this population. 
%M 25993907
%R 10.2196/mhealth.4409
%U http://mhealth.jmir.org/2015/2/e41/
%U https://doi.org/10.2196/mhealth.4409
%U http://www.ncbi.nlm.nih.gov/pubmed/25993907

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications Inc.
%V 17
%N 3
%P e78
%T Know Your Audience: Predictors of Success for a Patient-Centered Texting App to Augment Linkage to HIV Care in Rural Uganda
%A Siedner,Mark J
%A Santorino,Data
%A Haberer,Jessica E
%A Bangsberg,David R
%+ Center for Global Health, Massachusetts Genneral Hospital, Harvard Medical School, 15th Floor, 100 Cambridge Street, Boston, MA, 02114, United States, 1 617 726 4686, msiedner@partners.org
%K telemedicine
%K text messaging
%K randomized controlled trial
%K Uganda
%K HIV
%D 2015

%7 24.03.2015
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Despite investments in infrastructure and evidence for high acceptability, few mHealth interventions have been implemented in sub-Saharan Africa. Objective: We sought to (1) identify predictors of uptake of an mHealth application for a low-literacy population of people living with HIV (PLWH) in rural Uganda and (2) evaluate the efficacy of various short message service (SMS) text message formats to optimize the balance between confidentiality and accessibility. Methods: The trial evaluated the efficacy of a SMS text messaging app to notify PLWH of their laboratory results and request return to care for those with abnormal test results. Participants with a normal laboratory result received a single SMS text message indicating results were normal. Participants with an abnormal test result were randomized to 1 of 3 message formats designed to evaluate trade-offs between clarity and privacy: (1) an SMS text message that stated results were abnormal and requested return to clinic (“direct”), (2) the same message protected by a 4-digit PIN code (“PIN”), and (3) the message “ABCDEFG” explained at enrollment to indicate abnormal results (“coded”). Outcomes of interest were (1) self-reported receipt of the SMS text message, (2) accurate identification of the message, and (3) return to care within 7 days (for abnormal results) or on the date of the scheduled appointment (for normal results). We fit regression models for each outcome with the following explanatory variables: sociodemographic characteristics, CD4 count result, ability to read a complete sentence, ability to access a test message on enrollment, and format of SMS text message. Results: Seventy-two percent (234/385) of participants successfully receiving a message, 87.6% (219/250) correctly identified the message format, and 60.8% (234/385) returned to clinic at the requested time. Among participants with abnormal tests results (138/385, 35.8%), the strongest predictors of reported message receipt were the ability to read a complete sentence and a demonstrated ability to access a test message on enrollment. Participants with an abnormal result who could read a complete sentence were also more likely to accurately identify the message format (AOR 4.54, 95% CI 1.42-14.47, P=.01) and return to clinic appropriately (AOR 3.81, 95% CI 1.61-9.03, P=.002). Those who were sent a PIN-protected message were less likely to identify the message (AOR 0.11, 95% CI 0.03-0.44, P=.002) or return within 7 days (AOR 0.26, 95% CI 0.10-0.66, P=.005). Gender, age, and socioeconomic characteristics did not predict any outcomes and there were no differences in outcomes between those receiving direct or coded messages. Conclusions: Confirmed literacy at the time of enrollment was a robust predictor of SMS text message receipt, identification, and appropriate response for PLWH in rural Uganda. PIN-protected messages reduced odds of clinic return, but coded messages were as effective as direct messages and might augment privacy. Trial Registration: Clinicaltrials.gov NCT 01579214; https://clinicaltrials.gov/ct2/show/NCT01579214 (Archived by WebCite at http://www.webcitation.org/6Ww8R4sKq). 
%M 25831269
%R 10.2196/jmir.3859
%U http://www.jmir.org/2015/3/e78/
%U https://doi.org/10.2196/jmir.3859
%U http://www.ncbi.nlm.nih.gov/pubmed/25831269

%0 Journal Article
        
%@ 2369-2960
%I JMIR Publications
%V 1
%N 1
%P e1
%T Stories From the Field: The Use of Information and Communication Technologies to Address the Health Needs of Underserved Populations in Latin America and the Caribbean
%A Farach,Nasim
%A Faba,Gladys
%A Julian,Soroya
%A Mejía,Felipe
%A Cabieses,Báltica
%A D'Agostino,Marcelo
%A Cortinois,Andrea A
%+ Public eHealth, Innovation & Equity in Latin America & the Caribbean (eSAC) project, Altos de Miraflores Sur, S7, Tegucigalpa, , Honduras, 504 94573521, nfarach@gmail.com
%K eHealth
%K Latin America
%K vulnerable populations
%K qualitative research
%D 2015

%7 17.03.2015
%9 Original Paper
%J JMIR Public Health Surveill
%G English
                
%X Background: As their availability grew exponentially in the last 20 years, the use of information and communication technologies (ICT) in health has been widely espoused, with many emphasizing their potential to decrease health inequities. Nonetheless, there is scarce availability of information regarding ICT as tools to further equity in health, specifically in Latin American and Caribbean settings. Objective: Our aim was to identify initiatives that used ICT to address the health needs of underserved populations in Latin America and Caribbean. Among these projects, explore the rationale behind the selection of ICT as a key component, probe perceptions regarding contributions to health equity, and describe the challenges faced during implementation. Methods: We conducted an exploratory qualitative study. Interviews were completed via Skype or face-to-face meetings using a semistructured interview guide. Following participant consent, interviews were audio recorded and verbatim transcriptions were developed. All transcriptions were coded using ATLASti7 software. The text was analyzed for patterns, shared themes, and diverging opinions. Emerging findings were reviewed by all interviewers and shared with participants for feedback. Results: We interviewed representatives from eight organizations in six Latin American and Caribbean countries that prominently employed ICT in health communication, advocacy, or surveillance projects. ICT expanded project's geographic coverage, increased their reach into marginalized or hard-to-reach groups, and allowed real-time data collection. Perceptions of contributions to health equity resided mainly in the provision of health information and linkage to health services to members of groups experiencing greater morbidity because of poverty, remote place of residence, lack of relevant public programs, and/or stigma and discrimination, and in more timely responses by authorities to the health needs of these groups as a result of the increased availability of strategic information on morbidity and its social determinants. Most projects faced initial resistance to implementation because of lack of precedents. Their financial and technical sustainability was threatened by reliance on external funding and weak transitional structures amidst key staff changes. Projects often experienced challenges in establishing meaningful communication with target audience members, mainly because of divergent motivations behind ICT use between projects and its target audience and the lack of access or familiarity with ICT among the most underserved members of such audiences. Conclusions: ICT can benefit projects focusing on the health needs of underserved populations by expanding the breadth and depth of target audience coverage and improving data management. Most projects tended to be small, short-term pilot interventions with limited engagement with the formal health sector and did not include health equity as an explicit component. Collaborative projects with government institutions, particularly those with health surveillance objectives, seemed to be the most optimistic about long-term sustainability. 
%M 27227124
%R 10.2196/publichealth.4108
%U http://publichealth.jmir.org/2015/1/e1/
%U https://doi.org/10.2196/publichealth.4108
%U http://www.ncbi.nlm.nih.gov/pubmed/27227124

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e26
%T SMSaúde: Design, Development, and Implementation of a Remote/Mobile Patient Management System to Improve Retention in Care for HIV/AIDS and Tuberculosis Patients
%A Nhavoto,José António
%A Grönlund,Åke
%A Chaquilla,Walter Ponce
%+ Informatics, School of Business, Örebro University, Fakultetsgatan 1, Örebro, 70182, Sweden, 46 760833032, janhavoto@gmail.com
%K mobile health
%K text messaging
%K SMS system
%K patient management
%K design science research
%K Mozambique
%D 2015

%7 09.03.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: The widespread and low cost of mobile phones and the convenience of short message service (SMS) text messaging suggest potential suitability for use with alternative strategies for supporting retention in care and adherence to the treatment of various chronic diseases, such as HIV and tuberculosis (TB). Despite the growing body of literature reporting positive outcomes of SMS text message-based communication with patients, there is yet very little research about the integration of communication technologies and electronic medical records or electronic patient tracking systems. Objective: To design, develop, and implement an integrated mobile phone text messaging system used to follow up with patients with HIV and TB in treatment in Mozambique. Methods: Following the design science research methodology, we developed a Web-based system that provides support to patients. A case study involving three health care sites in Mozambique was a basis for discussing design issues for this kind of system. We used brainstorming techniques to solicit usability requirements, focus group meetings to discuss and define system architecture, and prototyping to test in real environments and to improve the system. Results: We found six sets of system requirements that need to be addressed for success: data collection, telecommunication costs, privacy and data security, text message content, connectivity, and system scalability. A text messaging system was designed and implemented in three health facilities. These sites feed data into a central data repository, which can be used for analysis of operations and decision support. Based on the treatment schedule, the system automatically sent SMS text message appointment reminders, medication reminders, as well as motivational and educational messages to patients enrolled in antiretroviral therapy and TB treatment programs. Conclusions: We successfully defined the requirements for, designed, and implemented a mobile phone text messaging system to support HIV and TB treatments. Implementation of this system could improve patients’ self-management skills and strengthen communication between patients and health care providers. 
%M 25757551
%R 10.2196/mhealth.3854
%U http://mhealth.jmir.org/2015/1/e26/
%U https://doi.org/10.2196/mhealth.3854
%U http://www.ncbi.nlm.nih.gov/pubmed/25757551

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e21
%T Qualitative Evaluation of a Text Messaging Intervention to Support Patients With Active Tuberculosis: Implementation Considerations
%A Iribarren,Sarah J
%A Sward,Katherine A
%A Beck,Susan L
%A Pearce,Patricia F
%A Thurston,Diana
%A Chirico,Cristina
%+ School of Nursing, Columbia University, 617 West 168th Street, New York, NY, 10032, United States, 1 212 342 0689, si2277@cumc.columbia.edu
%K mHealth
%K tuberculosis
%K sociotechnical evaluation
%K text messaging
%D 2015

%7 27.02.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Tuberculosis (TB) remains a major global public health problem and mobile health (mHealth) interventions have been identified as a modality to improve TB outcomes. TextTB, an interactive text-based intervention to promote adherence with TB medication, was pilot-tested in Argentina with results supporting the implementation of trials at a larger scale. Objective: The objective of this research was to understand issues encountered during pilot-testing in order to inform future implementation in a larger-scale trial. Methods: A descriptive, observational qualitative design guided by a sociotechnical framework was used. The setting was a clinic within a public pulmonary-specialized hospital in Argentina. Data were collected through workflow observation over 115 days, text messages (n=2286), review of the study log, and stakeholder input. Emerging issues were categorized as organizational, human, technical, or sociotechnical considerations. Results: Issues related to the intervention included workflow issues (eg, human, training, security), technical challenges (eg, data errors, platform shortcomings), and message delivery issues (eg, unintentional sending of multiple messages, auto-confirmation problems). System/contextual issues included variable mobile network coverage, electrical and Internet outages, and medication shortages. Conclusions: Intervention challenges were largely manageable during pilot-testing, but need to be addressed systematically before proceeding with a larger-scale trial. Potential solutions are outlined. Findings may help others considering implementing an mHealth intervention to anticipate and mitigate certain challenges. Although some of the issues may be context dependent, other issues such as electrical/Internet outages and limited resources are not unique issues to our setting. Release of new software versions did not result in solutions for certain issues, as specific features used were removed. Therefore, other software options will need to be considered before expanding into a larger-scale endeavor. Improved automation of some features will be necessary, however, a goal will be to retain the intervention capability to be interactive, user friendly, and patient focused. Continued collaboration with stakeholders will be required to conduct further research and to understand how such an mHealth intervention can be effectively integrated into larger health systems. 
%M 25802968
%R 10.2196/mhealth.3971
%U http://mhealth.jmir.org/2015/1/e21/
%U https://doi.org/10.2196/mhealth.3971
%U http://www.ncbi.nlm.nih.gov/pubmed/25802968

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e24
%T Analyzing the Mobile “Digital Divide”: Changing Determinants of Household Phone Ownership Over Time in Rural Bangladesh
%A Tran,Michael Clifton
%A Labrique,Alain Bernard
%A Mehra,Sucheta
%A Ali,Hasmot
%A Shaikh,Saijuddin
%A Mitra,Maithilee
%A Christian,Parul
%A West Jr,Keith
%+ Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, United States, 1 443 287 4744, alabriqu@gmail.com
%K digital
%K mobile Health (mHealth)
%K finances
%K mobile
%K phones
%K Bangladesh
%K family characteristics
%K Demography, ownership
%K socioeconomic factors
%D 2015

%7 25.02.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: We had a unique opportunity to examine demographic determinants of household mobile phone ownership in rural Bangladesh using socioeconomic data collected as part of a multiyear longitudinal cohort study of married women of reproductive age. Objectives: This paper explores how the demographics of household mobile phone owners have changed over time in a representative population of rural Bangladesh. Methods: We present data collected between 2008 and 2011 on household mobile phone ownership and related characteristics including age, literacy, education, employment, electricity access, and household wealth among 35,306 individuals. Respondents were enrolled when found to be newly pregnant and contributed socioeconomic information once over the course of the time period serving as a “sample” of families within the population at that time. Univariate and multiple logistic regressions analyses were performed to identify the socioeconomic determinants of household phone ownership. Results: Across 3 fiscal years, we found that reported household ownership of at least 1 working mobile phone grew from 29.85% in the first fiscal year to 56.07% in the third fiscal year. Illiteracy, unavailability of electricity, and low quartiles of wealth were identified as overall demographic constraints to mobile phone ownership. However, over time, these barriers became less evident and equity gaps among demographic status began to dissipate as access to mobile technology became more democratized. We saw a high growth rate in ownership among households in lower economic standing (illiterate, without electricity, low and lowest wealth index), likely a result of competitive pricing and innovative service packages that improve access to mobile phones as the mobile phone market matures. In contrast, as market saturation is rapidly attained in the most privileged demographics (literate, secondary schooling, electricity, high wealth index), members of the lower wealth quartiles seem to be following suit, with more of an exponential growth. Conclusions: Upward trends in household mobile phone ownership in vulnerable populations over time underline the potential to leverage this increasingly ubiquitous infrastructure to extend health and finance services across social and economic strata. 
%M 25720457
%R 10.2196/mhealth.3663
%U http://mhealth.jmir.org/2015/1/e24/
%U https://doi.org/10.2196/mhealth.3663
%U http://www.ncbi.nlm.nih.gov/pubmed/25720457

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e19
%T Design and Multi-Country Validation of Text Messages for an mHealth Intervention for Primary Prevention of Progression to Hypertension in Latin America
%A Diez-Canseco,Francisco
%A Zavala-Loayza,J Alfredo
%A Beratarrechea,Andrea
%A Kanter,Rebecca
%A Ramirez-Zea,Manuel
%A Rubinstein,Adolfo
%A Martinez,Homero
%A Miranda,J Jaime
%+ CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av. Armendariz 497, Miraflores, Lima, Lima 18, Peru, 51 12416978, Jaime.Miranda@upch.pe
%K cross-cultural comparison
%K developing countries
%K health literacy
%K hypertension
%K Latin America
%K mHealth
%K preventive medicine
%K prehypertension
%K text messages
%K validation studies
%D 2015

%7 18.02.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Mobile health (mHealth) has been posited to contribute to the reduction in health gaps and has shown fast and widespread growth in developing countries. This growth demands understanding of, and preparedness for, local cultural contexts. Objective: To describe the design and validation of text messages (short message service, SMS) that will be used for an mHealth behavioral change intervention to prevent hypertension in three Latin American countries: Argentina, Guatemala, and Peru. Methods: An initial set of 64 SMS text messages were designed to promote healthy lifestyles among individuals in different stages of behavior change, addressing four key domains: salt and sodium intake, fruit and vegetable intake, consumption of high fat and sugar foods, and physical activity. The 64 SMS text messages were organized into nine subsets for field validation. In each country 36 people were recruited, half of them being male. Of the participants, 4 per country evaluated each subset of SMS text messages, which contained between 6 and 8 SMS text messages regarding different key domains and stages of change. The understanding and appeal of each SMS text message was assessed using a 7-item questionnaire. The understanding and appeal ratings were used to reach a final set of 56 SMS text messages. Results: Overall, each of the 64 SMS text messages received a total of 12 evaluations (4 per country). The majority of evaluations—742 out of a total of 767 (96.7%) valid responses—revealed an adequate understanding of the key idea contained in the SMS text message. On a scale from 1 to 10, the average appeal score was 8.7 points, with a range of 4 to 10 points. Based on their low scores, 8 SMS text messages per country were discarded. Once the final set of 56 SMS text messages was established, and based on feedback obtained in the field, wording and content of some SMS text messages were improved. Of the final set,  9, 8, and 16 of the SMS text messages were improved based on participant evaluations from Argentina, Guatemala, and Peru, respectively. Most SMS text messages selected for the final set (49/56, 88%) were the same in all countries, except for small wording differences. Conclusions: The final set of SMS text messages produced had very high rates of understanding and appeal in three different Latin American countries. This study highlights the importance of developing and validating a package of simple, preventative SMS text messages, grounded in evidence and theory, across three different Latin American countries with active engagement of end users. 
%M 25693595
%R 10.2196/mhealth.3874
%U http://mhealth.jmir.org/2015/1/e19/
%U https://doi.org/10.2196/mhealth.3874
%U http://www.ncbi.nlm.nih.gov/pubmed/25693595

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e17
%T Implementation of a Confidential Helpline for Men Having Sex With Men in India
%A Agarwal,Ashok
%A Hamdallah,Myriam
%A Swain,Suvakanta N
%A Mukherjee,Sonali
%A Singh,Neetu
%A Mahapatra,Sudip
%A King,Elizabeth J
%A Pulerwitz,Julie
%A Thior,Ibou
%+ FHI 360, H-5 Green Park Extension, New Delhi, 110016, India, 91 9873001090, aashok365@gmail.com
%K mobile phone
%K helpline
%K MSM
%K HIV prevention
%K India
%D 2015

%7 11.02.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: In India, men who have sex with men (MSM) often face physical violence and harassment from police and the general society. Many MSM may not openly disclose their sexual identity, especially if they are married to women and have families. Due to pervasive stigma and discrimination, human immunodeficiency virus (HIV) prevention programs are unable to reach many MSM effectively. Objective: The objective of this paper was to describe the design, operations, and monitoring of the Sahaay helpline, a mHealth intervention for the MSM population of India. Methods: We established the “Sahaay” mHealth intervention in 2013; a MSM-dedicated helpline whose main goal was to increase access to comprehensive, community-based HIV prevention services and improve knowledge, attitudes, and behaviors of MSM towards HIV and sexually transmitted infections (STI) in three states of India (Chhattisgarh, Delhi, and Maharashtra). The helpline provided a 24x7 confidential and easy to use interactive voice response system (IVRS) to callers. IVRS function was monitored through an online dashboard of indicators. The system also provided real-time reporting on callers and services provided. Results: The helpline received more than 100,000 calls from 39,800 callers during the first nine months of operation. The helpline maintained an operational uptime of 99.81% (6450/6462 hours); and answered more than 81.33% (83,050/102,115) of all calls. More than three-fourths of the calls came between 9:00 am-12:00 pm. The most successful promotional activity was “interpersonal communication” (reported by 70.05%, 27,880/39,800, of the callers). Nearly three-fourths of the callers self-identified as MSM, including 17.05% (6786/39,800) as rural MSM and 5.03% (2001/39,800) as a married MSM. Most callers (93.10%, 37,055/39,800) requested information, while some (27.01%, 10,750/39,800) requested counseling on HIV/acquired immune deficiency syndrome (AIDS), STIs, and other health and nonhealth issues. There were 38.97% (15,509/39,800) of the callers that were provided contacts of different HIV/AIDS referral services. Many MSM clients reported increased self-esteem in dealing with their sexual identity and disclosing the same with their family and spouse; and an increase in HIV/AIDS risk-reduction behaviors like consistent condom use and HIV testing. Conclusions: National HIV/AIDS prevention interventions for MSM in India should consider scaling-up this helpline service across the country. The helpline may serve as an important mechanism for accessing hard-to-reach MSM, and thus improving HIV prevention programing. 
%M 25673240
%R 10.2196/mhealth.3978
%U http://mhealth.jmir.org/2015/1/e17/
%U https://doi.org/10.2196/mhealth.3978
%U http://www.ncbi.nlm.nih.gov/pubmed/25673240

%0 Journal Article
        
%@ 1438-8871
%I JMIR Publications Inc.
%V 17
%N 1
%P e2
%T Health Checkup and Telemedical Intervention Program for Preventive Medicine in Developing Countries: Verification Study
%A Nohara,Yasunobu
%A Kai,Eiko
%A Ghosh,Partha Pratim
%A Islam,Rafiqul
%A Ahmed,Ashir
%A Kuroda,Masahiro
%A Inoue,Sozo
%A Hiramatsu,Tatsuo
%A Kimura,Michio
%A Shimizu,Shuji
%A Kobayashi,Kunihisa
%A Baba,Yukino
%A Kashima,Hisashi
%A Tsuda,Koji
%A Sugiyama,Masashi
%A Blondel,Mathieu
%A Ueda,Naonori
%A Kitsuregawa,Masaru
%A Nakashima,Naoki
%+ Medical Information Center, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 8128582, Japan, 81 92 642 5881, y-nohara@info.med.kyushu-u.ac.jp
%K public health informatics
%K preventive medicine
%K teleconsultation
%K body area network
%K sensor
%K developing countries
%D 2015

%7 28.01.2015
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: The prevalence of non-communicable diseases is increasing throughout the world, including developing countries. Objective: The intent was to conduct a study of a preventive medical service in a developing country, combining eHealth checkups and teleconsultation as well as assess stratification rules and the short-term effects of intervention. Methods: We developed an eHealth system that comprises a set of sensor devices in an attaché case, a data transmission system linked to a mobile network, and a data management application. We provided eHealth checkups for the populations of five villages and the employees of five factories/offices in Bangladesh. Individual health condition was automatically categorized into four grades based on international diagnostic standards: green (healthy), yellow (caution), orange (affected), and red (emergent). We provided teleconsultation for orange- and red-grade subjects and we provided teleprescription for these subjects as required. Results: The first checkup was provided to 16,741 subjects. After one year, 2361 subjects participated in the second checkup and the systolic blood pressure of these subjects was significantly decreased from an average of 121 mmHg to an average of 116 mmHg (P<.001). Based on these results, we propose a cost-effective method using a machine learning technique (random forest method) using the medical interview, subject profiles, and checkup results as predictor to avoid costly measurements of blood sugar, to ensure sustainability of the program in developing countries. Conclusions: The results of this study demonstrate the benefits of an eHealth checkup and teleconsultation program as an effective health care system in developing countries. 
%M 25630348
%R 10.2196/jmir.3705
%U http://www.jmir.org/2015/1/e2/
%U https://doi.org/10.2196/jmir.3705
%U http://www.ncbi.nlm.nih.gov/pubmed/25630348

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 3
%N 1
%P e4
%T Application of Mobile Technology for Improving Expanded Program on Immunization Among Highland Minority and Stateless Populations in Northern Thailand Border
%A Kaewkungwal,Jaranit
%A Apidechkul,Tawatchai
%A Jandee,Kasemsak
%A Khamsiriwatchara,Amnat
%A Lawpoolsri,Saranath
%A Sawang,Surasak
%A Sangvichean,Aumnuyphan
%A Wansatid,Peerawat
%A Krongrungroj,Sarinya
%+ Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Faculty of Tropical Medicine, Mahidol University, The 60 Anniversary of His Majesty the King's Accession to the Throne Building, 3rd - 4th floor,, 420/6, Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, 66 23549181, jaranitk@biophics.org
%K expanded program on immunization
%K EPI
%K hill tribes
%K stateless
%K behavioral change communication
%K mobile technology
%D 2015

%7 14.01.2015
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Studies of undervaccinated children of minority/stateless populations have highlighted significant barriers at individual, community, and state levels. These include geography-related difficulties, poverty, and social norms/beliefs. Objective: The objective of this study was to assess project outcomes regarding immunization coverage, as well as maternal attitudes and practices toward immunization. Methods: The “StatelessVac” project was conducted in Thailand-Myanmar-Laos border areas using cell phone-based mechanisms to increase immunization coverage by incorporating phone-to-phone information sharing for both identification and prevention.  With limitation of the study among vulnerable populations in low-resource settings, the pre/post assessments without comparison group were conducted. Immunization coverage was collected from routine monthly reports while behavior-change outcomes were from repeat surveys. Results: This study revealed potential benefits of the initiative for case identification; immunization coverage showed an improved trend.  Prevention strategies were successfully integrated into the routine health care workflows of immunization activities at point-of-care. A behavior-change-communication package contributes significantly in raising both concern and awareness in relation to child care. Conclusions: The mobile technology has proven to be an effective mechanism in improving a children’s immunization program among these hard-to-reach populations. Part of the intervention has now been revised for use at health centers across the country. 
%M 25589367
%R 10.2196/mhealth.3704
%U http://mhealth.jmir.org/2015/1/e4/
%U https://doi.org/10.2196/mhealth.3704
%U http://www.ncbi.nlm.nih.gov/pubmed/25589367

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 4
%P e49
%T Consumers' Perspectives on National Health Insurance in South Africa: Using a Mobile Health Approach
%A Weimann,Edda
%A Stuttaford,Maria C
%+ School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, PBag, Anzio Road, Observatory, Cape Town, 7925, South Africa, 27 794981377, prof.dr.weimann@gmail.com
%K health systems reform
%K public consultation
%K South Africa
%K National Health Insurance (NHI)
%K health systems strengthening (HSS)
%K WHO building blocks
%K social media, GINI Index
%D 2014

%7 28.10.2014
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective: This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform. 
%M 25351980
%R 10.2196/mhealth.3533
%U http://mhealth.jmir.org/2014/4/e49/
%U https://doi.org/10.2196/mhealth.3533
%U http://www.ncbi.nlm.nih.gov/pubmed/25351980

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 3
%P e38
%T Sexual and Reproductive Health for Young Adults in Colombia: Teleconsultation Using Mobile Devices
%A Lopez,Catalina
%A Ramirez,Daniel Camilo
%A Valenzuela,Jose Ignacio
%A Arguello,Arturo
%A Saenz,Juan Pablo
%A Trujillo,Stephanie
%A Correal,Dario Ernesto
%A Fajardo,Roosevelt
%A Dominguez,Cristina
%+ Center for Innovation and Health Education, Fundacion Santa Fe de Bogota, Cra 7B No 123 - 90, Bogota, , Colombia, 57 16030303 ext 5721, catalina.lopez@fsfb.edu.co
%K mobile health
%K youth and adolescents
%K telemedicine
%K remote consultation
%K Colombia
%K Latin America.
%D 2014

%7 25.09.2014
%9 Original Paper
%J JMIR mHealth uHealth
%G English
                
%X Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To report our experience with the use of DoctorChat Mobile to provide sexual education and information among university students in Bogota, Colombia, and knowledge about the sexual risk factors detected among them. Methods: A mobile app that allows patients to ask about sexual and reproductive health issues was developed. Sexual and reproductive risk behaviors in a sample of young adults were measured before and after the use of the app through the validated survey Family Health International (FHI) Behavioral Surveillance Survey (BSS) for Use With Adults Between 15 and 49 Years. A nonprobabilistic convenience recruitment was undertaken through the study´s webpage. After completing the first survey, participants were allowed to download and use the app for a 6-month period (intervention), followed by completion of the same survey once again. For the inferential analysis, data was divided into 3 groups (dichotomous data, discrete quantitative data, and ordinal data) to compare the results of the questions between the first and the second survey. The study was carried out with a sample of university students between 18 and 29 years with access to mobile phones. Participation in the study was voluntary and anonymous. Results: A total of 257 subjects met the selection criteria. The preintervention survey was answered by 232 subjects, and 127 of them fully answered the postintervention survey. In total, 54.3% (69/127) of the subjects completed the survey but did not use the app, leaving an effective population of 58 subjects for analysis. Of these subjects, 53% (31/58) were women and 47% (27/58) were men. The mean age was 21 years, ranging between 18 and 29 years. The differences between the answers from both surveys were not statistically significant. The main sexual risk behaviors identified in the population were homosexual intercourse, nonuse of condoms, sexual intercourse with nonregular and commercial partners, the use of psychoactive substances, and lack of knowledge on symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and postintervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting high-impact educational strategies on this matter and the importance of providing teenagers and young adults with easily accessible tools with reliable health information, regardless of their socioeconomic status. 
%M 25263432
%R 10.2196/mhealth.2904
%U http://mhealth.jmir.org/2014/3/e38/
%U https://doi.org/10.2196/mhealth.2904
%U http://www.ncbi.nlm.nih.gov/pubmed/25263432

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 2
%P e21
%T Mobile Technologies and Geographic Information Systems to Improve Health Care Systems: A Literature Review
%A Nhavoto,José António
%A Grönlund,Åke
%+ Informatics, Örebro University School of Business, Örebro University, Fakultetsgatan 1, Örebro, 70182, Sweden, 46 760833032, janhavoto@gmail.com
%K health care
%K eHealth
%K mobile technology
%K mobile phone
%K SMS
%K text messaging
%K geographic information system
%K GIS
%D 2014

%7 08.05.2014
%9 Review
%J JMIR mHealth uHealth
%G English
                
%X Background: A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation. Objective: The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care. Methods: The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review. Results: A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance. Conclusions: A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues. 
%M 25099368
%R 10.2196/mhealth.3216
%U http://mhealth.jmir.org/2014/2/e21/
%U https://doi.org/10.2196/mhealth.3216
%U http://www.ncbi.nlm.nih.gov/pubmed/25099368

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 1
%P e15
%T Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial
%A Lund,Stine
%A Rasch,Vibeke
%A Hemed,Maryam
%A Boas,Ida Marie
%A Said,Azzah
%A Said,Khadija
%A Makundu,Mkoko Hassan
%A Nielsen,Birgitte Bruun
%+ Department of International Health, Immunology and Microbiology, University of Copenhagen, Blegdamsvej 9, Copenhagen N, 2200, Denmark, 45 22440789, stine_lund@dadlnet.dk
%K perinatal mortality
%K text messaging (SMS)
%K mobile phones
%K developing countries
%D 2014

%7 26.03.2014
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care.  However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. Objective: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. Methods: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Results: Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births.  The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Conclusions: Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT01821222; http://www.clinicaltrials.gov/ct2/show/NCT01821222 (Archived by WebCite at http://www.webcitation.org/6NqxnxYn0). 
%M 25098184
%R 10.2196/mhealth.2941
%U http://mhealth.jmir.org/2014/1/e15/
%U https://doi.org/10.2196/mhealth.2941
%U http://www.ncbi.nlm.nih.gov/pubmed/25098184

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 1
%P e10
%T The Schisto Track: A System for Gathering and Monitoring Epidemiological Surveys by Connecting Geographical Information Systems in Real Time
%A Leal Neto,Onicio B
%A Albuquerque,Cesar M
%A Albuquerque,Jones O
%A Barbosa,Constança S
%+ Aggeu Magalhaes Research Center, Schistosomiasis Reference Service, Oswaldo Cruz Foundation, Professor Moraes Rego Avenue, Cidade Universitaria., Recife, 50670420, Brazil, 55 21012572, onicio@gmail.com
%K epidemiological survey
%K schistosomiasis
%K public health
%D 2014

%7 10.03.2014
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Using the Android platform as a notification instrument for diseases and disorders forms a new alternative for computerization of epidemiological studies. Objective: The objective of our study was to construct a tool for gathering epidemiological data on schistosomiasis using the Android platform. Methods: The developed application (app), named the Schisto Track, is a tool for data capture and analysis that was designed to meet the needs of a traditional epidemiological survey. An initial version of the app was finished and tested in both real situations and simulations for epidemiological surveys. Results: The app proved to be a tool capable of automation of activities, with data organization and standardization, easy data recovery (to enable interfacing with other systems), and totally modular architecture. Conclusions: The proposed Schisto Track is in line with worldwide trends toward use of smartphones with the Android platform for modeling epidemiological scenarios. 
%M 25099881
%R 10.2196/mhealth.2859
%U http://mhealth.jmir.org/2014/1/e10/
%U https://doi.org/10.2196/mhealth.2859
%U http://www.ncbi.nlm.nih.gov/pubmed/25099881

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 1
%P e7
%T Customized-Language Voice Survey on Mobile Devices for Text and Image Data Collection Among Ethnic Groups in Thailand: A Proof-of-Concept Study
%A Jandee,Kasemsak
%A Lawpoolsri,Saranath
%A Taechaboonsermsak,Pimsurang
%A Khamsiriwatchara,Amnat
%A Wansatid,Peerawat
%A Kaewkungwal,Jaranit
%+ Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Mahidol University, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, 66 23549181 ext 412, jaranit.kae@mahidol.ac.th
%K expanded program on immunization
%K EPI
%K ethnicity
%K mobile technology
%K smartphone questionnaire survey
%K voiced question
%D 2014

%7 06.03.2014
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys. Objective: This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants’ satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness. Methods: Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants. Results: The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities. Conclusions: To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings. 
%M 25098776
%R 10.2196/mhealth.3058
%U http://mhealth.jmir.org/2014/1/e7/
%U https://doi.org/10.2196/mhealth.3058
%U http://www.ncbi.nlm.nih.gov/pubmed/25098776

%0 Journal Article
        
%@ 2291-5222
%I JMIR Publications Inc.
%V 2
%N 1
%P e5
%T Integrating Mobile Phones into Medical Abortion Provision: Intervention Development, Use, and Lessons Learned From a Randomized Controlled Trial
%A de Tolly,Katherine Marianne
%A Constant,Deborah
%+ Cell-Life, Avalon 4 Building, 123 Hope Street, Gardens, Cape Town, 8001, South Africa, 27 21 462 6481, kmdetolly@gmail.com
%K mHealth
%K telemedicine
%K SMS
%K medical abortion
%K USSD
%K mobisite
%D 2014

%7 14.02.2014
%9 Original Paper
%J JMIR Mhealth Uhealth
%G English
                
%X Background: Medical abortion is legal in South Africa but access and acceptability are hampered by the current protocol requiring a follow-up visit to assess abortion completion. Objective: To assess the feasibility and efficacy of information and follow-up provided via mobile phone after medical abortion in a randomized controlled trial (RCT). Methods: Mobile phones were used in three ways in the study: (1) coaching women through medical abortion using short message service (SMS; text messages); (2) a questionnaire to assess abortion completion via unstructured supplementary service data (USSD, a protocol used by GSM mobile telephones that allows the user to interact with a server via text-based menus) and the South African mobile instant message and social networking application Mxit; and (3) family planning information via SMS, mobisite and Mxit. A needs and context assessment was done to learn about women’s experiences undergoing medical abortion and their use of mobile phones. After development, the mobile interventions were piloted. Recruitment was done by field workers at the clinics. In the RCT, women were interviewed at baseline and exit. Computer logs were also analyzed. All study participants received standard of care at the clinics. Results: In the RCT, 234 women were randomized to the intervention group. Eight did not receive the intervention due to invalid numbers, mis-registration, system failure, or opt-out, leaving 226 participants receiving the full intervention. Of the 226, 190 returned and were interviewed at their clinic follow-up visit. The SMSs were highly acceptable, with 97.9% (186/190) saying that the SMSs helped them through the medical abortion. In terms of mobile phone privacy, 86.3% (202/234) said that it was not likely or possible that someone would see SMSs on their phone, although at exit, 20% (38/190) indicated that they had worried about phone privacy. Having been given training at baseline and subsequently asked via SMS to complete the self-assessment questionnaire, 90.3% (204/226) attempted it, and of those, 86.3% (176/204) reached an endpoint of the questionnaire. For the family planning information, a preference for SMS was indicated by study clients, although the publicly available Mxit/mobisite was heavily used (813,375 pages were viewed) over the study duration. Conclusions: SMS provided a good medium for timed, "push" information that guided and supported women through medical abortion. Women were able to perform a self-assessment questionnaire via mobile phones if provided training and prompted by SMS. Phone privacy needs to be protected in similar settings. This study may contribute to the successful expansion of medical abortion provision aided by mobile phones. Trial Registration: Pan African Clinical Trials Registry (PACTR): PACTR201302000427144; http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201302000427144 (Archived by WebCite at http://www.webcitation.org/6N0fnZfzm). 
%M 25098569
%R 10.2196/mhealth.3165
%U http://mhealth.jmir.org/2014/1/e5/
%U https://doi.org/10.2196/mhealth.3165
%U http://www.ncbi.nlm.nih.gov/pubmed/25098569

%0 Journal Article
        
%@ 14388871
%I JMIR Publications Inc.
%V 15
%N 12
%P e269
%T Text Messaging Data Collection for Monitoring an Infant Feeding Intervention Program in Rural China: Feasibility Study
%A Li,Ye
%A Wang,Wei
%A van Velthoven,Michelle Helena
%A Chen,Li
%A Car,Josip
%A Rudan,Igor
%A Zhang,Yanfeng
%A Wu,Qiong
%A Du,Xiaozhen
%A Scherpbier,Robert W
%+ Department of Integrated Early Childhood Development, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, 100020, China, 86 1085695554, summyzh@126.com
%K text messaging
%K data collection
%K program evaluation
%K child nutrition sciences
%D 2013

%7 04.12.2013
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: An effective data collection method is crucial for high quality monitoring of health interventions. The traditional face-to-face data collection method is labor intensive, expensive, and time consuming. With the rapid increase of mobile phone subscribers, text messaging has the potential to be used for evaluation of population health interventions in rural China. Objective: The objective of this study was to explore the feasibility of using text messaging as a data collection tool to monitor an infant feeding intervention program. Methods: Participants were caregivers of children aged 0 to 23 months in rural China who participated in an infant feeding health education program. We used the test-retest method. First, we collected data with a text messaging survey and then with a face-to-face survey for 2 periods of 3 days. We compared the response rate, data agreement, costs, and participants’ acceptability of the two methods. Also, we interviewed participants to explore their reasons for not responding to the text messages and the reasons for disagreement in the two methods. In addition, we evaluated the most appropriate time during the day for sending text messages. Results: We included 258 participants; 99 (38.4%) participated in the text messaging survey and 177 (68.6%) in the face-to-face survey. Compared with the face-to-face survey, the text messaging survey had much lower response rates to at least one question (38.4% vs 68.6%) and to all 7 questions (27.9% vs 67.4%) with moderate data agreement (most kappa values between .5 and .75, the intraclass correlation coefficients between .53 to .72). Participants who took part in both surveys gave the same acceptability rating for both methods (median 4.0 for both on a 5-point scale, 1=disliked very much and 5=liked very much). The costs per questionnaire for the text messaging method were much lower than the costs for the face-to-face method: ¥19.7 (US $3.13) versus ¥33.9 (US $5.39) for all questionnaires, and ¥27.1 (US $4.31) versus ¥34.4 (US $5.47) for completed questionnaires. The main reasons for not replying were that participants did not receive text messages, they were too busy to reply, or they did not see text messages in time. The main reasons for disagreement in responses were that participants forgot their answers in the text messaging survey and that they changed their minds. We found that participants were more likely to reply to text messages immediately during 2 time periods: 8 AM to 3 PM and 8 PM to 9 PM. Conclusions: The text messaging method had reasonable data agreement and low cost, but a low response rate. Further research is needed to evaluate effectiveness of measures that can increase the response rate, especially in collecting longitudinal data by text messaging. 
%M 24305514
%R 10.2196/jmir.2906
%U http://www.jmir.org/2013/12/e269/
%U https://doi.org/10.2196/jmir.2906
%U http://www.ncbi.nlm.nih.gov/pubmed/24305514

%0 Journal Article
        
%@ 14388871
%I JMIR Publications Inc.
%V 15
%N 6
%P e116
%T Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa
%A van Heerden,Alastair
%A Norris,Shane
%A Tollman,Stephen
%A Richter,Linda
%A Rotheram-Borus,Mary Jane
%+ Human Sciences Research Council, PO Box 90, Msunduzi, Pietermaritzburg, 3201, South Africa, 27 333245015, avanheerden@hsrc.ac.za
%K mobile phones
%K human immunodeficiency virus
%K mobile health
%D 2013

%7 10.06.2013
%9 Original Paper
%J J Med Internet Res
%G English
                
%X Background: Most of the world’s women living with human immunodeficiency virus (HIV) reside in sub-Saharan Africa. Although efforts to reduce mother-to-child transmission are underway, obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge. Objective: To describe the acceptability and feasibility of mobile phones as a tool for clinic-based face-to-face data collection with pregnant women living with HIV in South Africa. Methods: As part of a larger clinic-based trial, 16 interviewers were trained to conduct mobile phone–assisted personal interviews (MPAPI). These interviewers (participant group 1) completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points. Questions were asked before training, after training, and 3 months after deployment to clinic facilities. In addition, before the start of the primary intervention trial in which this substudy was undertaken, 12 mothers living with HIV (MLH) took part in a focus group discussion exploring the acceptability of MPAPI (participant group 2). Finally, a sample of MLH (n=512) enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI (participant group 3). Results: Acceptability of the method was found to be high among the 16 interviewers in group 1. Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points. After 3 months of field use, interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training. The feasibility of conducting MPAPI interviews in this setting was found to be high. Network coverage was available in all clinics and hardware, software, cost, and secure transmission to the data center presented no significant challenges over the 21-month period. For the 12 MHL participants in group 2, anxiety about the multimedia capabilities of the phone was evident. Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them. For participants in group 3, having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94.7% of MHL. Privacy (6.3%) and confidentiality (5.3%) concerns were low for group 3 MHL. Conclusions: Mobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa. Trial Registration: Clinicaltrials.gov NCT00972699; http://clinicaltrials.gov/ct2/show/NCT00972699 (Archived by WebCite at http://clinicaltrials.gov/ct2/show/NCT00972699) 
%M 23748182
%R 10.2196/jmir.2207
%U http://www.jmir.org/2013/6/e116/
%U https://doi.org/10.2196/jmir.2207
%U http://www.ncbi.nlm.nih.gov/pubmed/23748182
als.gov/ct2/show/NCT00972699) 
%M 23748182
%R 10.2196/jmir.2207
%U http://www.jmir.org/2013/6/e116/
%U https://doi.org/10.2196/jmir.2207
%U http://www.ncbi.nlm.nih.gov/pubmed/23748182